In recent years, the conversation around glucagon-like peptide-1 (GLP-1) receptor agonists has sparked both excitement and caution. Originally developed to treat type 2 diabetes, these medications are now widely discussed as potential tools for weight loss, particularly for individuals facing obesity-related health challenges. However, while GLP-1 receptor agonists can provide valuable support, they are not universal solutions. At TejoMed, based in Lisbon, Portugal, we believe in a patient-centered approach that considers each individual’s unique health profile, needs, and goals.

This article will explore how GLP-1 receptor agonists work, the potential benefits and risks associated with their use, and why sustainable lifestyle changes remain the cornerstone of long-term health.

Understanding GLP-1 Receptor Agonists: How They Work

GLP-1 receptor agonists mimic a naturally occurring hormone that regulates blood sugar levels and appetite by slowing stomach emptying and reducing hunger signals in the brain. While originally approved to manage type 2 diabetes, their ability to promote weight loss has gained significant attention.

Family Medicine doctors and general practitioners (GPs) can play a crucial role in prescribing and monitoring GLP-1 receptor agonists, ensuring patients understand how they work and their potential impact on overall health.

It is important to note that these medications are not specifically weight-loss drugs. Their use for this purpose is off-label unless prescribed in formulations specifically approved for weight management. For example, semaglutide, considered the most potent GLP-1 receptor agonist, is marketed under the brand name Ozempic® for diabetes type 2, and under the brand name Wegovy® – at higher dosages – for weight loss. Unfortunately, Wegovy® is not commercialized in Portugal at the moment – the closest available alternative is liraglutide, which is approved for weight loss under the brand Saxenda®.

Common Brand Names of GLP-1 Receptor Agonists:

• Semaglutide: Ozempic®, Wegovy®

• Liraglutide: Victoza®, Saxenda®

• Dulaglutide: Trulicity®

• Exenatide: Byetta®, Bydureon®

The Potential Benefits of GLP-1 Receptor Agonists

Under the right circumstances and with medical guidance, GLP-1 receptor agonists may offer several key benefits:

Weight Loss Support: Clinical trials show that patients using GLP-1 receptor agonists like semaglutide can lose an average of 10-15% of their body weight, depending on the dosage. This can be transformative for those who struggle to lose weight through diet and exercise alone.

Blood Sugar Regulation: These medications improve insulin sensitivity and reduce glucose production in the liver, making them particularly effective for patients with type 2 diabetes or insulin resistance.

Cardiovascular Benefits: In Portugal, where cardiovascular diseases remain a leading cause of mortality, medications like GLP-1 receptor agonists may play an important role in reducing the risk of major cardiovascular events in patients with type 2 diabetes.

The Risks and Challenges of GLP-1 Receptor Agonists

Despite their potential, GLP-1 receptor agonists are not without risks and challenges. Understanding these is essential for making an informed decision:

Lean Mass Loss:

• Rapid weight loss from any intervention, including GLP-1 receptor agonists, can lead to the loss of lean mass, which includes muscles, bones, and connective tissues. This can result in loss of physical strength and bone density, among other unhealthy consequences.

• Losing lean mass slows metabolism, making it harder to maintain weight loss long-term.

Gastrointestinal Issues:

• Nausea, vomiting, diarrhea, and constipation are common side effects, especially during the initial weeks of use. While these side effects often subside, they can discourage adherence to the treatment.

• Rapid weight loss may increase the risk of gallstones or gallbladder disease.

• Though rare, inflammation of the pancreas (pancreatitis) is a serious potential side effect of GLP-1 medications.

Weight Regain:

• Without implementing sustainable lifestyle changes, most patients regain at least some weight after stopping GLP-1 receptor agonists, underscoring the importance of addressing the root causes of weight gain.

Thyroid Cancer:

• Animal studies have linked GLP-1 receptor agonists to an increased risk of thyroid tumors. While this risk has not been confirmed in humans, it remains a concern for individuals with a personal or family history of thyroid disease.

Cost and Accessibility:

• The high cost of GLP-1 receptor agonists can make them inaccessible to some patients, particularly those without comprehensive insurance coverage. In Portugal and within the public system in particular, these medications are only co-paid for by the state in cases of a formal type 2 diabetes diagnosis and a body mass index above 35 kg/m2.

• Largely due to wrongful prescription, there is currently a worldwide shortage of these drugs, making it very hard to maintain consistent access to them.

GLP-1 receptor agonists are not recommended for individuals who:

• Have a family or personal history of medullary thyroid cancer.

• Have been diagnosed with multiple endocrine neoplasia or have a family history of the condition.

• Have a history of pancreatitis or severe gastrointestinal disorders.

• Are currently pregnant, breastfeeding, or planning to conceive in the near future.

Lifestyle Changes: The Foundation of Long-Term Health

At TejoMed, we view medications like GLP-1 receptor agonists as tools – not solutions. Sustainable health is built on a foundation of lifestyle changes that address the root causes of weight gain, such as poor nutrition, lack of exercise, chronic stress, and inadequate sleep.

The Benefits of a Lifestyle-First Approach:

• Sustainable Results: Unlike medications, healthy habits provide long-lasting benefits.

• Comprehensive Health Improvements: Better nutrition, regular exercise, and stress reduction improve energy, mental health, and overall quality of life – not just your body composition.

• Empowerment: Developing healthy habits fosters confidence and control over one’s health and life journey.

How TejoMed Can Support Your Health Journey

Our stance at TejoMed remains clear: lifestyle changes – including a balanced diet, regular exercise, and stress management – are central to long-term health. Treatments like GLP-1 receptor agonists can be a useful adjunct when integrated thoughtfully and under professional supervision.

Our Personalized Approach Includes:

• Body Composition Monitoring: Our office in Lisbon is complete with an advanced InBody body composition analyzer, ensuring our patients receive world-class monitoring of fat, muscle, and overall body composition.

• Customized Nutrition Plan: Designed to help you lose fat while preserving lean muscle mass.

• Exercise Counselling: Tailored to your fitness level and lifestyle, with a focus on maintaining muscle and bone health.

• Behavioral and Emotional Support: Addressing psychological aspects of weight management, such as emotional eating and motivation challenges.

• Long-Term Guidance: Our membership-based model ensures continuous care, adapting your plan as your needs evolve.

Should You Consider GLP-1 Receptor Agonists?

The decision to use GLP-1 receptor agonists for weight loss should always be made in collaboration with a trusted medical professional. This requires a thorough evaluation of your unique health profile, medical history, personal goals, and a careful consideration of the potential benefits and risks to ensure the safest and most effective course of action.

Final Thoughts on GLP-1 Receptor Agonists and Sustainable Health

While GLP-1 receptor agonists can be helpful tools for managing blood sugar and supporting weight loss, they are not standalone solutions. Risks such as lean mass loss, gastrointestinal side effects, and potential weight regain highlight the importance of close medical supervision and a holistic approach to health.

At TejoMed, we are committed to empowering our patients through personalized care, sustainable lifestyle changes, and advanced medical support. If you are curious about whether GLP-1 receptor agonists – or any other weight management strategy – are right for you, our expert concierge doctors in Lisbon, Portugal, are here to guide you.

TejoMed: Humanizing Primary Care for Life.

For more information about our membership-based medicine, family medicine, and functional medicine services, contact us today. Your health is our priority.

Book a Call with Tejomed Advisor: Book Now

References

• U.S. Food and Drug Administration (FDA). "FDA Approves New Drug Treatment for Chronic Weight Management." Link

• European Medicines Agency (EMA). "Wegovy Approved for Weight Management in Adults with Obesity or Overweight." Link

• Wilding J.P., et al. "Once-Weekly Semaglutide in Adults with Overweight or Obesity." The New England Journal of Medicine, 2021. [DOI: 10.1056/NEJMoa2032183]

• Marso S.P., et al. "Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes." The New England Journal of Medicine, 2016. [DOI: 10.1056/NEJMoa1607141]Kushner R.F., et al. "Semaglutide for Weight Loss in Patients with Obesity: Tolerability and Adverse Effects." Diabetes Care, 2021. [DOI: 10.2337/dc21-0727]Novo Nordisk. "Ozempic Prescribing Information." Link

• FDA Review Documents on Semaglutide. Link

• American Diabetes Association (ADA). "GLP-1 Receptor Agonists and Risk of Gallbladder Disease." Diabetes Care, 2020.Egan A.G., et al. "Pancreatic Safety of GLP-1–Based Therapies." The New England Journal of Medicine, 2014. [DOI: 10.1056/NEJMra1307552]GoodRx. "Current Costs of Ozempic and Wegovy." Link

• Pharmacies and Insurance Data for Europe. Link

• Jensen M.D., et al. "Role of Lean Body Mass in Metabolic Rate and Long-Term Weight Management." The Journal of Clinical Endocrinology & Metabolism, 2012. [DOI: 10.1210/jc.2012-2233]

• Sumithran P., et al. "Long-Term Weight Maintenance and the Role of Hormonal Changes After Weight Loss." The New England Journal of Medicine, 2011. [DOI: 10.1056/NEJMoa1105816]

• Wing R.R., Phelan S. "Behavioral Approaches to Weight Loss Maintenance." The American Journal of Clinical Nutrition, 2005. [DOI: 10.1093/ajcn/82.1.222S]

• M. Regina Castro, M.D. “Diabetes Drugs and Weight Loss” Mayo Clinic, 2024