Interest in GLP-1 receptor agonist weight loss drugs like Ozempic, Wegovy, Mounjora, and Trulicity is exploding!
It’s easy to get excited about these satiety-inducing drugs, especially if your scale has done nothing but climb with no hope in sight.
When we look at the big picture, it looks like the deck is stacked against us.
- First, food corporations create a hyper-palatable, ultra-profitable food system that makes you feel ‘addicted to’ the only nutrient-poor, hyper-palatable foods that are affordable.
- Then we create high-priced drugs that mimic our satiety response to nutritious food.
- But if we keep eating the same food, we get fewer nutrients and become dependent on these drugs.
These new drugs could be life-changing for the many who desperately need to lose weight for their health, especially if they are able to build new habits and optimise their nutrition.
In this article, we’ll look at:
- How these new drugs work,
- Why they are prescribed for people with Type 2 Diabetes,
- The risks and the cost,
- How much weight can you lose, and what are the chances of gaining it back when you stop?
- How GLP-1 works in your body, and
- How you can increase GLP-1 naturally.
How Do Injectable Weight Loss Drugs Work?
The main active ingredient is Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist.
Your gut and brainstem naturally produce the signalling hormone GLP-1 after you consume food. GLP-1 signals satiety and lowers your hunger after eating.
GLP-1 is also an incretin hormone and hence enhances insulin and suppresses glucagon secretion in your pancreas, thus lowering blood glucose.
An agonist is “a drug that binds to a receptor inside a cell or on its surface and causes the same action as the substance that normally binds to the receptor”. So, the GLP-1 receptor agonist works because the drug binds to a receptor and acts like your endogenously produced GLP-1.
So, with the support of these drugs, someone is less consumed by thoughts of food, eats less, and can lose weight from the energy deficit they create and maintain their lowered calorie intake over the long term with the help of these drugs.
In addition to Semaglutide, there are a few other variants on the market or in the pipeline:
- Mounjaro is a GLP-1/GIP agonist, which means it also mimics glucose-dependent insulinotropic polypeptide (GIP).
- Carinlintide mimics amylin, another pancreatic hormone that influences satiety.
- Retatrutide is a GLP-1/GIP/glucagon agonist that will also encourage your liver to release more energy in addition to increasing satiety.
These medications are injectable satiety; they’re as close as we’ve come to the “magic pill” for weight loss. So, there is a lot of reason to be excited about them.
Why Is Semulglutide Used for People with Diabetes?
Rather than injecting more insulin, GLP-1 receptor agonists increase your body’s endogenous insulin and increase satiety, which helps you eat less. So, instead of just managing the symptom of T2D—erratic blood sugars—with injected insulin, these new drugs help to address the root cause—energy toxicity.
However, thanks to TikTok influencers and celebrity use, many people without diabetes are now asking their doctors to prescribe these drugs to help them lose weight. There is currently such a shortage of these drugs worldwide that doctors have been asked to stop writing new prescriptions until suppliers can produce more.
How Much Weight Can You Lose?
With the increased satiety from GLP-1 analogues, weight loss is quite promising. With a mean weight loss of 14.8%, the progress decimates the 2.4% weight loss in the placebo group (Garvey et al., January 2023). However, it’s interesting to note that the weight loss effect plateaus at around 60 weeks.
There has also been a lot of discussion on whether the benefits last after stopping taking these drugs, especially if no diet or lifestyle changes are made while on them. While some report that these drugs give them the control to develop new habits, many others have found have gained back the weight once they stopped.
The chart below from Weight regain and cardiometabolic effects after withdrawal of semaglutide also shows a rapid regain after stopping taking the drugs. In addition, researchers also found that participants’ cardiometabolic improvements reverted once their weight returned to their baseline and they regained what they had just lost.
How Much Do They Cost?
While the weight regain is concerning, the cost is the real sticking point; Wegovy’s monthly list price in the US is $1350!
That’s $16,200 per year or 30% of the average American’s annual salary!!!
Fortunately, health insurance often covers this cost if prescribed by a doctor. However, many insurance companies are starting to push back to manage their expenses.
But the cat is out of the bag for these new GLP-1 drugs. Everyone is talking about them! This definitely hasn’t hurt Novo Nordisks’ share price.
But if we do some quick calculations, if everyone who was obese in the US went on Wegovy, someone would have to foot a bill of $3 trillion per year.
That’s 10% of the United States’ massive $31 trillion national debt every year!
I wonder how long this can continue before health insurance rates become more expensive for everyone.
These drugs are certainly helpful for people to avoid the many complications that stem from metabolic syndrome, T2D, and obesity. However, the financial equation becomes very challenging if everyone who wants to be a bit leaner starts using these drugs.
How Can I Increase My GLP-1 Naturally (for Free)?
If you can’t afford GLP-1, cannot get a prescription, or want to do things without medication, you may be interested in how to increase your GLP-1 naturally.
As we mentioned earlier, GLP-1 is a satiety-inducing peptide hormone that your body naturally produces in response to food, but not just any food!
A 2016 paper, Nutritional modulation of endogenous glucagon-like peptide-1 secretion: a review (Girous et al., 2016), found that GLP-1 is stimulated more by foods rich in nutrients.
In another study, High-protein intake stimulates postprandial GLP1 and PYY release (Faroqui et al., 2012), protein was shown to stimulate GLP-1 more than fat and carbohydrates. Additionally, it showed that GLP-1 tends to align with our insulin response. So, it’s likely that GLP-1 follows a similar pattern as your blood glucose and insulin.
In our Data-Driven Fasting Challenges, we guide participants to use their blood glucose as a fuel gauge and eat when their glucose is lower than normal. They also learn to prioritise protein they are hungry, and their glucose is higher than normal.
Unfortunately, most of the interest in GLP-1 has been around patentable drug treatments rather than nutritional interventions, so we don’t know much about how our GLP-1 production responds to various nutrients in your food.
However, we know from our satiety analysis that the protein % of our diet impacts how much we eat throughout the day more than any other parameter. After protein, fibre, and other nutrients like potassium, calcium, sodium, and particular vitamins also tend to align with eating less, but not quite as much.
In converse, food containing more energy from carbs and fat and less from protein and fibre tend to align with eating more, especially when combined in ultra-processed foods.
While the new messaging seems to be that obesity is a genetic disease that we can manage with drugs, there’s undoubtedly more to why conditions stemming from metabolic syndrome weren’t so common half a century ago. Although genetic factors are certainly at play, nature (genes) vs nurture (environment) still holds true, and our food system has changed.
As the image below shows, fat consumption has been steadily rising over the last century since we discovered how to extract oil from crops at scale, fuelled by synthetic fertilisers. Meanwhile, our carb intake has risen since the agricultural revolution.
Together, these add up to a lot of extra cheap and tasty extra calories from ultra-processed foods that we love to overeat. Because our carb and fat intake has increased so much relative to carbohydrates, our overall per cent of total calories from protein (i.e., protein %) has decreased. It’s no wonder obesity is rising at such an alarming rate!
To learn more, check out How to Maximise Satiety Per Calorie. You can also join our Optimising Nutrition Community to access our food lists and meal plans that will help you increase your satiety naturally.
What About Nutrients?
Q: Why do we want to eat?
A: For pleasure.
EH! Wrong answer.
A: To get the nutrients and energy we require.
In recent years, studies looking at factors influencing eating disorders like binge eating, bulimia, and even anorexia have shown many probable causes, including mental and emotional stress as well as nutrient deficiencies.
Feel-good ‘happy’ neurotransmitters like dopamine and serotonin are synthesised from amino acids like tyrosine and tryptophan. Additionally, various vitamins and minerals like vitamins B1, B6, B9 and C and minerals like magnesium, zinc, and copper serve as catalysts for these reactions. Gut health also becomes essential, especially for serotonin synthesis.
So, if you suffer from one of these conditions and you’re not consuming adequate nutrients, you’re more likely to return to your old habits once the effect of the weight loss drugs wear off.
Much research—including our own—points to nutrients as the most critical factors for satiety. In other words, if you’re not getting enough of them, your body will send you in search of the vitamins, minerals, essential fatty acids, and amino acids you’re lacking by making you eat more.
Unfortunately, our modern food environment has replaced essential nutrients like protein, minerals, and vitamins with lots of cheap energy. Whether by accident or design, it has lowered the satiety value of our food and forced us to eat more of these cheap-but-profitable foods. As a result, we now have to consume more energy to get the nutrients we require to thrive.
Our work on satiety and nutrient density enables us to reverse engineer hunger and satiety to get the nutrients we require without excess energy. But, when it comes to weight loss in a pill—or in this case, an injection—people will no longer be hungry for the nutrients they need.
As a worst-case example, a person may have eaten two or three chocolate muffins before they started the weight-loss drug, but they are only hungry for one. While these muffins likely provided little in the way of real nutrients, they contain some synthetic (fortified) ones. Thus, they consume fewer nutrients than they require to thrive long-term.
While these people may achieve weight loss, their body composition may deteriorate unless they consume adequate protein. Additionally, their overall health might dive unless they incorporate nutrient-dense whole foods that provide other vitamins, minerals, and essential fatty acids.
Satiety-inducing drugs don’t change your requirements for nutrients from your food. In fact, when you’re eating less, nutrient density becomes even more important! If you’re eating less, it’s critical to find a way to pack more of the nutrients you need into fewer calories!
In an ideal scenario, someone could initially use Semaglutide to lose weight while they develop new lifestyle habits that allow them to make better food choices. Essentially, the drug becomes a bridge to get them to a healthier lifestyle.
As the results below show, craving control tends to improve initially. But interestingly, the studies show that cravings seem to come back after two years, especially for sweets. This may be why the weight loss results start to slow after a year or so.
What happens if someone is undernourished after years of eating a poor diet on these appetite-suppressing drugs and then gets to the point they can no longer obtain them?
Without building new habits around food, will all their cravings instantly return as their body seeks out the nutrients they have been missing?
Or if they stay on them long term without improving food quality, will their bodies be forced to trudge through nutrient deficiency into new diseases?
I suppose time will tell.
I had hoped to be more positive in this article. But I think there are some nutritional issues worth highlighting.
I hope you can use this information to consider whether or not these drugs are right for you.
To finish, I wanted to share some positive stories from people who have used these weight loss drugs in our groups.
My hormone doc suggested giving semaglutide a try (Ozempic, Wegovy). And it has worked wonders for me! I am still fasting, tracking blood glucose, and prioritising protein and nutrients, but it was a game-changer. It has been a challenge going through perimenopause and fluctuating hormones. This gave me more freedom, or a bridge, if you will, to balance hormones. I am now on Mounjaro, which has worked well at a low dose. It has helped with other areas in my body that have surprised me. I am down 25 lbs and now maintaining. — Joanne
I’ve been on the drug for Type-2 Diabetes for two years now and lost 25 kg of mostly (92% by my calculation) body fat… Independent of Optimising Nutrition, I discovered I could use my blood glucose levels to optimise fat loss whilst on this medication. I noticed that I consistently lost weight when I only ate below my blood glucose trigger of 4.8 mmol/L. Then I found Data-Driven Fasting, and your evidence backed up my experience. My GP said none of her other diabetes patients on Ozempic had had as good a result as mine… so what I was doing was the critical difference.
I was on Januvia, Metformin and Gliclazide and exercising *hard* at the gym, but not losing body fat very quickly, up at 36% body fat. I’m now on Metformin and Ozempic, down under 22% body fat and down 25kg, 23kg or so of which is fat.
But primarily because I noticed that I lost weight when I stopped eating until my glucose was low. I also started using my blood glucose to avoid the hypos I started getting when Ozempic was added to my three other meds.
My biggest concern with weight loss in a pill (or, in this case, an injection) is that people will no longer be hungry for the nutrients they need. It’s already an issue with weight loss surgery, where it’s a permanent state of affairs afterwards. At least with a pill, you can come off it. Last week I was diagnosed with low iron levels after 2+ years on semaglutide, even though I prioritise protein.
I am an admin of 30,000+ folks in the Ozempic Facebook group. I often feel they would benefit from Data-Driven Fasting. I like DDF because it addresses this single most challenging aspect of dieting: when should I eat, and can I train myself to eat less? — Paul Antoine
This is definitely a complex topic, so feel free to share your thoughts and experience below to add to the discussion!
- GLP-1 receptor antagonist drugs are an exciting new frontier in weight loss. However, they are expensive, meaning everyone living with obesity may not have the chance to use them.
- Studies show a dramatic initial weight loss that slows after 60 weeks as the appetite-suppressive effects appear to diminish.
- Once people stop taking these drugs, most seem to regain their lost weight.
- Maintaining a healthy weight is undoubtedly more challenging in today’s modern food environment. However, we do have a solid understanding of the properties of food that leads us to eat more or less. Therefore, changing what you eat directly impacts how much you will eat.
- Simply eating less of the same nutrient-poor foods with artificially lowered hunger is not ideal. Hence, it’s wise to do everything you can to dial in your food choices, eating habits, and appetite to ensure long-lasting results whether or not you’re using these weight loss drugs.