Sunshine, Lollipops, Rainbows, and GLP-1 Meds

Recent advances in medicines for treating obesity are stirring up quite a conversation. The enthusiasm for them is hard to miss. Subway ads, tabloid headlines, and celebrities are putting these meds front and center. From all this enthusiasm for the new GLP-1 medicines, the impression might be something like sunshine, lollipops, and rainbows.

No doubt, they represent a big stride forward for medical obesity care. But it would be a mistake to forget that these are serious medicines. They can offer serious help for improving a person’s health. Nonetheless, they require careful monitoring by healthcare professionals to guard against the possibility for complications.

The Need for Monitoring

Drugs in the class of GLP-1 receptor agonists have been in use now for almost two decades. So the safety profile is well understood. The most common side effects are gastrointestinal – principally nausea and vomiting. For people to tolerate these drugs well, they must start with a low dose and slowly increase to a full therapeutic dose. Even so, close to half of all persons who take semaglutide for obesity will experience some nausea. About seven percent of patients in clinical trials could not tolerate semaglutide for obesity and had to stop taking it – most often because of nausea or vomiting.

But other, less common, potential problems require vigilance. These include pancreatitis, gallbladder disease, and certain kinds of thyroid tumors. Patients who are taking these drugs may need monitoring for the possibility of retinopathy and other complications of the metabolic diseases that come along with obesity.

Pregnancy

Once again offering excellent reporting on these new drugs for obesity, Julia Belluz recently took on the complex subject of GLP-1 use in persons who may become pregnant. The simple fact, based on limited data, is that semaglutide might cause fetal harm. This has been observed in animal studies, but not yet in humans.

So the labeling for semaglutide in obesity recommends that someone who becomes pregnant while taking it should stop the drug right away. In diabetes, the labeling says to keep taking it only if the benefits outweigh the risks. The bottom line, says Belluz, is that we simply don’t have enough information:

“It may take years to understand the real impact of GLP-1 receptor agonists on pregnancy. At the FDA’s request, Novo Nordisk has organized a study to analyze complications related to Wegovy in pregnancies that already happened, and a registry that will prospectively follow the health outcomes of a group of people exposed to Wegovy during pregnancy compared to pregnant people who weren’t. The first will be completed in 2027, and the second in 2033. (No such studies are required for Ozempic.) Meanwhile, millions of people will take the drugs, including during pregnancy.”

Sunshine, Rainbows, and GLP-1 Medicines?

The enthusiasm for these medicines is totally understandable. They offer a significant advance for people who have long needed better options for medical help with obesity. That’s great. But they come at a cost – both in terms of money and a risk of side effects.

So let’s stay grounded in reality. The arrival of these GLP-1 medicines for obesity is not a miracle or a panacea. It’s merely a very important advance for which we can all be grateful.

Click here for reporting from Belluz on semaglutide in pregnancy, here and here for more on the safety of these medicines.

Lollipops, photograph by NIAID, licensed under CC BY 2.0

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

April 30, 2023