Exploring and Managing GLP-1 Receptor Agonists in Weight Loss

Standard of Care for Weight Management

To start, Bhatt provided some insight into the standard of care for obese and overweight patients.

“The standard of care for my patients has been a complementary approach of lifestyle changes, dietary changes, and exercise as well as addressing things like blood pressure or stress or thyroid condition, other conditions that may impact weight gain,” Bhatt revealed.

However, the availability of GLP-1 drugs and other weight loss medications has added another treatment layer, providing an additional option for weight management in overweight or obese patients.

According to a 2023 report by Trilliant Health, GLP-1 drugs could potentially replace bariatric surgery in some patients looking to lose weight. The report estimates that replacing 5% of bariatric surgeries with GLP-1 medications could reduce annual revenues for surgical interventions by $133.33 million.

What Are GLP-1 Drugs?

Understanding what GLP-1 drugs are and their role in healthcare is critical when discussing how to manage the drugs and monitor the patients taking them.

“These drugs are marketed two different ways,” explained Dua. “One group is marketed to help people with diabetes better control their blood sugars and their long-term blood sugar numbers. The other set of drugs is marketed just for weight loss. They're called, altogether, GLP-1 inhibitors.”

According to Bhatt, the GLP-1 class of drugs mimics glucagon-like peptides that cause the body to feel satiated, minimizing the risk of overeating.

“It sends a signal to the brain to say, ‘I don't need anything more in my body,’” he noted.

Although the drugs have traditionally been indicated in diabetes management, healthcare professionals note that there is an increasing number of GLP-1 approvals for weight management in people who are overweight or obese.

“We, [as healthcare providers], want to focus on obesity as a chronic disease. We understand that not everybody loses weight just by dieting and exercising. Many people have to have hormonal control. This enzyme works to help control weight gain and stop it and lead to weight loss,” Dua noted.

Time and time again, studies on GLP-1 drugs have shown their ability to reduce body weight significantly in overweight and obese patients, superseding some other weight management strategies.

For example, a recent study published in Obesity showed that semaglutide, a type of GLP-1 drug, helped patients with failed bariatric surgeries achieve weight loss. Study participants who had a failed bariatric procedure reduced their body weight by approximately 9.8%, while patients who had not had surgery had an average weight reduction of 8.7%.

Cardiovascular Health

In addition to its weight loss effects, this class of medications has also proven effective in improving cardiovascular health.

“Obesity affects 100 million people, and the public health impact can be significant for these medications,” Bhatt noted. “What's been interesting is the impact on cardiovascular [health] to improve the health of obese patients with other conditions.”

For example, a recent study published by the New England Journal of Medicine and presented at the American Heart Association annual meeting revealed the cardiovascular benefits of semaglutide, a type of GLP-1 drug sold under the brand names Wegovy and Ozempic.

The study recruited over 17,000 overweight or obese patients who did not have a diabetes diagnosis. Patients were assigned to an experimental group, which received 2.4 mg of semaglutide weekly through a subcutaneous injection, or a control group, which received a placebo.

To evaluate the impact of semaglutide on cardiovascular health, researchers calculated a composite of death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke. Compared to the placebo group, those taking semaglutide had a 1.5% reduction in primary cardiovascular end-point events.

“It also showed a reduction of heart failure by 18% and all-cause mortality by 19%,” Bhatt added.

Challenges

Despite the high demand for these medications, Bhatt points out that health equity challenges based on the cost of the medicines pose concerns.

In addition to challenges associated with side effects, healthcare professionals note the potential risks associated with taking GLP-1 drugs.

“These medications offer benefits in ways that other medications may not be based on the data, but the challenge is side effects that must be considered,” Bhatt continued.

Another challenge he considers is whether patients should stay on the medications for extended periods. He notes that if patients come off the drug, the weight can return because the appetite is no longer suppressed.

Aside from the risks associated with compounded or illegal products, another consideration that Bhatt brought up is managing the side effects of the medications.

Recently, a study in Nature Medicine evaluated the risk of suicidal thoughts in patients taking GLP-1 drugs. While that study revealed that there is no correlation between suicidal ideation and GLP-1 use, the FDA continues to investigate the safety of these drugs.

“The other side effects, nausea, diarrhea, decreased appetite, vomiting, constipation, and ulcers — those all can then impact [patients’] day-to-day life and ability to live a healthy life or do the things that are important to [them],” Bhatt noted.

Managing GLP-1 Medications

Considering the broad range of side effects and risks associated with these medications, providers must leverage all the tools available to manage these medications.

With that in mind, Dua developed a smartphone app, Together, that helps providers and patients manage medications relatively easily.

“There are two reasons I built Together — first, my patients. I'm a kidney doctor. My patients are diabetics; they have kidney disease, and drugs like Ozempic, Wegovy, and Mounjaro help my patients tremendously. I have patients who are actively losing weight; their blood sugars have improved, and I've taken them off medications for blood pressure and blood sugar,” explained Dua.

“Together turns [patients’] smartphones into a personal health assistant and allows them to share their data,” she revealed.

For example, in patients taking Ozempic, the app may help provide insight on how to take the medication, the potential side effects, and notifications on when to get refills.

Beyond these standard factors, the app is also equipped to take vitals. For example, the app can measure blood pressure by holding the phone camera up to the patient’s face. However, Dua notes that using the app does not replace traditional vitals during checkups.

“Basically, the camera can look at vessels under the skin and, using RPPG technology, make an assessment of [a patient’s] blood pressure. Again, it's to be used as a guide; it's not a doctor's office and doesn't replace home methodologies [like blood pressure monitors at home]. So, the vitals feature is what everybody gets very excited about,” she explained.

Dua described multiple other features in the app that may ease the medication management strategy.

“One of the features that [Together] just released is that [patients] can photograph their doctor's care plan, and Together will summarize it into simplified health tasks and then remind them to [follow it],” she revealed.

Moving Forward

Regardless of how providers choose to manage the medications, it is clear that more research on these medications is critical. 

“It's important to continue to research the side effect profile and the safety of the medication, how long that individuals need to be on it to generate sustained benefit. This is the kind of innovation and thinking that we need to see from industry, but there's still a lot to learn about the long-term impact of these medications,” Bhatt stated. “This is an exciting but new area, and we've got to continue to follow the science and study it.”