Glucagon Like Peptide-1 Receptor Agonists (GLP-1RA’s) are drugs you don’t prescribe for a patient and then forget about. They are potent chemicals that have adverse effects and can harm a patient just as easily as they help. A few years of the use of GLP-1’s have shown doctors that monitoring a patients weight loss and adverse effects is very important to the success of treatment and satisfaction of the patient. After all, these drugs were first developed to bring diabetes mellitus under control, and significant weight loss was found as an unexpected bonus.
Endocrinologists have weighed in on this whole issue and have developed a list of preventive measures as solutions to the “common pitfalls” of GLP-1’s. There are five easy to perform recommendations that GLP-1 users will find helpful to avoid problems and maintain weight loss. Those five recommendations are:
1. Track Weight: Patients can lose too much weight or not enough.
2. Preserve Muscle Mass: 40% of weight loss is muscle loss.
3. Monitor Vitamins and Minerals: Watch patients for vitamin and mineral deficiencies
4. Manage Side Effects: GI side effects are common. Use effective treatments to counter
5. Prevent Relapse: Develop a strategy to prevent weight gain after GLP-1 is stopped
Weight: If the patient loses too much weight, look for signs and symptoms of other medical conditions which may be coincident. Amenorrhea, decreased libido, and protein deficiency are signs of problems. If no problem is found, reduce the dose of GLP-1. If weight loss is less than 5%, increase the dose, or try another GLP-1.
Muscle Mass: Be certain the patient is taking in adequate dietary protein. Prescribe protein-rich supplements and 150 minutes per week of strenuous exercise. Brisk walking, cycling, and strength training “can limit muscle loss by 95%.”
Vitamins, Minerals (Micronutrients): Obese folks often have deficiencies of Vitamin D, B12, folate, calcium, iron, magnesium, and zinc. These can be supplied by a nutrient-rich diet or oral supplementation.
Side Effects: Nausea, constipation, bloating, and reflux are common. Prescribe frequent, small, low fat, meals. Eat high fiber foods like oatmeal and vegetables, drink a lot of fluids, take a mild osmotic laxative. Stay upright after eating and avoid spicy foods. Avoid caffeinated beverages.
Prevent Relapse: After stopping GLP-1’s there is a tendency to regain a significant amount of weight. Obesity is a chronic condition that should be treated continually and monitored closely. Slow tapering to a minimal dose, or to complete discontinuation, along with lifestyle changes—diet, exercise—should be emphasized. “If weight gain exceeds 5%, further treatment with GLP-1 receptor agonists may be advisable.”
DrG’s Opinion: I agree with all of the above points and recommendations. GLP-1’s definitely work, while you take them, but we don’t yet know how not taking them, and regaining lost weight, will affect patients in the long run. Will re-losing weight be as easy a second time? Will side effects be the same, worse? Will some other unforeseen adverse reaction, or long-term harm, become evident? Or will patients have to take GLP-1’s the rest of their life?
Reference: van den Huevel M. Most GLP-1 Prescriptions Miss the Mark: Are Yours? Medscape 2025 July 28.
