Since more of you are taking the GLP-1 medications (Mounjaro/Zepbound or Ozempic/Wegovy) I will try to keep you informed of any and all information that comes up because what you don’t realize is that we really DO NOT know the potential side effect of these medications in non-diabetic , overweight or obese patients. Again, as I pointed out in a previous post, these medications were first developed for diabetics. When you are diagnosed as being a diabetic you have essentially lost up to 80% of your insulin producing capabilities and without a medication or insulin your risk of death is exponentially higher than a healthy patient without diabetes, Recent studies and data show that the relative risk (often measured as a hazard ratio or a rate ratio for all-cause mortality) typically ranges between 1.3-1.8, depending on factors like age of diagnosis, sex, control of risk factors,(e.g., blood sugar, blood pressure, smoking) and other comorbidities (diseases). This means that diabetic individuals are roughly 30-80% more likely to die in a given period compared to non-diabetic people, after adjusting for age and the other variables. This risk is much higher when diabetes is diagnosed at a younger age. Diagnosis of diabetes in your 30s -40’s can lead to a risk as high as 2-3 times increased compared to non-diabetics of the same age. Every decade of earlier diagnosis is linked to roughly 3-4 years of reduced life expectancy. So if a diabetic is not treated, then their risk of death and complications are, needless to say, extremely high so the potential risks of a medication such as the GLP-1 agonists are outweighed by the benefits of not only lowering their sugar but, also, promoting weight loss.
We especially do not know the side effect potential in normal weight individuals who are taking them for vanity sake alone. I have a patient who is 5’6″ who weighed 127 pounds and when she came in for her physical I saw that she was now on a “peptide” that she had got from her salon, of all places. These places, and when I say these places they are typically not a place where there would be a doctor. (Hair salons, nail shops, gyms and back alleys). They do not like pointing out that the peptides are the GLP-1 agonists-“semiglutide or tirzepetide” . I guess it feels better because these individuals are a bit embarrassed. (Like the patients who were younger than 65 when the Covid 19 vaccines were first available to only those individuals who were greater than 65, or essential workers and they said they were essential because they were in farming and I guess being on the families payroll for doing nothing other than having a last name counted as being and farmer and therefore and essential worker. (Yes this happened with a few of my patients and in hind sight I know they now regret it. Again, I digress.)
The following information was based on an article in the January 29, 2026 Wall Street Journal (WSJ) by Sumatha Reddy in the Health Section.
She comments on an add featuring the tennis phenom, Serena Williams saying, “If you are carrying an extra 15-20 pounds, medications like Wegovy can help jump start your progress.” For doctors and researchers this message is problematic because these medications are not made to get you to a weight then be discontinued. This analogy is like the good old days when you had a manual transmission car (a stick shift for the younger lads out there who have no idea what I am talking about) and if the battery was dead you could pop the clutch after your friends pushed you to a certain speed and then it would fire up and you would be on your way). There is no “popping the clutch” or “jump starting” with this class of medication. These medications are designed as life long treatments. Obesity care is no different that treating someone for high cholesterol or diabetes. When you stop taking your statin your cholesterol will go up. When you stop taking your insulin your sugars will go up. When you stop taking you GLP-1 your weight will go up.
Nearly 18% of U.S.adults have taken a GLP-1 drug for weight loss or to treat a chronic condition and, about half of the people will stop taking it within a year. Nearly one in five individuals that you know or who are around your inner circles of friends and family. Often they do not understand what is likely to happen next. Studies show that after stopping the drugs, people will typically regain the weight they lost in ~1.5 years. And ANY improvements in blood sugar, blood pressure or cholesterol are reversed as well. People who take GLP-1s regain weight 4 times faster than those who lose weight through lifestyle interventions alone based on a British Medical Journal which examined 37 studies that included people taking weight loss medications. On average, people taking the GLP-1 lost 32 pounds on the medication but gained back 21 pounds in the first year after stopping them.
While taking the weight loss medications, the patient’s health markers such as blood pressure, cholesterol and blood sugar levels improved. When the patients stopped the medication, the levels returned to baseline within 1.4 years and is “virtually parallel with the weight gain”. So it is not the medication that is promoting the health benefits, it is the weight loss that the medication causes which is the beneficial part. So that is why I am always pressuring you to work on weight loss because the benefits are just as good as what these medications promote: 30% decrease risk of cardiovascular disease, 20-30% decrease risk of arthritis of the hips and knees. Decreased risk or reversal of sleep apnea, decreased cancer risk and the list goes on.
Part of this rapid regain of weight is because, in general, when you lose weight, your metabolism slows and you burn fewer calories. But another, less known impact is that your appetite goes up once you stop them. These drugs interfere with the feed back control system while you are on them, but once you are off the drugs and lost so much weight, your appetite is much higher than it was to begin with so you will be overeating calories. When you stop taking a GLP-1, the hunger and food noise symptoms that people refer to come back with a vengeance. The concept of metabolic adaptation explains the bodies desire to regain weight after stopping a GLP-1 medication. This is our bodies survival mechanism, which has evolved over many thousands of years to slow our metabolism down and conserve energy during times of famine or stress and to replenish your depleted stores when food is available. Another less studied phenomenon is when people stop taking a GLP-1 and then decide that they want to go back on the medication it isn’t always as successful the second time around.
In addition to your appetite roaring back, there is also the psychological impact of gaining weight back which can lead to individuals feeling defeated and depressed and less likely to exercise.
So the take home of this information is to realize that once you start this medication you really need to plan on staying on it for the rest of your life and if you are okay with that, then that is fine. When you have truly exhausted all other measures to lose weight (and please be honest with yourself when you say you truly have exhausted yourself), then this class of medication may be a good choice for you, in spite of the potential side effects, but don’t let any (salon, nail shop, gym or back alley person tell you otherwise). Micro-dosing just means that you can be on a smaller dose the rest of your life, not that you will be able to come off when you micro-dose. To quote our previous president “Come On Man!” “Beware of those who promise a quick and easy way, for much ease brings many difficulties”–Jonthan Star. Stay healthy my friends.
Doug
