Amanda Wilde (Host): This is A Podcast a Day with Memorial Health System. I'm your host, Amanda Wilde. Nurse practitioner Loni Collins is here to help us understand how GLP-1 diabetes treatment is being used for weight management. This is a topic that has captured the attention of the public. And Loni, thank you for being here to help us break it down

Loni Collins, NP: Thank you for having me.

Host: So, can GLP-1 be used safely without a diagnosis of diabetes or pre-diabetes?

Loni Collins, NP: That is correct. It can. It was originally created for type 2 diabetes. And we were very successful with that introduction. And we found that during the treatment for diabetes, other outcomes occurred along with the reduction of the blood sugars. And so now, we have medications that are specifically approved for not only diabetes originally like it was, but now for weight management, fatty liver disease, and sleep apnea, even if you do not have diabetes. Some were fearful of using it, thinking, "Well, it's a diabetic medicine and it'll lower your sugars." But actually, this medication is glucose-dependent, meaning that it really only works if a blood sugar is elevated. And the body can protect itself by shutting off other insulin secretion when our sugar starts to go low, even on a GLP-1.

Host: So, who should consider GLP-1 therapy for weight management and who should avoid it?

Loni Collins, NP: Well, like we said, it was originally created for a type 2 diabetic. But now, it's starting to be recognized that GLP-1s can be used for patients with BMIs greater than 30 or a BMI greater than 27 if they have other comorbidities such as high blood pressure, sleep apnea, fatty liver disease. And it can especially be helpful for people that have tried lots of other lifestyle changes and just haven't been successful.

Host: How long does someone typically need to be on GLP-1 treatment to maximize results?

Loni Collins, NP: Well, they're best thought of as like a long-term metabolic treatment rather than a short-term weight loss tool. And usually, most patients remain on them for one or two years. Many require ongoing treatment to continue that maintenance weight loss that they've had. And some studies even show that once they stop the medicine, their appetite does return and weight gain can reoccur So, it just depends. It's individual.

Host: Well, this leads right into my next question, which are, what are some of the common do's and don'ts that patients should follow when starting out the GLP-1 therapy? So, what are some of the most common do's?

Loni Collins, NP: As far as the dos, I think it's important that you understand that no weight loss medicine, whether it's a GLP-1 or a stimulant is going to be miraculously causing weight loss. You have to understand and be realistic that you've got to put some effort into it. You need to start with small portion sizes. You need to increase your dose gradually. If you try to increase the dose too fast, it could make you sick. And you need to maintain regular followup with a healthcare provider so they can recognize early side effects. Also, hydration is definitely a do.

Host: What are some of the most important don'ts that can prevent side effects or complications?

Loni Collins, NP: I find that one of the biggest mistakes is overeating. Digestion is slower on a GLP-1 medication. And so, overeating can cause significant nausea, even vomiting. You need to avoid high fat, greasy, spicy foods because the food stays in the stomach longer. And then also make sure you don't titrate your dose too quickly. Make sure you get used to the dose before you go to the next dose, because going up too fast really is the most common reason people develop intolerable side effects.

Host: What are the most common side effects that we see from GLP-1 therapy and how can they be managed?

Loni Collins, NP: Yeah. Most of the side effects are GI as discussed, you know, so burping, bloating, belching. Some patients experience nausea, early fullness, constipation, diarrhea. But these are not with every patient. And most of the time, it tends to improve the longer you're on the medicine. Less commonly, with any weight loss medicine, whether it's a GLP-1 or other, or if you just lose weight on your own, sometimes gallstones can develop just from rapid weight loss. So, that's what we try to avoid.

Host: Yes. Well, that might be one of the longer term risks. Are there are other long-term risks associated with GLP-1 drugs for non-diabetic weight loss patients?

Loni Collins, NP: Yeah. So far, long-term research really has been encouraging. There's a lot of areas that are still being studied, like I mentioned with the gallbladder disease, and then rare pancreatic complications. But overall, the safety profile is really favorable. And I'd really consider the benefit of the weight loss that improves the overall metabolic health of the patient, instead of focusing on occasional GI side effects.

Host: And are there lifestyle changes like diet and exercise that should accompany GLP-1 therapy to maximize results? You've mentioned that diet is still an important factor and not overeating.

Loni Collins, NP: Yes, 100%. I kind of previously mentioned, you know, these medicines work with changes. So when you combine the healthy habits, water, more exercise into your daily routine, you are going to have a lot better results on this. You should focus on whole foods, adequate proteins, regular physical activity, and just set realistic expectations and get your needed rest every day.

Host: How should healthcare providers like yourself educate patients about having those realistic expectations and maybe even possible plateauing on the way to weight loss?

Loni Collins, NP: Well, when it comes to diabetes, you know, we just want to set the expectation that your sugars will improve if we can change your dietary modifications, lifestyle modifications. We want to make sure that they know that it's a slow process. It's nothing that's going to happen overnight. We want to make sure that they realize they have to stay hydrated.

Typically, a patient could lose up to 20% of their body weight on these medicines over a year's timeframe. And so, we also want to make sure that they're realistic and they understand that your weight could plateau. And it doesn't mean that the medicine stopped working, it just means that your body's adjusting to the new balanced weight that it's just reached. And so, it's really helpful to think about these medicines They reduce the drive to eat and they make the healthy choices easier, but you still have to maintain the changes.

Host: Right. A big takeaway from our conversation, I think, is that the GLP-1 therapy affects our gradual, and it's not the silver bullet that we tend to think that it is.

Loni Collins, NP: You got it.

Host: Loni, thank you so much for your guidance on the use of GLP-1 therapy to aid in weight loss. It was a fascinating conversation.

Loni Collins, NP: Thank you.

Host: That was Loni Collins, nurse practitioner, Department of Endocrinology at Memorial Health System. And that wraps up this episode of A Podcast a Day with Memorial Health System. Visit mhsystem.org to learn more and connect with the provider. And be sure to subscribe for more conversations from Memorial Health System.