Weight loss can be hard. Really hard. So when a new class of drugs called GLP-1 receptor agonists started making headlines a few years ago, people took notice. Celebrities posting about Ozempic may have turned heads, but for many, the real questions are: Do they work? Who should take them? And are they worth the hype — or the price tag?
Zach Peterson, PA-C, is a Primary Care Physician Assistant at Monument Health Hill City Clinic. He’s also a passionate expert in weight management and has extensive experience guiding his patients concerning GLP-1 drugs. Comprehensive clinical trials show these drugs deliver real, measurable results. But Zach explained that GLP-1 medications are not some overnight magic solution to weight loss.
“I caution that kind of thinking,” he said, “because with these medications, they are indicated for long-term weight loss strategies. In other words, when we put a person on either Wegovy or Zepbound for weight loss, the conversation we have to have with the individual is that this medication should be used long-term to manage weight loss. We don’t want them on the roller coaster any longer, losing weight and then gaining it back.”
How Do GLP-1 Drugs Work?
GLP-1, or glucagon-like peptide-1, is a hormone naturally found in everyone’s gut. It helps regulate appetite and digestion. Semaglutide is a synthetic version of this hormone, designed to work longer and help with diabetes or weight management. In pharmacologic doses, these drugs slow gastric emptying and signal the brain that it’s time to stop eating, reducing hunger and helping patients eat less. Initially discovered in the 1980s and studied for type 2 diabetes in the 1990s and 2000s, researchers noticed a consistent side effect: significant weight loss. It wouldn’t be until 2014 that the FDA approved the first GLP-1 drug for weight management.
Today, Body Mass Index (BMI) is the main factor in determining who can use these drugs for weight loss. Patients with a BMI of 30 or higher may qualify, regardless of other health conditions. Those with a BMI between 27 and 30 may need additional comorbidities, like high blood pressure, high cholesterol or diabetes.
The Real Issue
Obesity is more than cosmetics. It’s linked to heart disease, diabetes, chronic kidney disease, sleep apnea, arthritis and even several cancers. Reducing BMI by even a few points can dramatically increase the probability of avoiding these major health concerns.
So how can GLP-1 drugs help someone with obesity? In some recent trials, GLP-1 drugs were compared head-to-head with bariatric surgery. One study found patients who were prescribed these drugs lost an average of 50 pounds over 15 months — a figure previously only seen with weight-loss surgery. “The thing to keep in mind,” Zach pointed out, “every one of these trials also included some fairly intense lifestyle modifications — exercise and diet.”
Patients taking a GLP-1 drug are encouraged to get at least 150 minutes of activity per week and focus on healthy eating. “The first visit that I always have with a patient is where I’m trying to figure out what their baseline is,” Zach said. “If they’re not eating very healthy and they’re not exercising at all, I want to incorporate that first and see if that can be the catalyst to long-term success.”
What to Consider Before Starting
Portrayal in the media has made these drugs seem like a shortcut, but the reality is more complicated. GLP-1 therapy is meant for long-term weight management, not short-term fixes. Abruptly stopping the medication can lead to regained weight, sometimes even more than before. Patients must also learn to adjust behaviors around hunger cues and emotional eating.
The Real Issue
Obesity is more than cosmetics. It’s linked to heart disease, diabetes, chronic kidney disease, sleep apnea, arthritis and even several cancers. Reducing BMI by even a few points can dramatically increase the probability of avoiding these major health concerns.
So how can GLP-1 drugs help someone with obesity? In some recent trials, GLP-1 drugs were compared head-to-head with bariatric surgery. One study found patients who were prescribed these drugs lost an average of 50 pounds over 15 months — a figure previously only seen with weight-loss surgery. “The thing to keep in mind,” Zach pointed out, “every one of these trials also included some fairly intense lifestyle modifications — exercise and diet.”
Patients taking a GLP-1 drug are encouraged to get at least 150 minutes of activity per week and focus on healthy eating. “The first visit that I always have with a patient is where I’m trying to figure out what their baseline is,” Zach said. “If they’re not eating very healthy and they’re not exercising at all, I want to incorporate that first and see if that can be the catalyst to long-term success.”
What to Consider Before Starting
Portrayal in the media has made these drugs seem like a shortcut, but the reality is more complicated. GLP-1 therapy is meant for long-term weight management, not short-term fixes. Abruptly stopping the medication can lead to regained weight, sometimes even more than before. Patients must also learn to adjust behaviors around hunger cues and emotional eating.
Patients with a history of pancreatitis or rare thyroid cancers are generally excluded. The most common side effects are nausea and vomiting, usually related to slowed digestion. Those with chronic constipation or reflux issues may also struggle taking these drugs.
Cost is another consideration. Branded medications can run $500 to $650 per month without insurance. Some compounded alternatives from pharmacies can be cheaper, around $250 to $350 monthly, but quality and regulation are less certain. Insurance coverage varies, and ongoing affordability is a crucial factor in planning long-term therapy.
It’s also worth noting that GLP-1 drugs are injections, typically administered once a week. For those with a needle phobia, the consistent jabbing is something to keep in mind. Oral options exist, like Rybelsus. “It hasn’t been shown to have near the weight loss effects because it has to go through stomach acid and gets broken down,” Zach said. “An effective oral option may come down the road sometime.”
The drugs are not just about losing pounds; they’re about preserving the right kind of weight. Without exercise, patients may lose lean muscle along with fat. “Without exercise, you could be sacrificing a lot of lean mass, which actually burns three times the amount of calories that fat does.”
A Game Changer
For the right patient, GLP-1 drugs can be transformative. Zach has seen individuals who tried everything — even bariatric surgery — make significant progress in their weight by combining these medications with lifestyle changes. Some of his patients have lost more than 60 pounds and maintained that loss. “It can be a game changer,” he said. “But a patient’s mindset matters. These drugs are a tool, not a cure.”
Genetics play a role, too. Some people are simply predisposed to gaining weight. GLP-1 medications don’t change genetics, but they can help manage appetite and improve outcomes when combined with proper diet and exercise.
Ultimately, GLP-1 medications represent a major step forward in the fight against obesity and related conditions. They are not a magic solution, but when used responsibly, they can help patients achieve and maintain meaningful weight loss. As Zach put it, “Generally, these drugs help tremendously … It’s literally the first time in history that it’s been proven that people can lose 50 pounds with anything other than bariatric surgery.” Still, he emphasized, “These drugs aren’t a silver bullet.”
For those interested in GLP-1 therapy, Zach recommends starting by speaking with a primary care provider. “Having a conversation with your provider — dedicating a visit to discuss lifestyle changes and ways to improve health, including GLP-1 medications — is a great first step,” Zach said. “But sometimes providers aren’t fully focused on medically directed weight loss, and that’s where I can come in. There are also other providers throughout the Black Hills, like the Monument Health Bariatric Clinic in Rapid City who can also offer this kind of specialized help.”