Baptist Health Experts Weigh the Impact of Popular Weight-Loss Drugs

Demand is still surging for medications known medically as GLP-1 agonists -- including brands such as Wegovy, Ozempic, Rybelsus and Saxenda -- that are primarily meant for blood sugar control and to help diabetics lose weight. You’ve probably seen them frequently advertised on network commercials.

Sold under a variety of brand names, semaglutide is the drug that is part of the class of medications known as “glucagon-like peptide 1” (GLP-1) – and it is part of therapy already established for the management of type 2 diabetes. GLP-1 therapy is recommended early in the treatment of type 2 diabetes, also resulting in some weight reduction and favorable management of heart disease.

The “off-label” use of semaglutide is raising concerns in the medical community.

“These drugs represent an exciting new class of medications for the treatment of type 2 diabetes,” explains Angel Alejandro, M.D., endocrinologist at Baptist Health. “What they found during the research and the trials is that these patients had substantial weight loss when they took these drugs. And, obviously, that is something for an endocrinologist that's extremely exciting -- to have a drug that targets one of the problems with diabetes, which is obesity. And we know that obesity increases insulin resistance. And we know that losing just 10 percent of your weight has a significant impact on a diabetic’s glycemic control.”

Dr. Alejandro joined Elaina Rosario, Pharm. D, a pharmacist with Baptist Health, and host Kendis Gibson for a recent Resource Live on YouTube to discuss the newest weight-loss drugs.

“These medications are very fascinating because they work in different ways,” explains Ms. Rosario. “In our body we produce a natural hormone called GLP-1. These medications give us a little bit more of this hormone, so it helps with digestion. Slowing the digestion down helps with blood sugar control, as well as appetite suppression.”

The popularity of these drugs for weight loss among non-diabetics is concerning. Everyone considering their use for weight loss should consult with their doctor. Additionally, new research has found that GLP-1 agonists have been associated with a 9-times higher risk of pancreatitis, or inflammation of the pancreas, which can cause severe abdominal distress. GLP-1 agonists were also linked to a 4-times higher risk of bowel obstruction, whereby food is prevented from passing through the small or large intestine, resulting in symptoms like cramping, bloating, nausea and vomiting. 

“When I counsel my patients, the biggest side effect is nausea” said Ms. Rosario. “To minimize that side effect, I always tell patients they have to eat at least every three to five hours. And because this medication is suppressing your appetite, you might forget to eat. So, you have to be very conscious of the fact that you need to eat something. If you go too long without eating, then the nausea will get worse.”

The “off-label” popularity of these weight-loss drugs has led to vital shortages which have resulted in diabetics not having full access to their medications.

“Obviously, supply and demand always play a role …” explains Dr. Alejandro. “We're talking about off-label. But now we have two drugs that are ‘on-label.’ You can use Wegovy, which is semaglutide, which is approved for weight loss if your BMI (body mass index) is greater than 30. And you can use the drug if your BMI is greater than 27 and you have a risk factor. Now, what is happening is that insurance companies may not cover the use of the drug. And patients are returning to the off-label use of Ozempic, which is the same drug. And that's where we ran into trouble. We don't have enough drug to go around, and patients with type 2 diabetes who need the drug may not have been able to get it for a period of time.”

For the full discussion on weight-loss drugs, go to the Resource Live segment on YouTube.