GLP-1 Weight Loss Injections: Who Are They Suitable For?

One of the most talked about recent advancements in obesity treatment are GLP-1 weight loss injections. The media often depicts them as ‘game-changing’ for cosmetic purposes however in clinical practice this is far from the truth. GLP-1 injections are prescription medications in the healthcare industry and are intended for tackling obesity hence used in several weight management programmes.

It has been made clear via several guidelines from regulatory bodies such as NICE and the US Food and Drug Administration that these medications are to be used as an aid alongside several lifestyle changes. This includes diet, physical activity and also following up with the healthcare professional. It is not to be used as a sole means to reduce weight.

Obesity is now considered a chronic, relapsing, multifaceted disease. It has been stigmatised in society quite heavily and was always regarded as a question of the individual’s willpower whilst invalidating their struggles. During normal physiology, our bodily functions are regulated by hormones which aided by the brain’s signalling pathways enable insulin signalling, gastric emptying, regulate sleep and cortisol levels and also appetite.

However, in a person with obesity, these mechanisms do not function adequately. Therefore, GLP-1 medications are useful as they work by targeting the above biological systems which can help reduce hunger and increase satiety. This eventually leads to reduced portion sizes, fewer cravings and mindfulness when eating, allowing the individual to be in a caloric deficit in a sustainable manner.

However, it is important to be wary of side-effects that come with every medication including GLP-1 injections. These are not suitable for every individual and have to be carefully monitored at all times. Therefore, it is not a question of whether these injections are effective but moreso, “Who are they appropriate for and under what circumstances?”

The following article aims to explain the mechanism and actions of GLP-1 injections including who are GLP-1 injections for and how this is assessed by a healthcare professional. It will also delve into the side-effects of GLP-1 injections and who should avoid taking them but also educate on why lifestyle support is still equally as important.

How GLP-1 Injections Work in the Body

Glucagon-like peptide 1 (GLP-1) is a naturally occurring endogenous incretin hormone released from the intestines normally after a meal. It works to regulate blood glucose levels in the body by enhancing glucose-dependent insulin secretion. It also regulates appetite and increases satiety by acting directly on the hypothalamus.

The benefits of using this therapy includes delayed gastric emptying and also the inhibition of glucagon production from pancreatic a-cells when blood sugar levels are high. This allows the individual to feel fuller a lot sooner, remain full for longer and overall eat a lot less. GLP-1 increases the uptake of glucose in the muscles and reduces glucose production in the liver and is also known to exhibit neuroprotective effects.

As evidenced, hunger and satiety are regulated by gut-brain signalling processes, endocrine responses and metabolic adaptations. Therefore, the above mechanism is important because it reframes the stigma of obesity and highlights its importance about being accepted as a biological and a medical condition instead of reducing it to something that requires “more discipline”.

In order to maintain a reduced caloric intake, GLP-1 medications can work to modify and rebrand the body’s signalling pathways. Several users have also reported a reduction in “food noise” – preoccupation with food (excessive and constant thoughts about eating)

There are several types of GLP-1 medications, and each works slightly differently from the other. Semaglutide is the most popular choice and is considered a true GLP-1 receptor agonist. Tirzepatide, however, is considered a dual incretin agonist as it can act on both GIP and GLP-1 receptors.

Both are considered GLP-1 medications as both exhibit similar properties and are used for weight management. Both require weekly injections, dose monitoring and can cause gastrointestinal side-effects.

Types of GLP-1 Medications Used for Weight Loss

There are several types of GLP-1 medications with the popular choice being Semaglutide weight loss UK sold under Wegovy, Ozempic and Rybelsus. Other popular ones include Tirzepatide sold under Mounjaro and also Liraglutide, sold under various brand names. These are all licensed medications therefore these have been carefully assessed by the Medicines and Healthcare products regulatory agency (MHRA) and deemed to be safe and effective for medical use.

However, the above medications are not regulated by the MHRA if sold or used outside of licensing guidelines. This includes using it for aesthetic or cosmetic purposes in order to lose weight when it is not clinically indicated.

Semaglutide and Liraglutide for weight loss:

Both Semaglutide and Liraglutide are part of a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. They work by mimicking the actions of GLP-1 which is a naturally occurring hormone. These work by stimulating the release of insulin after eating which lowers blood sugar levels. It also stops the liver from secreting glucagon and raising blood sugar levels. By delaying gastric emptying, it allows you to feel satiated quicker. GLP-1 medications also keep you feeling fuller for longer by acting on the hypothalamus for appetite regulation.

Tirzepatide for weight loss:

Tirzepatide however, works by mimicking two specific digestive hormones – glucose-dependent insulinotropic polypeptide (GIP) and GLP-1. Therefore, although Tirzepatide exhibits similar properties to both Semaglutide and Liraglutide, it is known to have a greater effect on weight loss by being able to mimic both GLP-1 and GIP hormones.

The table below shows the different doses for the above listed medications:

Who Is an Ideal Candidate for GLP-1 Weight Loss Injections?

To answer who is most suitable for GLP-1 injections, the following groups of people can take GLP-1 agonists as outlined below:

1. Adults over the age of 18 years with Type II Diabetes Mellitus (T2DM)
2. Children over the age of 10 years with Type II Diabetes Mellitus (T2DM)

However, NICE guidelines state that adults over the age of 18 years are only eligible for treatment with GLP-1 agonists if they meet the following criteria:

1. Have used at least three medications previously which have proved to be ineffective for controlling T2DM
2. Unable to take other Diabetes medications due to severe side-effects or other appropriate causes.

BMI guidelines:

GLP-1 agonists should only be prescribed when a patient has an Body Mass index (BMI) of 35kg/m2 or higher alongside other psychological or medical conditions related to obesity.

Patients with T2DM can be prescribed GLP-1 agonists if they have a BMI below 35kg/m2 and the following outlined below:

• Using insulin would cause them to become hypoglycaemic and affect their job
• Weight loss may improve other obesity-related health issues

On the other hand, patients from a minority background such as Black African, African-Carribean, Asian, South Asian and so on are eligible for GLP-agonist even if they have a lower BMI as this group of individuals is highly susceptible to obesity related health issues.

Use of GLP-1 Injections in Non-Diabetic Individuals

GLP-1 weight loss injections are prescribed not only to treat and manage weight in patients with diabetes but also for patients with other medical conditions including obesity. Certain formulations of both semaglutide and tirzepatide have been approved for use in weight management in patients with a high BMI who struggle with other medical conditions and have tried various methods to decrease their weight but failed to achieve this.

There are many patients without diabetes who struggle with obesity and may also suffer from various other medical health conditions which may be exacerbated due to the excessive weight such as hypertension, polycystic ovarian syndrome (PCOS), sleep apnoea, reduced mobility and so on and having excessive weight can make it harder to take an active approach in changing your lifestyle habits for the better.

However, even if the GLP-1 medications are prescribed for non-diabetic patients, these patients should still be monitored closely and carefully in case they develop any adverse side-effects or for any doses that need readjustments.

Who Should Not Use GLP-1 Weight Loss Injections?

Some groups of people are ineligible for GLP-1 agonists due to several risk factors or other medical conditions as outlined below:

• You may need to stop using GLP-1 agonists if you develop diabetic ketoacidosis (DKA) therefore your doctor should be notified and treatment should be stopped.
• If you are suffering with severe digestive issues or any medical conditions related to digestion then certain GLP-1 medications may be unsuitable for you.
• If you are going to have a surgical operation and would need to stop the treatment.
• If you suffer from chronic kidney disease, you may need to have your dose modified to fit in with your management plan and this will need careful monitoring.
• If you suffer from liver disease or any associated liver-disease conditions.
• If you are pregnant or breastfeeding then you may be unable to take this medication as evidence shows potential harm to foetus if taken during pregnancy.
• If you have a personal or a family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 (MEN 2)
• If you have a history of gall-bladder disease
• If you are hypersensitive to the medication
• If you suffer from dehydration

It is recommended to speak to your healthcare adviser and discuss all possibilities before starting treatment with a new medication. Also make yourself familiar with any side effects so you can take appropriate action in the case of an emergency .

Common Side Effects and Potential Risks

Like with all medications, GLP-1 agonists also come with their specific set of side-effects. Therefore, it is advised to make yourself informed about the potential adverse side effects that may occur before commencing treatment using GLP-1 agonists. If you have any doubt about your suitability for this medication, speak to your healthcare provider for more information.

One of the major side-effects of taking GLP-1 medications is developing gastrointestinal symptoms such as vomiting, nausea, diarrhoea and constipation and is common in every 1 in 10 patients. Once symptoms start to show, it may prolong in patients for many days and may lead to severe dehydration therefore careful monitoring and rehydration therapy is key.

If the symptoms do not improve then it is advised to find your nearest emergency department as severe  dehydration may lead to further complications such as kidney damage or kidney failure.

The following table outlines several other side effects which may occur with GLP-1 medications:

GLP-1 agonist medications can also make you susceptible to the following risks outlined below:

Risk of Hypoglycaemia (low blood sugar)

• GLP-1 agonists when taken alongside other diabetes medications such as insulin or sulfonylurea can cause blood glucose levels to drop rapidly leading to hypoglycaemic symptoms in patients
• It is advised to speak to your healthcare provider for a carefully monitored treatment plan which takes into account the diabetes medications and other risks before starting treatment

Risk of exacerbation retinopathy

• Patients who have been diagnosed with diabetic retinopathy should be cautious before using GLP-1 agonists especially if they already use insulin as a combination of both can worsen symptoms of diabetic retinopathy

• Ensure to notify your healthcare provider as soon as possible if you notice any changes to your vision or eye-health whilst on treatment

Risk of Hyperglycaemia (high blood sugar)

• Patients on GLP-1 agonists who are using it alongside insulin need to be cautious because if the insulin dose is reduced too quickly too soon, it can cause symptoms of hyperglycaemia which may lead to Diabetic Ketoacidosis (DKA) proving dangerous.
• Ensure to discuss this with your healthcare provider and also be familiar with sick day rules used by patients with diabetes to manage your symptoms better in case you fall ill.

Risk of increase in suicidal thoughts and tendencies

• Although no evidence has been found directly associating taking GLP-1 leading to an increase in suicidal tendencies, it is still recommended to be aware of GLP-1 medications potentially causing suicidal thoughts and tendencies.
• Be aware of any changes in your mood, behaviour or way of thinking either in yourself or of anyone else who you know is on GLP-1 agonist treatment.

How Effective Are GLP-1 Injections for Weight Loss?

Research shows that Semaglutide can reduce the risk of strokes, heart attacks and cardiovascular disease-related deaths by around 20%. The above is also true for Liraglutide with its usage being associated with lower chances of cardiovascular deaths in patients with diabetes. Furthermore, Tirzepatide is also shown to reduce cardiometabolic risk factors by upto 23.5% compared to only 12.75% with a placebo.

The below table outlines the effects of using the above medications for weight loss:

Role of Diet and Exercise While Using GLP-1 Injections

It is highly recommended to use GLP-1 injections treatment alongside lifestyle changes such as managing your diet and exercising regularly as these seem to have the most benefit overall in reducing weight in a controlled, healthy manner.

• Follow a balanced diet with nutrient dense food
• It is recommended to choose food groups which consist of lean proteins, healthy fats and fruits which can contribute to your daily fibre intake.
• This will help you create healthy habits with food alongside the weight loss medication and also enable the medications to work more effectively
• Avoid highly processed food with high salt content and fats and sugar as these may counteract the benefits of taking the GLP-1 medications
• Exercise and physical activity
• It is recommended to keep your body active with resistance exercises as this can preserve muscle mass especially during weight loss. This is extremely beneficial for long-term health and physical function.
• It is recommended to do at least 150 minutes of moderate-intensity exercises every week and this can include walking, cardio, strength training and so on as it will help most metabolism and overall decrease cortisol levels in the body.

Conclusion: Are GLP-1 Weight Loss Injections Right for You?

GLP-1 agonist weight loss injections can be extremely beneficial for specific patients. These are recommended for adults with health issues related to obesity and Type II Diabetes Mellitus and various other medical conditions such as hypertension, PCOS, sleep apnoea where excessive weight may affect their way of living and quality of life. They are normally prescribed as a medical aid alongside other medications and lifestyle adjustments.

GLP-1 injections are known to be effective and are considered safe for treatment purposes but only when used within their licensing indications. You can browse these on Meds for Less. It is not recommended to purchase these medications without a prescription from a registered healthcare provider. Hence, it is discouraged to use it purely for cosmetic or aesthetic purposes as it can cause harm if used without supervision and close monitoring of symptoms.

The benefits of using GLP-1 medications outside of licensing indications for weight loss has not been studied therefore it is not advised to do so if the treatment is not clinically indicated.

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