How to Talk About Weight-Loss Medications With Your Doctor
Two years ago, Jennifer Silver, 34, a dentist in Alberta, Canada, began taking a GLP-1 agonist medication to lose weight. It wasn’t a decision she took lightly—rather, it was one she came to “after careful consideration and consultation with my healthcare provider,” she says.
Silver was putting in the effort—for years she’d tried managing her weight with lifestyle changes. But she struggled to achieve any lasting results until she started taking a GLP-1, the weight loss medication that has recently grabbed headlines. Within just a few months, Silver began to see benefits: Since starting the medication, she’s lost 20 pounds.
GLP-1s can be used to treat chronic weight management, especially for those living with obesity or who are overweight. Obesity is defined as a body mass index (BMI) of 30 or more; overweight is defined as a BMI of 25. Many people in the U.S. may benefit from taking these medications. According to the latest statistics from the Centers for Disease Control and Prevention, about 42 percent of adults age 20 and older have obesity; another 32 percent have overweight.
Silver is among the 10 percent of Canadian adults who has taken a GLP-1 medication (for comparison, 12 percent of U.S. adults), and in her case, benefited from doing so. “It’s helped me manage my weight more effectively, and improve my overall quality of life,” she says.
The medications work by mimicking a naturally occurring hormone in the body called GLP-1, which helps to regulate appetite. GLP-1 drugs “slow down the emptying of the stomach, so as a result, people feel fuller and ultimately eat less,” says Robert Gabbay, MD, PhD, chief scientific and medical officer with the American Diabetes Association. “They also have some effects in the brain to decrease hunger.”
If you’ve struggled to manage your weight, you may be wondering if you’re a candidate for GLP-1 medications. The answer will depend, in part, on your BMI, as well as other factors. Start the conversation with your primary care provider, but if your doctor or nurse practitioner doesn’t have training in weight management—or if you simply want to seek out a second opinion—ask for a referral to an obesity medicine specialist. Either way, use this guide to start the conversation with your doctor, so you can find out if the medication is right for you.
Start with a clear question
If you’re not sure whether you’re a candidate for GLP-1s, ask: Should I take a GLP-1 to help me lose weight? Here’s how your doctor may advise you, depending on your goals and current BMI status.
You’re overweight.
Certain GLP-1s are approved to treat people with obesity and overweight and maybe at-risk for related conditions such as type 2 diabetes, high cholesterol, and high blood pressure. “Blood pressure, blood sugar, and cholesterol levels all tend to improve with weight loss, and overall, these medications have benefits in terms of lowering the risk of cardiovascular disease,” says Dr. Gabbay.You want to lose weight for an event, like a wedding.
GLP-1 drugs are intended to be used over the long-term, to treat obesity as a chronic condition—not in the short-term for a big event, says Ethan Lazarus, MD, an obesity medicine specialist in Denver, CO, and past president of the Obesity Medicine Association. “We have to differentiate between just wanting to lose weight without necessarily having a good medical reason to do so versus wanting to lose weight because of the health benefits.” If your BMI is already normal, then you’re probably not a candidate for GLP-1s.You have 100 or more pounds to lose.
Losing this much weight may not be realistic over the long-term—with either medications, lifestyle changes, or even surgery. GLP-1s can usually help people lose about 15 to 20 percent of their body weight, which translates to about 35 to 50 pounds, depending on a person’s starting weight, says Dr. Lazarus. (Compare this to weight-loss surgery, which usually helps people lose 25 to 30 percent of their weight, he says.)
You’re better off trying to achieve a weight loss that’s a percentage of your current body weight—not as a target number to hit on a scale, he says. “If you say, ‘I used to be 200 pounds, and now I’m 350 pounds, and I wanted to be 200 pounds again, it’s not a realistic goal,’” he says. “A person is not going to lose half of their body weight and sustain it, and the risks of doing that probably outweigh the benefits.” However, percentages tend to take your whole health situation into account (e.g., hormonal life stage, health conditions, etc.) and research shows that losing certain percentages of weight—not a magic number—can benefit your health.You’re not losing weight despite your diet and exercise habits being stellar.
If diet and exercise have only taken you so far—or you haven’t experienced weight loss benefits despite your lifestyle habits—you may be a candidate for a GLP-1 medication. A person’s body weight is partly a combination of hormones and biology, not an indication of willpower, says Dr. Lazarus. Here’s how it works in real life: You may want to lose weight, but your body doesn’t—and it fights back by lowering your metabolism, thereby making weight loss even harder, he says. “So that now a person is only supposed to be eating 900 or 1,000 calories, but they’re hungry all the time,” he says. “And that’s going to push the weight back to where it started.”
“To think a person can just keep the weight off by eating less reinforces an old argument,” he adds. “We’ve had four or five decades proving that’s not true.”
If your doctor recommends GLP-1s, ask the following questions
Just because you may qualify for these weight-loss drugs doesn’t mean that you should take them without understanding the ins and outs of the treatment.
What side effects might I experience?
Nausea, vomiting, diarrhea, constipation, headaches, and abdominal pain are some of the more common side effects of the medication. But there are less common—albeit, more serious—side effects that could occur, including gallbladder attacks and pancreatitis (i.e., inflammation of the pancreas), says Dr. Lazarus.
For her part, Silver experienced some mild nausea and occasional headaches during the first few weeks on the medication. But these “were manageable and subsided as my body adjusted to the treatment,” she says.
How long will I need to stay on the medication?
There’s a good chance you’ll need to stay on the medications forever, says Dr. Lazarus, mainly because the weight will likely return once you stop taking them. “Obesity is a chronic, relapsing disease,” says Dr. Gabbay, although “we don’t always think of it the way we should.”
Dr. Gabbay compares obesity to high blood pressure. “We don’t tend to ask people if they need to continue to take statins,” he says. “If you stop taking statins, the high blood pressure returns.”
What kind of results can I expect, and when might these appear?
Generally speaking, people can lose about 10 to 20 percent of their body weight in nine months, although this can vary according to the medication, according to some research. You may not see results right away, says Dr. Gabbay. That’s because doctors tend to start people out on a low dose and gradually increase it over time, partly to help offset some of the side effects. “If you don’t see anything in a month, don’t be surprised, because at a low dose, it may not be enough to cause weight loss,” he says.Is the medication available in my area?
Some GLP-1 medications have been in short supply, according to the Food and Drug Administration, although this can vary by brand and by location. Ask your doctor or pharmacist which, if any, medications are currently available near you.
Will insurance cover the costs of the medication?
Some commercial insurance plans cover some or most of the cost of GLP-1 weight loss medications, but not all policies do. Even among insured adults, more than 50 percent of people who take GLP-1s say it’s difficult to afford the medication, according to a 2024 poll from the Kaiser Family Foundation. (Currently, Medicare doesn’t cover GLP-1s when used solely to treat obesity.)
Will I still need to diet and exercise?
Even if you don’t diet or exercise, the medications can still be effective, says Dr. Lazarus. But it’s always a good idea to eat a healthy diet and exercise regularly. Your health will “still benefit if you eat quality foods and exercise,” says Dr. Gabbay.
If you’re not a candidate, ask about other options
The goal of your treatment will likely be to get your BMI into a healthy range, or as close to that range as possible, says Dr. Gabbay. For people with elevated BMIs, it may be worth doing a trial of lifestyle interventions, such as diet and exercise, before adding a medication to the treatment, says Dr. Lazarus. As a general rule of thumb, for people who are experiencing more severe complications of obesity, such as high blood pressure or high blood sugar levels, doctors tend to prescribe higher-intensity treatments, such as surgery.
Note: Some people who take GLP-1s may not ever reach a healthy BMI—but that can be okay. “It’s of value to lose that 15 percent of their body weight because it puts the person in a much healthier situation,” says Dr. Gabbay.
You Might Also Like
