Weight Loss Medication Education

How GLP-1a Medications Work

GLP-1a medications support weight loss and metabolic health in four key ways:

1. Slowing stomach emptying: They help you feel full for longer after eating.

2. Signaling satiety to the brain: By activating feedback mechanisms, they reduce hunger signals, preventing ‘hangry’ feelings.

3. Suppressing glucagon secretion: This lowers glucose levels by reducing the release of glucose from the liver.

4. Stimulating insulin secretion: They enhance insulin release from the pancreas in a more physiological manner, responding appropriately to high blood glucose levels.

GLP-1a medications address regulatory failures in the body that occur with Type 2 Diabetes, helping restore more normal metabolic function.

Practical Advice for Using GLP-1a Medications

While these medications reduce your appetite and may even make you forget to eat, it’s essential to maintain a healthy eating pattern. You may be tempted to delay meals or skip eating altogether, but this is not advisable.

To optimize results and prevent complications, follow these key tips:

• Eat regularly: Aim for three smaller, balanced meals a day, supplemented with healthy snacks as needed.

• Stay hydrated: Drink plenty of water, and use the color of your urine (aim for a straw-yellow shade) as a guide. Dehydration can lead to headaches, kidney stones, or more severe issues.

• Avoid drastic diet changes: Do not start high-protein or low-carbohydrate diets. Stick to your usual diet initially, simply eating smaller portions. You will lose weight by consuming less of what you normally eat.

Long-Term Strategy

As you begin to lose weight, we’ll gradually introduce a healthier, calorie-controlled diet to maintain progress, as weight loss typically plateaus over time. All studies on GLP-1a medications have shown that combining medication with a balanced diet and regular exercise produces the best results.

While exercise will eventually become an important part of your routine, we’ll wait until it’s safer to begin. Starting intense physical activity too early, especially with a raised BMI, increases the risk of injury or joint problems. Everything will be introduced in stages to ensure long-term success.

The Importance of Time

This is not a quick fix. Sustainable weight loss is about gradual, controlled changes over one to two years. Rapid weight loss can pose health risks and often leads to long-term failure, as it doesn’t allow time to develop healthy habits and strategies for maintenance.

This is a journey, not a race. The goal is not just to lose weight but to develop sustainable, healthy behaviors that support your well-being for the rest of your life.

Types of GLP-1a Medications

1. Saxenda (Liraglutide):

Saxenda was the first GLP-1a medication approved for weight loss and is administered as a once-daily injection. I began prescribing Saxenda a couple of years ago, and most patients reached the “treatment dose” by week 5, at which point weight loss typically began.

Some patients who transitioned from Saxenda to Wegovy noticed slower initial weight loss with Wegovy. This is because the full treatment dose of Wegovy (2.4 mg) is not reached until month 5, compared to Saxenda’s more rapid titration schedule.

Unfortunately, due to heightened media attention and soaring demand in 2023, Saxenda has been subject to a Medicines Shortage Notification and is currently unavailable for weight treatment.

2. Ozempic (Semaglutide):

Ozempic is perhaps the most well-known GLP-1a medication. It contains semaglutide and is licensed in the United States for both type 2 diabetes and weight loss. However, in the UK, Ozempic is only licensed for managing type 2 diabetes and is not available in the higher doses required for effective weight loss (2.4 mg).

In the UK, Ozempic is available in pens delivering 0.25 mg, 0.5 mg, and 1.0 mg doses, making it unsuitable for weight loss treatment. I found it deeply concerning that some practitioners prescribed Ozempic for weight loss despite its inappropriate dosing, leading to patient dissatisfaction and ineffective results.

3. Wegovy (Semaglutide):

Wegovy is the trade name for semaglutide specifically licensed for treating obesity and raised BMI. While initially planned for release in May 2023, worldwide demand delayed its availability. It finally became accessible in late 2023 or early 2024, but supply issues remain inconsistent, though improving.

Wegovy requires a slow titration over five months, starting at 0.25 mg and gradually increasing to the full dose of 2.4 mg. Significant weight loss typically begins at month 4 (1.7 mg dose) or month 5 (2.4 mg dose).

4. Mounjaro (Tirzepatide):

Mounjaro is a newer medication and represents a slightly different approach. It is a dual receptor agonist, targeting both GLP-1 and GIP receptors. This dual mechanism promotes greater satiety and potentially enhances weight loss outcomes.

Mounjaro became available in Jersey in September 2024(it was available far earlier but there had been a legal issue around the licensing from the MHRA which hadn't actually covered Jersey!), and its supply has been more consistent compared to other GLP-1a medications. Patients can reach the treatment dose (5 mg) within one month, making it more time-efficient than Wegovy. Additionally, Mounjaro is currently more affordable.

My current clinical practice

• First-Line Treatment: I typically start patients on Mounjaro. Most patients remain on the 5 mg dose if it is well-tolerated. If they do not achieve a specific percentage of weight loss after four months, I increase the dose to 10 mg.

• Dose Optimisation: I avoid routinely increasing doses of Mounjaro unnecessarily, following the ALARA principle (As Low As Reasonably Achievable) to minimise medication exposure while achieving effective results. The dose escalation is often done by clinics that make money from sales of the medication, which I do not.

• Alternative Options: If Mounjaro is not well-tolerated, I switch patients to Wegovy. Due to its gradual dose escalation, weight loss with Wegovy tends to begin later in the treatment course, typically around months 4 to 5.

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Exercising

Exercise is an important part of the journey, but it should be enjoyable and introduced gradually. Here’s some advice:

• Start slow and steady: Seek guidance from Vic Kelly, our personal trainer. Setting realistic goals will help you avoid injury or feeling discouraged.

• Avoid overambitious plans: Don’t jump straight into signing up for a marathon! Instead, consider achievable programs like Couch to 5K.

• Get proper footwear: If you choose running or jogging, visit Graeme Le Maistre Sports for a proper gait analysis and technical running shoe fitting. Avoid selecting shoes based on appearance—choose what fits your needs.

• Explore low-impact activities: Swimming is an excellent option for non-weight-bearing exercise, as is cycling, which minimizes impact on joints.

• Join a class (or don’t!): It’s entirely up to you. If you’re not ready to join a class, start on your own. You can always join later when your confidence grows.

• Consider walking: Walking is great for both your body and mind. Could you walk to work instead of driving?

Whatever activity you choose, it should feel enjoyable—not like torture for your body or mind.

The Direction of Your Management

My role is to support you throughout your weight control journey. The goal is not drastic or rapid weight loss—it’s about achieving sustainable, long-term changes. This process shouldn’t feel like torture!

I will connect you with a team of experts who can guide you toward lasting lifestyle improvements. 

I said this earlier but I constantly remind patients that whilst on medication, it’s important to:

• Stay hydrated: Drink plenty of water throughout the day.

• Eat 3 square meals a day

• Avoid eating too much: please dont be polite and try and finish a plate of food. If you feel full then leave it. Otherwise its likely you will vomit the whole meal back shortly afterwards!

• Eat small, healthy snacks: You may feel like eating less, but it’s essential to maintain balanced nutrition. Snacks such as cashew nuts or fruit can help.

• Avoid extreme diets: If you have a raised BMI, there is a higher likelihood of non-alcoholic fatty liver disease (NAFLD). Sudden weight loss or cutting carbohydrates completely can cause complications like liver inflammation or gallstones.

Please resist the urge to “augment” the treatment by drastically reducing carbs or focusing only on protein. Instead, focus on smaller portions of the foods you already eat. If you’re unsure, our dietitian is here to help.

In our clinic, we emphasize slow, incremental lifestyle changes—nothing extreme or unsustainable.