GLP-1 medications have undoubtedly revolutionized the field of medical weight management in a remarkably short period of time. From shortages leading to difficult decisions on who should receive treatment to now grappling with the challenges of excessive weight loss, the landscape of weight management has evolved significantly.
In my previous article for STAT in 2023, I highlighted the struggles caused by GLP-1 shortages, which resulted in treatment delays and interruptions. The ethical dilemma of prescribing GLP-1s approved for type 2 diabetes to individuals without diabetes for weight loss was a major concern. Fast forward to today, and my clinical dilemma has shifted towards managing individuals who are aiming for unhealthy and unsustainable body weights.
In my practice, I have observed that individuals on GLP-1 therapies typically fall into different categories. The majority experience a weight loss of 10% to 20% over six to 12 months and are able to maintain most of that weight loss while on treatment. However, there are also individuals who do not respond to or tolerate GLP-1 medications, as well as super responders who achieve significant weight loss, sometimes exceeding 25%.
One of the challenges I face is helping patients navigate the plateau in weight loss that occurs at the maximum tolerated dose of GLP-1 treatment. Many individuals become fixated on reaching a specific number on the scale and struggle to see the improvements they have made in their overall health. It can be difficult to guide patients who are dissatisfied with their current weight after reaching a plateau.
Furthermore, I encounter difficulties in addressing situations where I believe a patient has lost too much weight and may need to decrease or discontinue their GLP-1 treatment. Recognizing signs of eating disorders or disordered eating behaviors is crucial in these cases. While GLP-1 therapies can be beneficial for managing cravings and promoting weight loss, excessive weight loss can have serious implications for both physical and mental health.
As an endocrinologist, I emphasize the importance of considering various factors beyond just weight and BMI when assessing a patient’s health. Objective measurements such as cholesterol levels, blood pressure, and blood sugar levels, as well as lifestyle factors like diet and physical activity, play a significant role in determining overall health.
In conclusion, while GLP-1 medications offer a valuable tool for weight management, they are not a one-size-fits-all solution. It is essential to carefully monitor patients for signs of excessive weight loss and eating disorders throughout treatment. By taking a comprehensive approach to weight management and prioritizing overall health and well-being, we can ensure that individuals achieve sustainable and healthy outcomes.
(Jody Dushay, M.D., is an assistant professor of medicine at Harvard Medical School and an attending endocrinologist at Beth Israel Deaconess Medical Center.)
