GLP-1 Drugs for Obesity and Weight Loss

Note: Compounded drugs are not approved by the U.S. Food and Drug Administration (FDA) and may carry greater risks than FDA-approved treatments.

Glucagon-like peptide-1 (GLP-1) agonists are injectable weight loss drugs that help people feel fuller and eat less food, leading to weight loss. The drugs also boast other health benefits, such as protection against cardiovascular disease.

What Are GLP-1 Drugs?

The U.S. Food and Drug Administration (FDA) has approved four GLP-1 drugs for weight loss in people with overweight or obesity:

• liraglutide (Saxenda)
• orforglipron (Foundayo)
• semaglutide (Wegovy)
• tirzepatide (Zepound)

Liraglutide, semaglutide, and tirzepatide are injectable medications that come in prefilled pens. Once per day or per week, users attach a needle to their pen, prick themselves in the torso or another fleshy area, and press a button on the pen to administer their medication.

Orforglipron comes only as a pill, which can be taken at any time of day without restrictions. An oral version of semaglutide is also available. Users take this pill in the morning on an empty stomach and wait half an hour before eating or drinking.

Doctors start their patients on lower “starter” doses and work their way up — it can take months to work up to a full-strength dosage.

Each of these drugs is also marketed under a different name for the treatment of diabetes: semaglutide (Ozempic), tirzepatide (Mounjaro), and liraglutide (Victoza). This may cause some confusion: Though Ozempic and Wegovy, for example, come in different packages and in different doses, they are in fact the same drug.

How GLP-1 Drugs Promote Weight Loss

• Signals a feeling of being full
• Slows down digestion
• Regulates the release of insulin from the pancreas

Who Is Eligible to Use GLP-1 Drugs for Weight Loss?

Wegovy, Zepbound, Saxenda, and Foundayo are all approved as weight loss medications for the following people with a demonstrated medical need to lose weight.

• Adults with a body mass index (BMI) of 30 or greater
• Adults with a BMI of 27 or greater who also have one weight-related condition, such as type 2 diabetes, high blood pressure, or high cholesterol

Wegovy and Saxenda are also approved for the treatment of children age 12 and older; the precise BMI cutoffs for children differ by age.

Only your healthcare team can decide which of these drugs, if any, will work best for you.

How Much Weight Will I Lose?

Not everybody responds equally well to these treatments, and it’s impossible to predict how effective any specific weight loss medication will be for you. The results of major clinical trials suggest how much weight the average user may expect to lose.

Liraglutide didn’t achieve quite the same level of weight loss. On average, users taking a 3-mg dose lost 11 lb. after the first year. The average weight loss decreased to 7.5 lb., according to results extending beyond 12 months.

It’s important to emphasize that GLP-1 weight loss drugs are meant to be used in tandem with regular exercise and a healthy diet. The weight loss reported in the above studies all occurred in volunteers who were also asked to maintain healthy eating and exercise habits.

Additional GLP-1 Benefits

GLP-1s have health benefits that extend beyond weight loss.

Heart Health Protection

When people who are overweight use GLP-1 medications, they tend to experience broad cardiovascular and metabolic health improvements, depending on the medication. Benefits can include:

• Lower blood pressure

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• Lower total cholesterol

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• Better liver health for those with metabolic dysfunction–associated steatotic liver disease (MASLD)

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• Lower blood sugar and reduced diabetes risk

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• Lower risk of kidney disease

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Tirzepatide and orforglipron are newer drugs that don’t yet have results from long-term cardiovascular health trials.

Secondary Benefits

GLP-1 drugs also appear to have some extra benefits.

• Zepbound is also an FDA-approved treatment for moderate to severe obstructive sleep apnea (OSA).

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• GLP-1 drugs have anti-inflammatory properties that may benefit those with asthma and chronic obstructive pulmonary disease (COPD).

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• GLP-1 drugs also seem to have anti-addictive properties — some users report that they have fewer cravings for alcohol or have become less likely to engage in other addictive behaviors, such as gambling, shopping, or nail-biting. Researchers are now studying semaglutide and similar drugs for their anti-addiction effects.
• Preliminary studies have suggested that GLP-1 drugs might protect against or treat dementia and Alzheimer’s disease.

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GLP-1 Drug Risks and Side Effects

GLP-1 drugs are associated with a wide variety of side effects.

Common Side Effects

In the majority of people in clinical trials, these side effects have been mild or moderate. Gastrointestinal issues are usually strongest in first-time users, or when people step up to a larger dosage, but they usually dissipate over time. A small number of users may experience gastrointestinal effects so severe that they need to stop taking the medication.

Rare, More Serious Side Effects

Anecdotal Side Effects

There has also been plenty of media buzz about anecdotal side effects with names like “Ozempic face” and “Ozempic butt.”

These cosmetic side effects aren’t unhealthy, and aren’t directly caused by GLP-1s. Instead, they are caused by rapid, significant weight loss.

Weight loss can make parts of your body look different. While your belly may slim down, so might your buttocks and face. In some people, weight loss can lead to looser or sagging skin. Weight loss can also cause hair loss, and may be responsible for other rarely reported side effects, such as tiredness.

Warnings

GLP-1 drugs are powerful medications that may not be appropriate for everybody.

GLP-1s may be risky for older adults. Significant weight loss isn’t always a benefit for older adults, especially if it means the loss of bone and muscle mass, which are critical for good physical health. It’s possible to reduce the risks by eating enough protein and engaging in strength-building exercises, such as weight lifting.

People who should not use GLP-1s include:

• Pregnant people
• People with a personal or family history of medullary thyroid cancer
• People with multiple endocrine neoplasia syndrome type 2, a rare condition that affects the endocrine glands
• People who are hypersensitive to GLP-1 agonist drugs

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GLP-1 Drugs Are Lifelong Treatments

Cost, Insurance Coverage, and Access

Public insurance coverage for GLP-1 obesity treatments is spotty in the United States.

Many users are left to pay for GLP-1 weight loss medications, which can cost more than $1,000 per month, out of pocket.

Alternatives to GLP-1 Drugs

GLP-1 agonists are not the only option for weight loss.

It may go without saying, but the old-fashioned way — diet and exercise — remains a preferred weight loss method. Indeed, many doctors require people to try diet and exercise alone before trying GLP-1s. Different eating patterns and exercise regimens work for different people, and it’s best to work with a doctor or dietitian if you can. Low-carb and Mediterranean diets are both popular and research-backed ways of eating that can help people lose excess fat. A combination of cardio exercises and strength training is often the best exercise strategy for weight loss.

If you cannot access or afford newer GLP-1 medications, a generation of older weight loss drugs is still available. Though these drugs are generally less effective than newer alternatives, they can work for many people:

• Orlistat (Alli, Xenical) reduces the amount of fat absorbed by the intestines.
• Phentermine-topiramate (Qsymia) suppresses appetite and helps people eat less.
• Bupropion-naltrexone (Contrave) reduces hunger signals in the brain.

Weight loss surgery, or bariatric surgery, is also an option for some people with a need to lose weight. The benefits are comparable or superior to the benefits of GLP-1 drugs, including dramatic weight loss and secondary long-term health benefits, such as improved blood sugar levels. Weight loss surgery may seem intense and expensive, but it is often covered by insurers, and the out-of-pocket cost could be far less than years of GLP-1 therapy.

Dive into our GLP-1 resource center for stories on weight loss, medications, side effects, and more.