Few medications have changed medicine as quickly as GLP-1s. Patients ask me about them every week, and for good reason: for the right person, they can lead to meaningful weight loss and real improvements in health. They also come with trade-offs worth understanding before you start. As a nurse practitioner with more than 22 years in healthcare, here’s what I want every patient to know.
What GLP-1 medications are
GLP-1 (glucagon-like peptide-1) is a hormone your gut releases after you eat. It tells your brain you’re full, slows how quickly your stomach empties, and helps your body release insulin when blood sugar rises. GLP-1 medications mimic this hormone, so you feel satisfied with less food and think about food less often. Many patients tell me the constant “food noise” finally quiets down.
The options today
Semaglutide (Wegovy): a once-weekly injection, and since early 2026, a once-daily pill. Wegovy is also approved to lower the risk of heart attack, stroke and cardiovascular death in adults with heart disease and excess weight, and the injection is approved to treat MASH, an advanced form of fatty liver disease.
Tirzepatide (Zepbound): a once-weekly injection that acts on two hormones, GLP-1 and GIP. It’s also approved for moderate to severe obstructive sleep apnea in adults with obesity.
Orforglipron (Foundayo): a once-daily pill approved in April 2026 that can be taken without food or water restrictions.
Liraglutide (Saxenda): an older daily injection that is generally less effective than the newer options.
You may also hear about Ozempic and Mounjaro. They contain the same medications as Wegovy and Zepbound but are approved for type 2 diabetes.
How much weight do people lose?
In major clinical trials, adults taking weekly semaglutide lost about 15% of their body weight on average over 68 weeks, and adults on the highest dose of tirzepatide lost about 21% over 72 weeks. The Wegovy pill produced about 17% weight loss in people who stayed on treatment, and orforglipron about 12% at its highest dose. Results vary from person to person. Some people lose more, some lose less, and a few don’t respond well.
Long-term health benefits beyond weight loss
Weight is only part of the story. Some of the most exciting research on GLP-1 medications is about what they do for long-term health:
Heart health. In the SELECT trial of more than 17,000 adults with heart disease and excess weight, weekly semaglutide lowered the risk of heart attack, stroke or cardiovascular death by 20%.
Less chronic inflammation. Low-grade, ongoing inflammation fuels heart disease and many conditions of aging. In SELECT, semaglutide lowered hs-CRP, a key blood marker of inflammation, by about 38% compared with placebo over two years, and the drop started within weeks, before much weight was lost.
Blood sugar and metabolism. GLP-1s lower A1c, reduce the risk of progressing from prediabetes to diabetes, and can improve blood pressure, cholesterol and triglycerides.
Kidney protection. In people with type 2 diabetes and chronic kidney disease, the FLOW trial found semaglutide lowered the risk of serious kidney outcomes by 24%.
Liver, sleep and joints. Wegovy is approved to treat MASH, an advanced form of fatty liver disease, and Zepbound is approved for obstructive sleep apnea. Many patients also notice less joint pain as they lose weight.
GLP-1s and PCOS
Polycystic ovary syndrome (PCOS) is closely tied to insulin resistance, which makes weight hard to lose and drives many of its symptoms. GLP-1 medications aren’t FDA approved for PCOS, but early research is encouraging. In a 2026 randomized trial, women with PCOS who added semaglutide to metformin lost more weight, had lower insulin resistance and testosterone, and were more likely to have regular cycles than those on metformin alone. Larger, longer studies are still needed.
One important note: as cycles become more regular, fertility can return. If you have PCOS and start a GLP-1, reliable birth control and a plan for stopping the medication before trying to conceive are essential.
Brain health and dementia: promising, but not proven
Large observational studies have linked GLP-1 medications to a lower risk of dementia. One 2025 study of more than 60,000 adults with type 2 diabetes and obesity found about a 37% lower risk of dementia in people taking semaglutide or tirzepatide compared with other diabetes medications.
Observational studies can’t prove cause and effect, though. When researchers tested oral semaglutide as a treatment in nearly 3,800 people with early Alzheimer’s disease in the EVOKE trials, it did not slow the disease. The takeaway: protecting your heart, blood vessels and metabolic health is good for your brain, but GLP-1s aren’t a proven way to prevent or treat dementia.
Who GLP-1 medications are good for
FDA-approved weight loss medications are generally for adults with:
A BMI of 30 or higher (obesity), or
A BMI of 27 or higher plus a weight-related condition such as high blood pressure, prediabetes or type 2 diabetes, high cholesterol, sleep apnea, fatty liver disease or heart disease.
They’re also worth considering if you’ve done the work, eating well and moving more, and still can’t lose weight or keep it off. That isn’t a lack of willpower. When you lose weight, your body fights back with more hunger and a slower metabolism. These medications help level the playing field.
Who should avoid them or needs extra caution
A personal or family history of medullary thyroid cancer or MEN 2. Semaglutide, tirzepatide and similar medications carry a boxed warning about thyroid C-cell tumors seen in animal studies.
Pregnancy, breastfeeding or planning a pregnancy. Wegovy, for example, should be stopped at least two months before a planned pregnancy.
A history of pancreatitis or severe digestive conditions such as gastroparesis.
Gallbladder disease, kidney disease or diabetic eye disease, which need closer monitoring.
A current or past eating disorder, which calls for a careful, individualized conversation.
Insulin or sulfonylurea use, which raises the risk of low blood sugar and may require dose changes.
Side effects and how to manage them
Most side effects are digestive and show up early or after a dose increase: nausea, constipation, diarrhea, heartburn, burping and feeling full quickly. They usually ease with time. What helps most:
Start low and go slow. Doses are increased gradually, usually every four weeks or so.
Eat smaller meals and stop as soon as you feel satisfied.
Limit greasy, fried and very sweet foods, which tend to worsen nausea.
Stay well hydrated and get enough fiber to prevent constipation.
Less common but serious risks include pancreatitis, gallbladder problems, dehydration that can affect the kidneys, and low blood sugar when combined with certain diabetes medications. Call us right away if you have severe or persistent abdominal pain, vomiting you can’t stop, or signs of dehydration. Because GLP-1s slow stomach emptying, always tell your surgeon or anesthesiologist you’re taking one before a procedure. If you take birth control pills and start tirzepatide, use a non-oral method or add a backup method for four weeks after starting and after each dose increase.
What about microdosing?
You may have heard about “microdosing,” using doses below the standard starting dose to avoid side effects. It’s an appealing idea, but the research is still very thin. A 2026 review found that direct evidence for GLP-1 microdosing is extremely limited, and it isn’t yet known whether the heart, metabolic and other benefits seen in clinical trials hold up at much lower doses. Splitting doses from pens designed for set amounts also raises accuracy and safety concerns.
What works well for many patients is a gentler approach within approved dosing:
Start at the lowest dose and give your body time to adjust.
Increase more slowly, or not at all, if you’re doing well at your current dose.
Stay at the lowest dose that works for you. Many patients reach their goals without ever needing the top dose.
Pause or step back if side effects flare, then try again when you’re ready.
Protecting your muscle
When you lose weight quickly, part of what you lose can be muscle. Muscle matters for strength, balance, metabolism and healthy aging, so protecting it is a big part of how we use these medications.
Prioritize protein at every meal. Most people need more than they think, and we’ll set a target for you.
Strength train two to three times a week, even with simple bodyweight or band exercises.
Stay active every day. Walking after meals also helps with blood sugar and digestion.
What happens if you stop
Obesity is a chronic condition, and these medications work while you take them. In the STEP 1 trial extension, people who stopped semaglutide regained about two-thirds of the weight they had lost within a year. That doesn’t mean you’re locked into the highest dose forever. Many patients move to a lower maintenance dose over time, and the habits you build during treatment, like protein, strength training, sleep and stress management, make a real difference in keeping weight off.
How we approach GLP-1 therapy at Lovena
A full medical evaluation: your history, current medications, goals and a lab panel chosen for you.
An honest conversation about whether a GLP-1 is right for you, and if so, which one.
A careful start, with dose changes based on how you feel and how you’re progressing.
Nutrition and strength guidance to protect your muscle and build habits that last.
Regular follow-up and lab monitoring for as long as you’re on treatment.
Medical weight loss is a cash-pay service at Lovena, and we’ll go over the cost of each option before you start.
Ready to talk about it?
If you’ve been working hard and the scale won’t budge, a GLP-1 may be the missing piece, or it may not be, and that’s worth knowing too. Call or text (484) 350-5145 or book online to schedule a medical weight loss appointment.
Sources
Wilding et al., Once-weekly semaglutide in adults with overweight or obesity (STEP 1), NEJM 2021
Jastreboff et al., Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1), NEJM 2022
Wilding et al., Weight regain after withdrawal of semaglutide (STEP 1 extension), 2022
Plutzky et al., Semaglutide and hs-CRP in the SELECT trial, Circulation (summary)
Perkovic et al., Semaglutide and kidney outcomes in type 2 diabetes (FLOW), NEJM 2024
Zhang et al., Semaglutide and metformin in PCOS: a randomized trial, 2026
Semaglutide and tirzepatide and dementia risk, JAMA Network Open 2025 (summary)
EVOKE and EVOKE+ trial results in early Alzheimer’s disease, 2025
This article is for general education and isn’t medical advice. Talk with your own provider about your situation.