Weight-loss medications that regulate blood sugar levels and reduce appetite have offered new hope for many people struggling with obesity and those with diabetes.
The development of GLP-1 agonist (glucagon-like peptide agonist) medications for weight loss and Type 2 diabetes has been a game changer, said Tulsi Sharma, MD, a UCSF assistant professor of Medicine at the Fresno regional campus, and who is board-certified in Endocrinology, Diabetes, Metabolism and Obesity.
“We are seeing amazing results. I would say 95% of our patients are really happy. They’ve lost weight which they have struggled with for years,” said Dr. Sharma, who sees patients at the Inspire Health Medical Group – Endocrinology office in northeast Fresno.
GLP-1 medications help regulate blood sugar levels and appetite by stimulating the pancreas to release more insulin when blood sugar is high and suppressing glucagon, a hormone that raises blood sugar levels. They also slow down the emptying of food in the stomach, which reduces appetite by promoting a feeling of fullness.
“The beauty of these medications for diabetes is that they cause a drop in blood sugar, but do not crash it too low. It doesn’t cause hypoglycemia,” Dr. Sharma said. The weight-loss medications do not eliminate the need for insulin in all cases, but they are effective for diabetes because weight is directly related to insulin resistance, Dr. Sharma said. “When we gain fat, especially in our abdomen, that increases our insulin resistance.”
Besides diabetes, unhealthy weight can affect cholesterol levels, high blood pressure, and sleep apnea, among other conditions. Weight-loss medications have been studied for their action on the liver, pancreas, brain and fat cells. The GLP-1 agonist helps the liver metabolize glucose more effectively, for example. Some studies have shown protective action on the heart and kidneys, and there are potential protective benefits for coronary artery disease as well.
“Over time, we realized that a BMI (Body Mass Index) of 30 or higher has a very high association with Type 2 diabetes, high blood pressure, and hyperlipidemia (high levels of fats in the blood). And we recognize obesity is not just extra weight; it’s actually that extra fat that is abnormal, and it actually creates inflammatory molecules,” Dr. Sharma said. “That high inflammatory state can cause changes in the blood vessels in the heart and in the liver. When the extra fat deposits, it can cause cirrhosis or fibrosis. So, it is not just fat which is bad; it’s the fat that causes inflammation, which can raise the risk of cancers and all metabolic diseases.”
People may recognize weight-loss medications by brand names – Ozempic, Wegovy, Rybelsus, Victoza, Saxenda, Trulicity, Byetta, Bydureon, Adlyxin, Mounjaro, Zepbound. The medications are not without side effects, however, and with so many options available, finding the right medication and the correct dosage of the medication for patients is important.
The most common side effects are gastrointestinal because the medications slow down stomach emptying, which can cause bloating, nausea, and, in some cases, constipation.
“You have to be cautious with diabetes patients who have gastroparesis (a condition affecting the stomach muscles) because they already have slowed metabolism and slow food digestion, so they can get worse with weight-loss medications. So, we must talk with our patients in detail about all the other co-morbidities to make sure they are good candidates,” Dr. Sharma said.
The medications are not indicated for somebody who has pancreatitis or who is at risk of developing pancreatitis, an inflammation of the pancreas. People who are heavy alcohol users are among those who are at higher risk for pancreatitis. Of interest, though, the GLP-1 agonists have decreased the incidence of alcohol abuse, Dr. Sharma said. “Patients don’t feel like drinking as much anymore when they take the medication.”
Weight-loss medications are not substitutes for a healthy diet and daily exercise.
It’s very important to first make sure the patient is leading a healthy lifestyle, Dr. Sharma said. “In fact, insurance really does want documentation that the patient has done everything possible before they are placed on the medication. So, we talk about cutting back on sugars, sodas, and juices – making sure they are exercising. And very important is making sure they are doing weight-bearing exercises because these medications can cause rapid weight loss; most of it will be fat mass, but part of it can be muscle loss.”
Dr. Sharma encourages patients to begin a weight-bearing exercise regimen before placing them on medication, so they retain and even build muscle mass as they lose weight. It also has the advantage of helping with more weight loss and more fat mass loss as they are building their muscles. Once she has talked to patients about their medical history, their lifestyle, and their struggles in managing a healthy weight, a decision can be reached on whether they are good candidates for weight-loss medications.
Many of her patients have struggled for years to lose weight and to maintain a healthy weight and they feel ashamed and a measure of guilt, but research has shown that obesity is like any other medical condition and is not always in a person’s control to prevent. Genetics plays a big role, and environmental factors can contribute.
“Unfortunately, it’s very easy for patients to lose control of their weight and at some point, it becomes beyond their lifestyle, and it’s a real struggle. And the last thing we should do is blame the patient. But we should try to understand the cause,” Dr. Sharma said.
“We’re exposed to so many things that can make it easier to gain weight,” she said, citing hormone imbalances, thyroid conditions and insulin resistance, to name a few. “When we first see a patient with obesity struggling or rapid weight gain but still not in the obesity range yet, I like to do a complete medical workup. We have to treat them in a multi-disciplinary way.”
Obesity is a growing field of study, and Dr. Sharma is excited by advances in weight-loss medications. Medications with even more promising weight-loss results, as well as medications that would promote muscle gain along with fat loss, may be on the horizon.
“It’s satisfying to see a change in people’s lives who have been struggling with Type 2 diabetes for a while and struggling with their weight,” she said. “These medications have been life-changing.”
Established in 1975, UCSF Fresno is celebrating 50 years of training doctors and improving health in the San Joaquin Valley this year. A regional campus of the UCSF School of Medicine, UCSF Fresno offers training in eight medical residency programs, one dental surgery residency program and 20 Accreditation Council on Graduate Medical Education (ACGME) and non-ACGME sub-specialty fellowships. UCSF Fresno plays a vital role in expanding access to health care in the Valley, training physicians and medical students for the region and state, conducting research that addresses regional health issues, and academically preparing students from the San Joaquin Valley to pursue careers in health and medicine.
