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La. (WAFB) – Doctors have used GLP-1 drugs for weight loss for about five years, and researchers say some of the benefits are catching them off guard
Dr. Steven Heymsfield, a professor at Pennington Biomedical Research Center and director of the Metabolism Body Composition Laboratory, has studied GLP-1 drugs for 15 years
“Some were predicted beforehand and others were completely surprising,” Heymsfield said. “So for example, we know that people who are obese have a higher risk of diabetes.”
“The unpredictable type is that people report less desire to drink alcohol,” Heymsfield said. “And now there are studies beginning to show that that’s been confirmed.”
Heymsfield said people with arthritis have unexpectedly reported improved symptoms, less pain and less inflammation, and can walk better. He said studies have shown people need fewer knee replacements as a result
Heymsfield also pointed to cardiovascular improvements. “We’ve already shown with GLP-1s that it reduced the risks of heart attacks, cardiovascular disease, mortality,” he said. “And it’s thought that it’s not just the weight loss, but processes like inflammation also are improving that might mediate these effects on the heart.”
He said not all benefits are tied directly to weight loss. “It looks like it’s not just the weight loss, but these drugs that actually have themselves some properties that improve inflammation,” Heymsfield said, adding that effect is being actively studied
Heymsfield said it is likely that GLP-1 drugs are already being prescribed off-label to treat inflammation, including in people of normal weight. He said off-label prescribing carries risk because the effects of the drugs are not known in people who are not approved to take them
On decreased interest in alcohol and substance use, Heymsfield said researchers do not know exactly how the drugs work in that regard, but believe GLP-1s may act on areas of the brain tied to those behaviors
Heymsfield said some patients on GLP-1 drugs do not eat adequately and have developed vitamin deficiencies not usually seen, including scurvy from vitamin C deficiency, because of the way the drugs affect eating habits
He said some patients lose the enjoyment of eating altogether, a condition he described as hedonia, or lack of interest in eating. “Most people enjoy eating. It’s not just to get calories. It’s an enjoyment,” Heymsfield said. “And if you lose that enjoyment, some people go off the drugs because they’ve lost that part of their life.”
Heymsfield said the drugs have also been reported to reduce “food noise,” which he described as a beneficial effect that in some cases can become too pronounced
Muscle and bone loss are also concerns, Heymsfield said, occurring in everyone who loses weight on the drugs. He said Pennington researchers are studying ways to mitigate that loss, including increased protein intake, resistance exercise and drugs designed to prevent muscle loss, such as androgen-type drugs
Heymsfield said muscle loss becomes more of a problem for patients who are frail, such as a 75-year-old who is overweight and starts a GLP-1, which could worsen their ability to get around and increase fracture risk
Pennington researchers are testing retatrutide, a triple agonist drug combining GLP-1, GIP and glucagon, Heymsfield said. He said the drug has produced the most weight loss seen so far in this class of drugs, in the range of 25% to 30%, comparable to bariatric surgery
“That’s a lot,” Heymsfield said
Heymsfield said the drug also carries more side effects. He said retatrutide is in phase three trials, the last phase before approval, and could reach the market in the next few years. He said approval timelines for these drugs have been moving faster, pointing to two oral GLP-1 drugs that recently came to market quickly
Heymsfield said GLP-1 drugs are safe when taken as prescribed, with well-described gastrointestinal effects and low risk overall, particularly at lower doses
He said the drugs’ effects stop once a patient stops taking them, unless the patient has made lasting behavioral changes to diet and exercise during treatment. Heymsfield said weight cycling — losing weight, stopping the drug and regaining weight — is common and not a healthy way to live, and that regained weight is not muscle
Heymsfield said more powerful and more targeted GLP-1 drugs are in development, including potential once-a-month injections and drugs designed to preserve muscle and bone
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