Wellness Wednesday: GLP-1 Medications Explained: How They Work, Who They’re For, and the Risks of Compounded Alternatives
Over the past few years, GLP-1 receptor agonists, often referred to by brand names like Ozempic, Wegovy, and Mounjaro, have risen to the forefront of conversations around weight management and metabolic health. Praised by some as revolutionary and criticized by others as overhyped, these medications work by targeting deeply rooted physiological pathways that influence hunger, satiety, and blood sugar regulation.
For those unfamiliar, GLP-1s aren’t just “weight loss drugs.” They are medications originally developed for type 2 diabetes, with their mechanism rooted in endocrinology and gut-brain communication. But like all powerful therapies, they come with nuances, risks, and specific patient profiles for which they are appropriate.
As both a practicing endocrinologist and a board-certified health coach, I often sit at the intersection of science and everyday wellness. My clinical role requires that I evaluate the evidence and physiology behind these therapies, while my coaching lens focuses on helping individuals apply this knowledge safely and sustainably in their real lives.
The conversation about GLP-1s is often reduced to weight loss headlines, celebrity endorsements, or quick-fix promises. But the truth is much more nuanced. Understanding how these medications work at a biological level, who truly benefits from them, and what risks are involved—especially when using compounded versions outside of FDA oversight, is essential for anyone considering them.
What Are GLP-1 Medications?
GLP-1 stands for glucagon-like peptide-1, a hormone naturally produced in the gut in response to eating. It is part of a broader family of incretin hormones, which play critical roles in regulating glucose metabolism and signaling satiety to the brain.
Pharmaceutical GLP-1 receptor agonists (GLP-1 RAs) are synthetic drugs that mimic the effects of natural GLP-1 but last much longer in the body. Unlike the natural hormone, which is quickly degraded within minutes, these medications remain active for days to weeks, depending on the formulation.
They are administered via subcutaneous injection and prescribed primarily for:
Type 2 diabetes management (improving glycemic control and reducing cardiovascular risk).
Chronic weight management in individuals with obesity (BMI ≥30) or overweight (BMI ≥27) with comorbidities like hypertension, sleep apnea, or prediabetes.
How GLP-1s Work in the Body
To understand their impact, it’s helpful to trace the biological pathways these drugs influence.
Glucose Regulation
GLP-1 medications stimulate insulin secretion from pancreatic beta cells only when glucose is elevated, making them far safer than older drugs that risk hypoglycemia. They also suppress glucagon secretion (which raises blood sugar), leading to smoother blood glucose control.Slowed Gastric Emptying
GLP-1s delay how quickly food leaves the stomach. This prolongs digestion, stabilizes post-meal blood sugar, and creates a physical sensation of fullness.Appetite Regulation via the Gut-Brain Axis
Perhaps the most notable effect is their action on the hypothalamus, the brain’s appetite-control center. GLP-1 receptors are located in brain regions that regulate hunger, reward, and cravings. When activated, they dampen food-seeking behavior and reduce hedonic (pleasure-driven) eating.Clinical trials show that many patients experience:
Reduced appetite.
Fewer cravings for highly processed, calorie-dense foods.
Lower caloric intake without conscious restriction.
Weight Loss Pathways
Together, these mechanisms, enhanced insulin response, reduced glucagon, slowed gastric emptying, and appetite suppression, create a metabolic environment where weight loss is not only possible but often substantial. Large trials such as STEP and SURPASS have demonstrated average losses of 15–20% of body weight over 68 weeks in some individuals.
Why Some People Need GLP-1s (and Others Don’t)
Not everyone responds to GLP-1 medications in the same way. The need for pharmacological intervention depends on a complex interplay of genetics, biology, environment, and lifestyle factors.
Genetic Predisposition: Some people naturally produce less GLP-1 or have differences in receptor sensitivity, leaving them more vulnerable to dysregulated appetite and weight gain.
Metabolic Dysregulation: In obesity and type 2 diabetes, hormonal signaling between the gut and brain is often impaired. Here, GLP-1 medications essentially “correct” what the body struggles to regulate on its own.
Lifestyle vs. Biology: While nutrition, sleep, stress management, and exercise remain the foundation of health, some individuals face biological barriers that lifestyle changes alone cannot fully overcome. For these patients, GLP-1s can level the playing field by restoring normal satiety signaling and glucose control.
When They Aren’t Needed: Those without significant metabolic dysfunction—who maintain stable weight and glucose through lifestyle, may not benefit. In fact, unnecessary use carries risks without providing meaningful advantages.
Risks and Safety Concerns
Like any powerful therapy, GLP-1 medications are not without risks. Clinical trials and real-world evidence highlight several important considerations:
Common Side Effects: Nausea, vomiting, diarrhea, constipation, and abdominal pain are frequent, especially early in treatment.
Serious Risks: Pancreatitis (rare but serious), gallbladder disease, and potential associations with thyroid C-cell tumors in rodent studies (not confirmed in humans).
Nutritional Risks: Because appetite is suppressed, some individuals may inadvertently under-eat, risking nutrient deficiencies or loss of lean muscle mass if protein intake and resistance training aren’t prioritized.
Psychological Considerations: Appetite suppression may feel like freedom for some but can complicate the relationship with food if not monitored carefully.
For these reasons, GLP-1s should only be used under medical supervision with ongoing monitoring of labs, nutrition, and overall well-being.
The Dangers of Compounded GLP-1s
With growing demand and periodic shortages, compounded versions of GLP-1s have entered the market. Unlike FDA-approved medications, compounded drugs are not subject to the same rigorous testing or manufacturing standards.
Concerns include:
Purity and Dosing Inconsistencies: Inaccurate dosing can lead to under-treatment or dangerous overdosing.
Lack of Safety Data: Compounded versions may contain unknown contaminants or altered formulations not studied in clinical trials.
Regulatory Warnings: The FDA has cautioned against widespread use of compounded GLP-1s unless no commercial product is available and the prescription is medically necessary.
A Holistic View: Medication and Lifestyle
While GLP-1 medications can be life-changing for the right patient, they are not a magic bullet. The most successful outcomes occur when medication is integrated with lifestyle support:
A structured nutrition plan that ensures adequate protein, fiber, and micronutrients.
Strength training to preserve lean muscle during weight loss.
Stress management, sleep hygiene, and supportive coaching to address behavioral and psychological factors.
This is where the collaboration between an endocrinologist and a health coach becomes invaluable: the endocrinologist monitors safety, efficacy, and dosing, while the coach provides the tools and accountability needed to build sustainable habits.
Another Tool in the Toolbox
GLP-1 receptor agonists represent one of the most significant medical advances in metabolic health in decades. By leveraging the body’s natural gut-brain pathways, they provide powerful tools for controlling blood sugar and supporting weight loss in people who need them most.
But they are not for everyone, and their misuse, especially through unsafe compounded products or use without medical oversight, carries real dangers.
For individuals struggling with obesity or type 2 diabetes despite diligent lifestyle efforts, GLP-1s may offer a safe and effective pathway forward. Yet, as with all medical therapies, they work best when paired with personalized guidance, healthy routines, and a clear understanding of both benefits and risks.
