Prescription Weight-Loss Medication: What Nurses Need to Know

• While weight-loss trends are not new, a new class of medication, GLP-1 agonists, has hit the market.  
• GLP-1 agonists can cause side effects ranging from headaches and dizziness to muscle loss.  
• Medication is another option to achieve weight loss by adjusting the metabolic hormones that naturally curb appetites.  

What do Elon Musk and many Hollywood stars have in common? They allegedly are taking the same weight loss drug. You may have heard the buzz in your nursing break room or even public news about Hollywood stars losing weight from the new wonder weight loss drug class.

As an astute nurse, you are already aware of the concerning statistic that 45% of adult Americans are overweight or obese. Many hospitals and facilities are responding by ordering bariatric (larger width) beds, wheelchairs, and seats. Nurses see medical complications worsened by overweight and obesity. After decades of modest results from various diet trends and limited pharmaceutical options concerning adverse side effects, a new class of medication, known as the GLP-1 (Glucagon-Like Peptide-1) agonists, uses biology and the power of natural gastric hormones for weight loss. It is being called the fastest-growing medication ever.   

Which Prescription Weight-Loss Medications are New?

There are several medications in the arsenal for prescribers to use for pharmaceutical management of patients with obesity, including Phentermine with its adverse cardiac side effects and Orlistat with its production of oily stools and diarrhea. Weight loss results were modest at best

No class has ever been as successful as the new class known as GLP-1 agonists (Garvey et al., 2016), which represent an incredible step forward in treating obesity. Glucagon-like peptide receptor agonists, known as GLP-1a, offer patients hope of weight reduction up to 20% of their current weight compared to only 5% with phentermine.  

It all started with a lizard! This story begins in the 1980s when a scientist wondered why a Gila monster lizard does not have a blood sugar spike after eating a large meal only once every three to four months. Chemists identified GLP-1, an endogenous hormone released by the small intestines during food ingestion, which helped control appropriate insulin release and satiety (Knudsen & Lau, 2019). GLP-1 plays an essential role in managing blood sugar and insulin secretion.

At first, GLP-1’s short half-life and rapid degradation made its use as medication unpractical, so in the early 2000s, pharmaceutical companies started creating synthetic versions, known as GLP-1 agonists, as injectable solutions. Exenatide (Byetta), one of the first GLP-1 agonists approved for therapeutic use by the FDA in 2005, became widely prescribed to manage Type 2 diabetes as a daily injectable (Bessesen & Van Gall, 2018). Since the introduction of GLP-1s, several other GLP-1 agonists made by Novo Nordisk, such as Victoza (liraglutide), Trulicity, and Semaglutide (Ozempic) were successfully created and approved as once a week subcutaneous injection (Kushner et al., 2020)

This marked a significant breakthrough in diabetes care, as GLP-1s offered a novel approach to controlling blood glucose. People with diabetes began losing weight in addition to enjoying better blood glucose control and cardiovascular benefits, which triggered the thought that those without diabetes may also benefit. 

How Do They Work?

GLP-1 agonists have gained prominence in the past few years for their weight-loss potential. Testing in people without diabetes proved highly effective for up to 15% weight loss when taken by injection compared to less than 5% by a placebo trial (Wilding et al., 2021). Semaglutide earned FDA approval as an effective weight management treatment in 2021 for people without diabetes under its brand name, Wegovy. GLP-1 agonists represent a marked evolution from their use exclusively as blood sugar-control medications into being used for weight loss in those with obesity.  

Research on GLP-1 agonists demonstrates efficacy in numerous studies exploring their benefits in cardiovascular health and non-alcoholic fatty liver disease (NAFLD) (Aroda et al., 2019). Because the medication is so effective, the competitor Eli Lilly (the first pharmaceutical company to successfully produce exogenous insulin) created and began marketing tirzepatide (Mounjaro), which boasted studies showing up to 20% weight loss with a weekly titrated subcutaneous injection. The evolution from hormone discovery into a practical class of medications provides both patients and healthcare providers with new hope and options to address complex challenges associated with diabetes and obesity.

Combined with meal management and exercise, the weight loss is impressive. Studies do show, however, that up to 75% of people who lose weight will regain weight after one year if they do not continue implementing lifestyle behavior changes. Medical management, follow-ups, and nutritional coaching should be incorporated into this class of medications. Purchasing the medication without a prescription and online without medical guidance may decrease the desired outcome of long-lasting weight loss and even dupe people into buying something that is not the proper active medication.  

What are the Side Effects?

GLP-1 agonists work on four main organs, including the brain, to decrease cravings and increase satiety, but dizziness (from low blood sugar) and headaches could be side effects. The next organ it works on is the pancreas, which stimulates the correct insulin response after a meal of carbohydrates. For people without diabetes, this may decrease their blood sugar levels, causing hypoglycemia.

Next, GLP-1 agonists work on the stomach to slow gastric emptying time and decrease blood sugar spike after a carbohydrate meal. However, possible side effects include a lingering sense of fullness, nausea, sulfur-smelling burping, and vomiting. Finally, it works on the intestines to slow digestion and decrease the need for more insulin, which may create sluggishness and constipation, or the opposite of diarrhea and cramping. Gastroparesis and intestinal ileus, or slowing down of the intestines, is a severe concern and potential side effect linked to 33 cases. The side effects are dose-related, and medical providers and nurses must alert the recipient about what to expect.

Muscle loss can also occur if weight loss occurs too rapidly. Eating higher quantities of protein will help preserve muscle mass, as 25% of the lost weight may come from skeletal muscle, which is not desired (Wilding et al., 2021). Taking incorrect dosages can cause an increase in the side effects and has even caused two deaths. Reports of deaths from fake Ozempic use have also been reported when online supplies contained insulin rather than GLP-1.  

The long-term consequences of this class of medications are unknown as there is still only limited data on the non-diabetic population. Studies show that people who lost weight on semaglutide 2.4 mg (the maximum dosage) regained two-thirds of their prior weight loss and lost any cardiometabolic advantages after 12 months, if they did not implement healthy habits, including exercise and careful nutrition (Wilding, 2022). 

What Do Nurses Need to Know?

American obesity levels have reached alarming rates, leading to numerous health complications, including Type 2 diabetes, cardiovascular diseases, and hypertension. GLP-1 agonists have shown promise in aiding weight loss while improving metabolic health.  

Nurses play an invaluable role in patient education and medication administration for this class of drugs. To effectively advise their clients about GLP-1 agonists as weight-loss options, nurses need an in-depth knowledge of their mechanisms, benefits, and side effects. Knowledge about these medications allows nurses to provide evidence-based guidance to obese individuals and facilitate healthier outcomes. Nurses should advocate for integrated approaches to obesity management, such as lifestyle modifications, diet modifications, and pharmaceutical interventions when necessary (Wharton et al., 2020).

Understanding GLP-1 agonists within the context of weight management allows nurses to engage in informed discussions with patients regarding potential risks and benefits and inform individuals on making better-informed choices regarding their health.   

Another concern is that most insurance companies are not paying for this class of drugs for those without diabetes. Medicare Part D covers this class for Type 2 diabetes, bariatric surgery, behavioral counseling by primary care providers, and obesity screenings. Legislation is pending for future approval.

In the meantime, the current average price for a four-week supply of a GLP-1 agonist ranges from $1,100 to $1,300, with an average expected time on the drug being at least 6-12 months. Many consumers who cannot afford that price out-of-pocket resort to purchasing online products that may or may not be the proper drug. In those cases, consumers often don’t receive medical guidance and monitoring while on the medication. Due to the effectiveness of this medication, a nationwide shortage has occurred, and the accompanying compound alternatives are available online. Concern about the legitimacy of compound pharmaceuticals is genuine.   

When to discontinue use of the drug has become an additional concern. People with diabetes should remain on the drug, and there is no recommendation for titration. For people with obesity, the American Obesity Association recommends treating obesity as any other chronic condition, like hypertension or COPD, which also requires no discontinuation of the drug. For those who have lost weight but do not desire to continue to be on the medication, rebound weight gain occurs within 12 months.   

As more is known about the complex causes of obesity, shaming and blaming are not part of positive weight loss strategies. This specialty includes identifying a person’s relationship with their own body and food, genetics, environmental factors, and daily health habits, including careful meal planning and movement. This class of medications gives real hope to people who have tried everything and have been unsuccessful. It is contraindicated in people with thyroid cancer, pancreatic cancer, and intestinal chronic conditions. Ironically and anecdotally, it is helpful for patients with a history of migraines, GERD, and even substance use disorder. This class of medications is one to watch, and nurses must be at the forefront of the news to better inform interested people.   

The Bottom Line

Providing information to patients about the benefits of achieving a healthy weight in language that is not demeaning or blaming is helpful in inspiring patients to know there are a variety of options available for weight loss. The new class of medication known as GLP-1 agonists has promise through its ability to adjust metabolic hormones that naturally curb the appetite and decrease cravings. Remember that all medications have contraindications and possible side effects. Providing up-to-date patient education on weight loss medications can help empower someone to better health. You can make a difference by encouraging your patients to find a provider who compassionately provides medical guidance. 

Read More