What You Need to Know Before Taking a GLP-1 Agonist

In my years of medical practice, I’ve never seen a class of medications gain as much attention in both medical and cultural spheres as GLP-1 agonists. These medications have sparked tremendous interest, yet it’s crucial to understand both their benefits and limitations before adding them to your own health journey.

As someone who’s seen the transformative potential of GLP-1 drugs firsthand, I’d like to share an in-depth look at how they work, who they benefit, and the realities of using them. Let’s break down what you need to know when considering this class of medication.

How GLP-1 Agonists Work

At their core, GLP-1 agonists help balance your body’s energy regulation processes. But what does that mean?

As a culture, one of our greatest challenges is the over-provision of energy (read: food) to our bodies. We have food in abundance in this country, and that easy accessibility, alongside overfull calendars, often leads to too much energy without enough opportunities to use that energy efficiently. In other words, energy dysregulation.

One of the most significant signs of energy dysregulation is weight gain. Our body was created to store excess calories as fat, as a source of energy for a future rainy day. But since periods of fasting rarely occur on their own, we continually store that excess energy as an increasing body fat percentage. Eventually, chronic diseases appear and our health suffers.

At a physiological level, GLP-1 agonists work against energy dysregulation through three primary processes:

• Optimizing Insulin Secretion
  GLP-1 medications prompt the pancreas to secrete insulin, but only when blood glucose levels warrant it. This glucose-dependent action ensures insulin production aligns with the body’s actual needs.
• Reducing Glucose Production in the Liver
  GLP-1 agonists slow down the liver’s glucose production, helping combat the common problems of visceral fat and fatty liver disease.
• Slowing Gastric Emptying
  By slowing the stomach’s emptying process, these medications promote a feeling of fullness. Unlike typical appetite suppressants, this action allows you to feel satiated faster and stay full longer.

All three mechanisms work toward a healthy regulation of energy in the body. If you can take in less energy and then use that energy more efficiently, you create an excellent foundation. Lifestyle behaviors can then multiply the efforts of the medication.

Agonists vs. Antagonists: Encouraging Natural Functions

An interesting point about GLP-1 medications is that they’re agonists, not antagonists. This means they encourage your body to function as it was naturally created to work, rather than blocking natural processes like many other medications do. When pharmaceuticals support natural processes rather than stopping them, we typically see better results and fewer side effects.

Who Are GLP-1 Agonists For?

GLP-1 agonists are incredibly versatile and are useful both for treating existing conditions and preventing chronic diseases. However, not everyone will benefit equally. As a primary care physician, here are the top three categories of patients that GLP-1 drugs might benefit:

• Individuals who are overweight: If you’ve struggled to lose weight with lifestyle changes alone, a GLP-1 agonist could provide the assist you need to make real progress.
• Individuals with borderline diagnoses: If your lab numbers have been trending in the wrong direction, whether for blood sugar, blood pressure, cholesterol, or hemoglobin A1C, your doctor may have described a “borderline” issue to you. This “borderline” diagnosis is a signal that your body is already undergoing unhealthy changes — a trajectory GLP-1 agonists could help reverse.
• Individuals with metabolic conditions: Fatty liver disease and prediabetes are just two of the various metabolic red flags that GLP-1 medications can effectively address.

Despite the potential upside of these medications, I always advise caution for those looking for a quick fix without addressing lifestyle factors. This leads us to the next critical subject.

No Wonder Drug: Realistic Considerations for GLP-1 Agonists

No medication is a magic bullet, and GLP-1 agonists are no exception. A top concern and even complaint about these drugs has been that they don’t “work” after you get off them.

I find this criticism rather unfair. Just like in life, if you’re producing an artificial result, the truth will eventually come out.

There’s no escaping the need for lifestyle modification if you want to see real, lasting change. A drug will not replace that for you. It may allow you to make progress for a time, but reality will demand its due. So, if you’re considering a GLP-1 agonist, keep these two principles in mind:

• Don’t Over-Rely on a Drug
  While these medications can deliver noticeable changes with minimal effort, the results aren’t sustainable without behavioral changes. On the positive side, behavioral changes will work with the drug to effect changes much faster.
• Start With the End in Mind
  From the very first prescription, I work with patients to plan how they’ll eventually transition off the medication. The goal is to use the time on the drug to instill sustainable habits — like improving diet, increasing activity, and recalibrating your relationship with food.

Side Effects to Consider

GLP-1 agonists are generally well-tolerated, but they’re not without side effects. The most common side effects relate to the medication’s gastric effects. Patients may experience:

• Nausea and upset stomach (sometimes severe enough to cause vomiting)
• Constipation from slowed gastric processes

To mitigate these unpleasant symptoms, I often tell my patients: Don’t try to “out-eat” the medication. If you get that fullness signal but continue eating because that’s how much you usually eat or because you paid for the whole meal, you’re much more likely to experience uncomfortable consequences.

A Note About Thyroid Concerns

While early animal studies showed a potential increased risk of thyroid cancer, this hasn’t been replicated in human studies. Nevertheless, I maintain vigilant monitoring of the thyroid in patients on these medications, particularly for those using them longer than 6–12 months.

Final Thoughts: Training Wheels and Coaching

I encourage my patients to think of GLP-1 agonists as a coach or mentor — or like training wheels on a bicycle. They help you learn and improve, providing positive feedback sooner and more clearly than you might receive otherwise. But just as training wheels aren’t meant to stay on forever, these medications work best when viewed as temporary supports.

The key is to lean into learning during your time on the medication. Use this period to understand your relationship with food, identify your specific challenges, and develop sustainable habits. When you eventually reduce or stop the medication, you’ll have gained valuable insights about yourself that you can continue implementing moving forward.

Remember, there’s no such thing as a wonder drug. While GLP-1 agonists can be valuable tools in your arsenal, they’re most effective when paired with meaningful lifestyle changes and a clear plan for the future.