Semaglutide and Tirzepatide have totally revolutionized weight loss and I don’t think anyone is sad about it. They are amazing tools for decreasing body weight, while others get other health benefits outside of weight loss. My biggest hurdle when educating patients, however, is the fixation on the appetite-suppressing element of these drugs over all the other things it is doing to help you be successful.
The main way you can lose weight on these medications is not through pure calorie restriction and appetite suppression; it’s through regulating blood glucose levels. Semaglutide activates GLP-1 receptors in the pancreas, which triggers insulin release when blood sugar levels are high. Insulin helps move sugar from the blood into other tissues, which can be used for energy, lowering blood sugar levels. Semaglutide also reduces the release of glucagon, another pancreatic hormone that raises blood sugar levels. It also helps break down fat itself. We also have GLP-1 receptors in other areas of our body, which is why we can feel full faster/longer in addition to craving control.
Some evidence also suggests that Semaglutide and Tirzepatide have anti-inflammatory effects. Users of these medications have been found to have lower levels of CRP (a biomarker for inflammation) and reduced circulating inflammatory cytokines that modulate immune system responses. This is not at all surprising after doing this day in and day out for the last few years. So many of my patients with autoimmune pathologies report drastically reduced symptoms or flare-ups.
Another clinical insight I have gained over the last few years of doing this is that my menopausal women feel really good on these medications. Many have reported it decreases the overall frequency and severity of hot flashes and other menopausal symptoms. Women become much more insulin resistant when postmenopausal, and addressing this leaves their overall metabolic functioning much improved (and this includes hormones!). I am looking forward to some hard science and data in the next few years to support what I am seeing in my own practice.
I will end on this note: the appetite-suppressing element of these medications is amazing at cutting down compulsive cravings and food noise (so much so that they are using these medications in drug, alcohol, and gambling addiction programs). However, it goes so much deeper than that! I am hopeful that by educating my patients on how these medications help us, everyone better understands what’s going on under the hood, which ultimately translates to continued success.
