It’s played on repeat in my head lately. I was at the supermarket retailer a few days ago, and stood in the pharmacy aisle when I heard two women conversing. One of them was talking to the other about her sister, who had shed 50 pounds over eight months thanks to “one of these latest diet shots.” The woman’s face was lit with a mixture of skepticism and hope which was immediately apparent as I’ve witnessed the exact face on many faces throughout time whenever a new treatment for obesity is introduced. “Is the product safe?” she inquired, her voice sinking to a whisper, almost as she was discussing something a bit embarrassing.

That question stuck with me. Because what we’re witnessing right now with GLP-1 and GIP medications isn’t just another fad diet drug or quick fix that’ll flame out in a year. It’s truly something completely different. It seems like that a lot of people are trying to determine the meaning behind the situation. 

The weight Loss Talk Nobody Ever Wanted to have

Let’s talk about a fact that we’ve done to people who struggle with obesity for a long time. We failed to recognize their shortcomings by giving ineffective advice on willpower and treatments that did little or nothing and usually had terrible adverse consequences. The medical profession advised patients to “eat less and exercise more” like a simple advice could be used to alter complex biological, genetic and hormonal systems that control the metabolism and appetite. I am reminded of my own battles to lose weight during my thirties and the process of losing 20 pounds, only to gain another twenty five. It was a shame every time I failed. Doctors who examined my labs and told me all was “fine” but I felt tired all the time and was unable to understand how my body was able to be unable to resist any attempt I made.

So when I started hearing about GLP GIP medications and their effects on weight loss, I’ll admit I was skeptical. We’ve been burned before. Remember fen-phen? Remember the parade of stimulants that either didn’t work or caused heart problems?

But this? This is different. And the science behind why it’s different actually matters.

Understanding GLP1 and GIP Agonist for Obesity: What Makes These Work

Here’s the thing about GLP1 and GIP agonist for obesity medications: they’re working with your body’s natural systems, not against them. That’s not marketing speak it’s actually what makes them fundamentally different from previous weight loss drugs.

Your gut naturally produces GLP-1 and GIP hormones when you eat. These methods send signals to the brain telling it that the stomach is full, reducing the speed of your stomach emptying it’s contents, as well as helping to regulate blood sugar. However, in a lot of people and especially in those suffering from obesity or metabolic problems the signals get distorted or neglected. 

GLP and GIP peptides for weight loss medications essentially turn the volume back up. They mimic these natural hormones but stick around in your system much longer than the ones your body makes. So instead of getting that satiety signal for a few minutes after eating, you’re getting it consistently throughout the day.

This is like turning up the volume of the system of communication was set down down.I’ve spoken to patients who are taking these drugs and their way to explain it is surprising. They do not say “I’m trying to make myself less likely to consume food” or “I’m trying to fend off desires.” They’ll tell you things like “Food is just does not appeal for me in the same way now” or “I feel full after eating regular portions, and am actually content.”

That’s your brain finally hearing the signals it was supposed to be hearing all along.

The Evolution: From Single to GLP GIP Dual Agonists

The first wave of these treatments focused solely on GLP-1. Medicines like Liraglutide (Saxenda) and Semaglutide (Wegovy) hit the market and were instantly successful, helping patients lose 10-20% of their bodyweight on average unprecedented for any other medications at that time. But then researchers had an interesting thought: what if we didn’t just target GLP-1? What if we combined GLP-1 effects with GIP effects? That’s where GLP GIP dual agonists enter the picture, and honestly, the results have been kind of stunning.

Tirzepatide (sold as Mounjaro for diabetes and Zepbound for weight loss) is the poster child for this approach. It activates both GLP-1 and GIP receptors. And people taking it? They’re seeing average weight loss of 15-22% of their body weight. Some people are losing even more.

Twenty percent of your body’s weight. Take a moment to think about it for a moment. If someone weighs 250 pounds which is 50 pounds, it’s a lot. This is life-changing weight loss of which can affect the joint sleep apnea and diabetes-related risk factors as well as cardiovascular health and your overall feeling as you go around the globe every single day. It is believed that the GIP GLP combinations seem to create synergy. GIP is believed to boost the effects on weight loss of GLP-1. It could be because of the effects it has on metabolism and the expenditure of energy. Researchers aren’t quite sure how this combo works than GLP-1 on its own However, what about clinically? The difference is clear.

New GLP GIP Obesity Medications Explained: What’s Available and What’s Coming

Let’s break down GLP GIP obesity medications because the landscape can get confusing quickly and can get confusing quickly.

Single GLP-1 agonists currently approved for weight loss:

• Liraglutide (Saxenda): offers solid but less dramatic weight loss results than more recent options like Belviq or Votrient.
• Semaglutide (Wegovy): Delivers impressive weight loss of around 15% through weekly injection.

Dual agonists:

• Tirzepatide (Zepbound): Weekly injection, the current heavyweight champion with average weight loss hitting 20%+ in clinical trials

But here’s where it gets really interesting. The pipeline of GLP GIP medications currently in development is robust. There are oral versions being tested (no more injections!), triple agonists that add glucagon receptor activation to the mix, and longer-acting formulations that might eventually allow for monthly dosing.

Researchers are also looking into the possibility of starting with an agonist that is dual from the beginning will be better than gradually increasing one agonist. Some are also studying whether metabolic or genetic profiles can determine which patients will respond the best to what medications. 

We’re in this weird phase where the science is moving faster than our clinical experience. Five years from now, I suspect the GLP and GIP diabetes and obesity treatment landscape will look completely different than it does today.

The GLP GIP Diabetes Breakthrough That Became an Obesity Revolution

You know what’s interesting? These medications weren’t originally developed as obesity new treatments. They were developed for type 2 diabetes. The weight loss was initially considered a “side effect” a beneficial one, sure, but still secondary to the primary goal of blood sugar control.

As the GLP GIP breakthrough in diabetes unfolded and scientists saw the amount of the weight loss was happening to people and the way people were losing weight, the thinking changed. It was then that we began to realize that overweight and type 2 diabetes don’t have to be separate issues that tend to be present in tandem. Perhaps they’re both symptoms of the same metabolic disorder. This realization was an incredibly profound experience. This has changed the way we view chronic diseases as well as the relationship between metabolism, weight as well as insulin resistance and inflammation. There are now conversations about obesity being a chronic condition that warrants treatment like we do for diabetes care or hypertensive care. I’ve seen this evolution first-hand. There was a time when doctors prescribed metformin to patients, and when the weight issue came up, only ‘lifestyle changes’ were offered. Now, they are addressing the complete metabolic dysfunction and incorporating obesity treatments with GLP and GIP dual agonism to manage these conditions.

A close friend of mine, Sarah, started on tirzepatide eight months ago. She was only diabetic, but now, after bringing her HbA1C value down from 8.1 to 5.9, she is also 45 pounds lighter. The best part for her is the change in her perception of food. “I was constantly thinking about food, and I didn’t even realize how much mental energy that was taking until it stopped,” she told me last week.

That is not solely about loss of weight. Such is about a better life.

The Challenging Question We Must Continue to Ask

However, I would be doing a disservice to everyone if I described this as a miracle, with no pitfalls. These are strong medications, with GLP-1 and GIP medications having to be taken with caution.

Side effects, especially early on, are common. Nausea is the most prevalent. For some, it involves significant nausea for extended periods of weeks to months. There is also the potential for vomiting, diarrhea, constipation, and discomfort in the abdomen. While most are eventually able to cope with it, some people are simply not able to cope with these medications well enough to be able to continue.

There are also concerns emerging about muscle loss during rapid weight loss, gallbladder issues, and potential effects on mental health (though the data here is mixed and still being studied). And we’re still in relatively early days for long-term safety data. These medications have been around for a decade or so for diabetes, but widespread use for obesity is much more recent.

Next is the most obvious part of the negotiations: price and availability to the general public. It is all over $1,000 a month and that is without any insurance. Coverage is really inconsistent. One of the most common issues with obesity medication coverage is that a lot of insurance companies will only cover it if it is documented that the individual is diabetic but not if it is just for obesity. Furthermore, insurance companies require extensive documentation of prior weight loss attempts before covering anything. Because of the aforementioned reasons, it becomes a situation where access is frequently contingent to insurance coverage and income, rather than any of the aforementioned medical necessity.

And what happens when you stop? For most people, weight comes back. Not always all of it, but a significant portion. That raises questions about whether this is truly solving obesity or just managing it, which then raises questions about lifelong medication use, cost sustainability, and whether we’re comfortable with that as a societal approach.

I don’t have any answers to these questions. I don’t think anyone does not yet. But I think it’s important we keep asking them even as we acknowledge the genuine benefits these medications provide.

What This Means for Real People

I always think about those two women in the pharmacy aisle. I always think about that one and her asking, ‘Is it safe?’ That voice, a little more than just fear. That voice is hope, too.

Here’s what I would have liked to have told her. GLP GIP medications are a revolutionary breakthrough in the treatment of obesity and metabolic disease. They work through mechanisms that make physiological sense. The clinical trial data is strong. For many people, they’re offering relief after years or decades of struggle.

But they’re not magic. Yes, there are risks and side effects. Yes, beneficial effects of these medications are not within the reach of a lot of people, and yes, they don’t replace the positive effects of good nutrition, movement, quality sleep, and stress management that a lot of people have access to.

They are a tool. A potentially powerful, life-changing one for a lot of people, but still, a tool that is best used in conjunction with other positive health measures.

You are always given the most recent data up to October 2023. Most people who go through Sarah’s experience with tirzepatide do not talk about the same things as her. They talk about the significant weight loss and how her diabetes is significantly improved. However, what she appreciates the most is the mental freedom. The mental freedom of not always being anxious and preoccupied by food. The food freedom to go to restaurants with friends and actually enjoy the dinner and social events.

Where these new GLP GIP obesity medications are giving people is not limited to weight loss. People are also gaining a new freedom and a better relationship with food and their bodies. An opportunity to escape the cycle of failed diets and shame and try something that addresses their biological mechanisms driving hunger and metabolism.

Is it the answer for everyone? No. Will everyone tolerate these medications or have access to them? Absolutely not. Are we still learning about long-term effects and optimal use? Without question.

But for people who’ve struggled with obesity or type 2 diabetes people who’ve tried everything else and felt like failures when nothing worked these medications represent something precious: hope backed by actual science.

In a field that’s dominating by judgment as well as pseudoscience, along with treatments which haven’t worked, it’s important to pay attention. It’s worthy of continued study and honest discussions regarding access and equity and a careful examination of the longer-term outcomes, and perhaps even a bit of hope about where this may result.

Since at the final analysis, behind each percentage point of weight loss and A1C reduction is someone else. A person who is entitled to the best treatment and care, a compassionate approach and the opportunity to be content with their own body.

This GLP and GIP the breakthrough in obesity and diabetes that we’ve witnessed? This could be a way of providing access to a greater number of people than before. This is something to be celebrated in spite of looking for answers to the tough questions and demand better accessibility and knowledge.

The current revolution is chaotic but it’s ongoing. It’s true. For many this reality is altering the way things are done.