The impact of GLP-1 medications
(a data-driven look at outcomes and expectations, from a weight-neutral lens)
By Sarah Petty, MS, CNS, CPT
Disclaimer: This information is delivered in good faith, with the goal of harm reduction and informed consent for people considering GLP-1 medication use. We will be discussing topics and terminology that you may consider to be offensive or harmful. I have done my best to use neutral language, but as this topic can be distressing, use your best judgement when reading and know that you can take a break at any time. This information is for educational purposes only. Nothing in this blog should be considered a recommendation for or against use of any medication. I am a board-certified nutritionist (CNS) and certified personal trainer with a master’s degree in nutrition and integrative health. I also have over 6 years of experience supporting clients with chronic metabolic health conditions through nutrition and lifestyle changes. However, I am not a doctor, and more importantly, I am not YOUR doctor. You are ultimately in charge of your health and wellbeing, and you are the person who has to live in your body. You can use the information in this presentation to make informed decisions, or simply use it to increase your awareness and understanding of the cultural phenomenon that is weight loss medication. I recommend that you verify the information presented here with your healthcare team before making any changes to your health care plan.You may be wondering, why is a size inclusive coach who doesn’t coach weight loss writing a blog about a weight loss medication? The answer is that many of my clients have asked me for resources and information, for a combination of the following reasons:
they have embraced body liberation principles, but are still experiencing the effects of weight stigma daily and are seeking relief in any way they can
they are committed to avoid dieting and self-harm behaviors, but they do desire to lose weight and want to know all the risks and potential outcomes
they don’t currently have a medical provider they trust to ask these questions
they have type 2 diabetes and it’s not managed well with their current medication, and they are curious if GLP-1s could help
they have another chronic condition with lots of inflammation, and heard that GLP-1s can reduce inflammation
they want to avoid the increasingly fat phobic discourse online about this medication
they want to know how to discuss GLP-1s with friends and family from a weight-neutral perspective
One thing I’m not going to do is gatekeep information, when I can offer a more thorough assessment than a typical Google search. Part of harm reduction is informed consent. So without further ado, let’s sit down for a cup of tea and dive in.
GLP-1 medications are the latest in a long line of medical treatments attempting to cause weight loss. I won’t share that history here, but this resource has a detailed overview. In summary, almost every drug intended for weight loss has been removed from the market due to ineffectiveness or pervasive side effects. The result? Researchers are constantly creating and testing new compounds, seeking the magic bullet drug that is both effective and safe to take long-term. In the meantime, hundreds of thousands of patients have been prescribed various medications, with mixed results.
So what are GLP-1 medications and how do they work?
What makes them better (in theory) than other weight loss drugs?
GLP stands for “glucagon-like peptide,” and GLP-1 is a naturally-occurring hormone and neurotransmitter. Your small intestine produces it every time you eat. Some of its (many) tasks include:
Telling your pancreas to release insulin, to lower glucose (sugar) in your blood
Blocking glucagon (another hormone) secretion, to prevent excess glucose from being created
Slowing stomach emptying, which slows the release of glucose from the food you eat into your bloodstream
Increasing satiety (how full you feel after eating) by signaling your brain
GLP-1 medications are manufactured “agonists” that mimic the function of the naturally-occurring hormone GLP-1 by attaching to GLP-1 receptors in the body, stimulating the same effects. The higher the dose, the stronger the stimulation of these receptors.
A GLP-1 medication was first approved by the FDA for treating type 2 diabetes in 2005, and since then, multiple variations have been created and tested. 2014 was the first time a GLP-1 medication was approved for weight loss.
Outcomes of GLP-1 medications
Personal anecdotes aside, it is so important to be aware of high-level data when considering a medication. What works well with minimal side effects for one person may be another person’s personal hell, and the only way to accurately consider both is to look at information from a large volume of experiences. From that kind of research, we can see these outcomes:
Modest, significant reduction in HgA1C in type 2 diabetics. Most participants saw these effects after 2-4 weeks of consistent use.
12-14% fewer major adverse cardiac events (MACE) outcomes for patients with type 2 diabetes. This is significant, because T2DM increases risk of cardiovascular disease and complications.
Of 1000 people treated with GLP-1s for 2 years, 375 had 10% weight loss, and 318 had 5% weight loss. This means they lost that percentage of their total body weight - 5-10 lbs for every 100 pounds a person weighs.
Only 15% of patients prescribed GLP-1s for weight loss were still taking the medication two years later.
After the drug was discontinued for a full year, participants gained back an average of 2/3 the amount of weight they lost.
Cardiometabolic improvements (like blood pressure and HgA1c) also reverted towards baseline 1 year after discontinuation.
To offer a generic example of typical use, if a 300 lb person took a GLP-1 medication for 2 years, they were 30% likely to not have a significant change in weight, 30% likely to lose 15 lbs, and 30% likely to lose 30lbs. If that person discontinued at the 2 year mark, they were likely to regain most of the weight they lost, leaving them at the end of year 3 around 290 lbs.
So what’s the long-term plan?
If weight loss is only successful as long as the medication is being taken, does that mean people are expected to take GLP-1s forever? There isn’t a definitive answer.
Quotes from medical professionals about the long-term use of GLP-1 medications:
“GLP-1s are unlikely to deliver therapeutic value when so many individuals stop treatment after two years.” - David Lassen, chief clinical officer of Prime Therapeutics
"We don't know, when an ideal BMI is achieved, what the next steps really should be." - Sarah Armstrong, MD, of Duke University School of Medicine
For those who have done well on GLP-1 drugs but want to stop taking them: ”Managing these individuals falls under the category of what I call the art of medicine, because we don't have the data or the studies to guide us with certainty what to do.” - Robert Kushner, MD, of Northwestern University Feinberg School of Medicine in Chicago
Side Effects of GLP-1 Medications
Keep in mind, this is data from large groups of people. Some people experience zero significant side effects and are (so far) planning to stay on this medication forever. However, most people have a different experience:
Mild to moderate gastrointestinal side effects occurred with over 80% of participants. Some experiences include:
nausea (less common with long-acting than short-acting compounds)
vomiting
diarrhea
abdominal pain
constipation
Injection site reactions and allergic reactions (rashes, anaphylaxis) occurred in 5-10% of recipients.
Rare (<10%), potentially serious side effects have been linked to GLP-1s, including:
Gallbladder problems, such as gallstones and inflammation
Pancreatitis (inflammation of the pancreas)
Acute (sudden) kidney damage related to GI losses
Gastroparesis (stomach paralysis)
Ileus (intestinal paralysis)
Bowel obstruction (blockage)
When considering GLP-1s, it’s important to be realistic about your expected outcome.
Additional factors to consider before taking GLP-1 medications:
Accessibility
As public demand for GLP-1 medications has increased, it has caused shortages for patients with type 2 diabetes who have been taking GLP-1 for years to manage their health. Pharmacies have mitigated shortages by compounding their own versions of the drug, which have not been approved by the FDA. There are potential serious outcomes of taking unregulated compounds, and we don’t have enough data to determine all of those risks.
Additionally, out of pocket costs for GLP-1 medications average ~$1000 per month, which is not accessible to the average person. This leads me to ask - what happens to all the people taking GLP-1s who lose their job/insurance, or have a crisis that causes them to not afford the out of pocket cost?
Regardless of cause, there is potential for a lot of time and money to be completely wasted if the medication is suddenly inaccessible, as it is only effective with continuous use.
Nutrient Insufficiency
One of the most common anecdotal experiences from taking GLP-1 medications is the loss of a strong desire to eat throughout the day. This has been described as “food noise,” a symptom that is a common experience in people who have tried to lose weight throughout their life. “Food noise” is a very real, distressing symptom often dismissed by eating disorder dietitians as simply “delayed hunger from restriction.” I will share a complete assessment of this symptom in another blog.
There are a myriad of physiological factors that can create “food noise,” and it may feel liberating at first to have those intense cravings silenced. For people who have experienced any variation of eating disorder, this loss of appetite can also be extremely triggering.
Regardless of the reason someone is taking a GLP-1 medication, there is potential for undereating to the point of nutrient insufficiency. It is my opinion that everyone prescribed a GLP-1 should be referred to a dietitian or qualified nutritionist who is experienced in supporting folks with eating disorders. Meals need to be carefully selected to be as nutrient dense as possible if overall volume is significantly lower than normal, and specific nutrients may need to be supplemented depending on the person’s health status and food intake.
Body Image
One thing’s for sure - even if you consistently take this kind of medication, have tolerable side effects, and lose weight, you may not be happy with the results. As anyone who’s lost a significant amount of weight can tell you, your body image is not guaranteed to improve after weight loss. Many people experience post-weight-loss body dysmorphia and struggle to accept the change their body has gone through. This is an understandable response to any major body change.
Weight loss can get you easier access to public spaces, social acceptance, and even a certain level of social credibility. These things can potentially improve your mental health and help you feel more safe in your body.
What weight loss cannot promise you is body trust, positive body image, and love. If any of these are the primary reason you seek to take a GLP-1, I recommend working with a therapist who is skilled in supporting folks through a body liberation journey. These challenges are an inside job and will not be solved by weight loss.
It is likely GLP-1s will eventually be added to the list of weight loss meds that worked for some but not most.
This leaves many people still stuck in limbo, trying their best to navigate a world that says “you can’t do ____ if you’re fat.”
However, some good news!
Recent research shows that positive body image and body neutrality are both protective against dieting, disordered eating behaviors, and interest in trying GLP-1 meds solely for weight loss.
Positive body image in this study was defined as:
appreciation for the body
attention to the body’s needs
desire to care for the body
recognition and acceptance of physical imperfections
rejection of unrealistic appearance ideals
Body neutrality can be defined as:
a neutral and accepting attitude toward the body
prioritizing function over appearance
acknowledgement that the body is only part of who you are
If you want the items on the list above, you can have them without any medications or change in body size. This does require a bit of internal work, and you don’t have to do it alone. Body image coaching is baked into many of my programs, and I can also recommend therapists, body image coaches, and other resources.
These are blogs I’ve shared on body image:
7 Ways Movement Can Improve Your Body Image
5 Ways to Say No to Negative Body Comments
My next blog will be all about body liberation, and will include a list of resources and practical tasks you can do to improve your body image!
Where do we go from here?
If you are currently on or seek to begin a GLP-1 medication, thoroughly review all risks and side effects with your doctor and consider all the possible long-term outcomes. If you do not want to take a GLP-1 medication but are struggling with body image, consider therapy, support groups, self journaling, workshops, and reading materials specifically focused on body neutrality/positivity from an anti-fat-bias lens.
Questions to Consider Before Taking GLP-1 Medications:
Would you take a GLP-1 medication if you knew your body size would not change?
What side effects are you NOT willing to tolerate?
What is your plan if access to medication is interrupted?
What will you do if you regain weight after discontinuation?
Resources:
The Body is Not An Apology by Sonya Renee Taylor
Citations:Parab, P. et al. (2023). Role of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists in Cardiovascular Risk Management in Patients With Type 2 Diabetes Mellitus: A Systematic Review. Cureus. https://pmc.ncbi.nlm.nih.gov/articles/PMC10584355/#:~:text=GLP%2D1%20receptor%20agonists%20appeared,disease%20when%20compared%20to%20placebo.Gsusn, W., and Hurtado, M. (2024). Glucagon-like Receptor-1 agonists for obesity: Weight loss outcomes, tolerability, side effects, and risks. Obesity Pillars. https://www.sciencedirect.com/science/article/pii/S2667368124000299#:~:text=The majority of side effects,in the placebo group only.Bray, George A. & Purnell, Jonathan Q., 2022. An Historical Review of Steps and Missteps in the Discovery of Anti-Obesity Drugs. Endotext. https:/ /www.ncbi.nlm.nih.gov/books/NBK581942/Wilding et al., 2022. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity, and Metabolism. https:/ /pubmed.ncbi.nlm.nih.gov/35441470/Sun et al., 2015. Impact of GLP-1 receptor agonists on blood pressure, heart rate and hypertension among patients with type 2 diabetes: A systematic review and network meta-analysis. Diabetes Research and Clinical Practice. https:/ /pubmed.ncbi.nlm.nih.gov/26358202/Henderson, J. September 26, 2024 The Data Are Clear: Patients Regain Weight After Stopping GLP-1 Drugs The Data Are Clear: Patients Regain Weight After Stopping GLP-1 Drugs. https://www.medpagetoday.com/special-reports/exclusives/112138Long, Pelletier, Koyfman, and Bridwell, 2024. GLP-1 agonists: A review for emoergency clinicians. American Journal of Emergency Medicine. https:/ /pubmed.ncbi.nlm.nih.gov/38241775/PR Newswire, 2024. Prime continues to lead industry on GLP-1 research: 1 in 7 stays on GLP-1 drugs for weight loss after two years. https://www.prnewswire.com/news-releases/prime-continues-to-lead-industry-on-glp-1- research-1-in-7-stays-on-glp-1-drugs-for-weight-loss-after-two-years-302192762.htmlMarkey, August, Malik, and Richeson, 2025. Body image and interest in GLP-1 weight loss medications. Body Image.https://www.sciencedirect.com/science/article/pii/S1740144525000415Bollmeier, 2023. Prescription Advertising in the Digital Age: Patient Safety Requires Better Regulation. https://pmc.ncbi.nlm.nih.gov/articles/PMC10441261/