GLP-1s Demystified: Tackling the TikTok Myths and Realities

Authors: Kara Fine MD, Eve Bloomgarden MD

As endocrinologists, we did not have “GLP-1 is trending on Tik Tok” on our bingo cards, but there’s no question that anti-obesity medications,  have taken the medical, digital and corporate realms by storm.  These medications go beyond simple weight loss; they are targeted treatments addressing the underlying metabolic imbalances, hormonal disturbances, and psychological factors that contribute to obesity. 

Obesity is a chronic, multifactorial, complex syndrome influenced by genetics, environment, hormones, and more with a myriad of short- and long-term adverse health outcomes.  Over 40% of US adults are currently grappling with obesity, and that number continues to rise.  Those of us in the business of “helping, healing, and preventing bad outcomes” (ahem, reader) know that obesity is not a moral deficit, nor a failure will power or as simple as “eat less, move more”.

Wait, there are gut hormones?

At the core of these drugs are two gut hormones, glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP). These are both part of the incretin family, which plays a critical role in regulating our glucose levels, appetite, and energy balance.  They are nutrient stimulating hormones, meaning they respond to nutrient stimulation.  Semaglutide, a GLP1 receptor agonist, and tirzepatide, a GLP-1R/GIPR dual agonist mimic these hormones, enhancing our body's response to food, leading to better insulin secretion, and appetite control. These are not mere weight-loss drugs; they are sophisticated treatments targeting the metabolic dysfunctions at the heart of obesity. 

What’s in a name?  

Semaglutide, a GLP-1 receptor agonist, was first approved for the treatment of type 2 diabetes mellitus under the brand name Ozempic. More recently, the same exact medication was approved for the treatment of adults with overweight or obesity under the trade name Wegovy. Tirzepatide is a dual receptor agonist for both the GLP-1 receptor and the GIP receptor. It was first FDA approved as Mounjaro for the treatment of T2DM, and in November 2023 the same exact medication was approved for the treatment of obesity without diabetes under the trade name Zepbound.

So am I #teamGLP?

Of course.  Having non-surgical evidence-based medication options with solid clinical trial data, highly favorable weight loss outcomes, manageable side effects, and reassuring safety data is game changing. It is unacceptable to not consider these medications for those patients at high risk for weight-related morbidity and mortality.

But these medications are not appropriate for everyone.  They do not replace lifestyle and exercise.  They aren’t going to be the one stop shop to solve the worlds’ problems.  We are giving an analog of a powerful hormones).  Endocrinologists everywhere would tell you that you need to replace hormones when they are missing.  - Take out a thyroid gland? Give thyroid hormone.  Knock out your adrenal glands?  Make sure you prescribe steroids!!  But… but this is more complicated.  Medications have risks.    Not everyone responds.  They are part of a comprehensive treatment plan that includes diet, exercise, and lifestyle changes.

So while I do not lose sleep over “Ozempic face” or the impending financial destruction of the fad diet snake oil tricksters who sell miracle diets on Facebook, there are some clear risks.  While my opinion may change as new data emerges, I am currently not concerned about these medications increasing the risk of non-medullary thyroid cancers (unless providers start ordering inappropriate thyroid screening ultrasounds- but that is a different article to write- don’t do that).  As with any rapid weight loss, there is a risk of gallstones and cholecystitis.  Patients are treating these drugs as “no brainers” and taking them with no dietary changes, leading to protein-calorie malnutrition.  The data on pancreatitis and bowel obstruction is  conflicting, and will become more clear as more people take them.  Overall, however, the risks of side effects from these medications is dwarfed by the risks of living with obesity.   The true urgent problem is clear - most people who need these medications cannot get them.   Medication shortages, outright insurance denials, high out of pocket cost, and lack of healthcare providers to treat obesity  are the problems that need to be addressed urgently. 

Oh, and watch out for counterfeit medications, and I would avoid compounded products.  Compounded versions of these drugs are an unknown in terms of safety and efficacy.  They are not FDA regulated, formulations may or may not even contain the right medication or active ingredients, and there is no oversight to assure sterility (Remember the people who acquired fungal meningitis from a compounding pharmacy with questionable hygiene practices?)..

The truth is these medications can produce results akin to bariatric surgery when used correctly. They are not miracle drugs but powerful tools in our arsenal against obesity. They require a partnership between patient and provider, where medications complement lifestyle changes, not replace them.  We welcome these medications as a milestone in obesity treatment, we must address the challenges they bring, and we must let the science guide us. Access, cost, misinformation, and regulation need careful consideration to ensure these advances benefit those in need. And somehow, we need to restore trust in vested and credible health resources and stop getting our medical information on Tik Tok!!

About the authors: Kara Fine, MD and Eve Bloomgarden, MD are board-certified in Endocrinology, Diabetes, and Metabolism. Dr. Fine is in private practice in the Chicagoland area. Dr. Bloomgarden is the Chief Development Officer of Women in Medicine ®. You can follow her on linked in www.linkedin.com/in/evebmd, instagram @Sincerely_dr.eve, or twitter @evebmd