Triad physician answers the GLP-1 questions everyone’s asking
With one in eight Americans now taking a GLP-1 to lose weight or treat another chronic condition, conversations are swirling about the cost and benefit of these medications. Edgardo Gil Maldonado, MD, answers 12 of the most common questions he hears from patients at Cone Health Healthy Weight & Wellness at Greensboro — from how these medications work and who may benefit to side effects, costs and common misconceptions.
How do GLP-1s work? And why are they so effective for people who struggle with weight?
“GLP-1s reduce hunger, increase feelings of fullness and help to regulate some of the biological signals that influence body weight. They are particularly effective because obesity is not an issue of willpower and discipline; it is a complex chronic disease influenced by biology, genetics, metabolism and environment. Some people’s energy regulation system is abnormal, leading to very strong hunger signals. GLP-1s mimic natural hormones released by the body in response to eating, but the injected hormones last longer and are more potent.”
What are some misconceptions about these medications?
“GLP-1s are not ‘a shortcut’ to weight loss. Rather, these medications treat biological drivers that affect people with obesity. People who can maintain healthy weight often have protective genes that help with that. For them, exercise and diets work, so they may not be able to relate to people who struggle with obesity. All these differing opinions can become very detrimental and even stigmatize patients affected by this disease.”
Who qualifies for GLP-1s?
“People with a BMI of 30 or above – or those with a BMI of 27 and at least one medical complication associated with obesity – qualify. GLP-1s are medically approved to treat obesity, Type 2 diabetes, sleep apnea and liver disease as well as to reduce risk for cardiovascular events such as stroke or heart attack.”
How much weight can people realistically lose?
“About 90% of people respond positively to GLP-1 medications, losing at least 5% of their body weight. But approximately 10% to 15% of patients may not experience significant weight loss. On average, most people could expect to lose anywhere between 5% and 20% of their body weight, but this depends on the type of medication, dose, duration of treatment and lifestyle factors. I’ve had some patients lose 30% to 40% of their weight, similar to the weight loss seen with gastric surgery, but these patients are the minority. Women also demonstrate greater weight loss than men. Not everyone responds the same because of factors that impact weight such as stress, sleep, quality of diet, other medications, biology, genetics and the environment. People who do the best make lifestyle changes and use the medications as an aid, not a standalone treatment.”
What happens if you stop taking the medications?
“GLP-1s are meant to be used as a long-term treatment for obesity, not just as a diet pill or for cosmetic reasons. If you want to lose 10-15 pounds for a wedding, this shouldn’t be your first choice. Weight regain after stopping these is common and substantial, especially when you come off quickly without tapering off. Nationwide, we find the discontinuation rate is about 20-30 percent, often driven by unwanted side effects or cost concerns.”
Are they safe? What are the most common side effects?
“These drugs have been out for a long time and appear to be safe in the long run. The more common side effects are nausea, vomiting, constipation, diarrhea and acid reflux – and may depend on diet. For instance, if you’re eating fried foods, whole fat dairy, or a lot of sugar, you’re going to get sick. Spicy foods and alcohol will worsen acid reflux. Not enough water and fiber can lead to constipation. Not getting enough protein or strengthening exercise may result in muscle loss. That is why we counsel patients about the importance of maintaining healthy eating patterns and staying active. Other possible long-term considerations include decreases in bone density or gallbladder problems, which can occur from rapid weight loss. Pancreatitis and thyroid cancer have been reported but remain rare. Some patients have had progression in diabetic retinopathy, although this may be related to underlying diabetes rather than the medication itself. It’s always a good idea to discuss your individual risks and benefits with your healthcare provider.”
How do I choose between trying GLP-1s or having weight-loss surgery?
“Treatments often depend on a patient’s BMI, what other weight-related conditions they may have, their treatment goals and preferences, and considerations such as cost or access to care. We consider surgery and medications to be complementary treatments — one is not better than another. Some patients start off with these medications and later have surgery; others choose surgery and then use medications to help maintain their weight loss.”
Microdosing seems to be a trend. Is this safe?
“We don’t have long-term data on this, and the American Board of Obesity Medicine doesn’t condone it. If you’re not adequately dosing or are giving yourself only periodic shots, you’re not reaching therapeutic levels and may not benefit. Microdosing also increases the risk of dosing errors and side effects.”
Does insurance cover GLP-1s?
“It depends on your insurance plan. Many employer-sponsored plans limit or exclude coverage because of cost, while Medicare now covers some anti-obesity medications for qualifying patients. Check with your insurer or health provider about your specific benefits.”
How much do they cost out of pocket?
“It varies. Prices have gone down considerably but remain out of reach for many. We now have oral formulations starting at $149 per month and injectables starting at $199 per month, but many individuals will require a higher dose, bringing the monthly price to around $299 to $449, depending on the medication. Considering that these are long-term treatments, the cost of GLP-1s over time could be significant.”
Do I have to exercise while on these medications?
“Maintaining fitness is vital. I understand that going to a gym can be intimidating, especially for patients with a higher body weight. Many of my patients have appreciated the welcoming atmosphere and support at Cone Health Sagewell Health & Fitness at MedCenter Greensboro. The medical fitness team there has special training, partners with patients to meet their personal goals and even offers scholarships to qualifying patients.”
If someone thinks GLP-1s are right for them, where should they start?
“GLP-1s work best when paired with medical guidance, healthy habits and realistic expectations. A conversation with a primary care provider or a visit to a medically supervised weight-management program is the best place to start.”
