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The Role of GLP-1 Receptor Agonists in Weight Management and Diabetes Control: What You Need to Know

Updated: Mar 6

You’ve likely noticed a growing interest in medications like Ozempic, Wegovy, Mounjaro, and Rybelsus, all of which belong to a class of drugs called GLP-1 receptor agonists (some, Mounjaro, for example, also belong to the GIP receptor agonist class of drugs).


As a quick overview, these GLP-1 receptor agonists mimic the glucagon-like peptide-1 hormone, which plays an important role in regulating blood sugar, appetite, and gastrointestinal motility (the movement of food through the digestive tract). While these medications have shown impressive results in managing diabetes and supporting weight loss, there are other important aspects that shouldn’t be overlooked, especially regarding nutrition, dietary habits and sustainable behaviour change.

Lets get into it...


In a nutshell, GLP-1 receptor agonists slow down digestion, keeping food in your stomach longer. This delay in gastric emptying helps you feel fuller for longer and reduces hunger. This effect may be particularly helpful for people with type 2 diabetes and obesity, who often struggle with appetite control and maintaining stable blood sugar levels.


A randomized controlled trial (RCT) published in The Lancet showed that semaglutide (which is the active ingredient in some of these medications) led to an average weight loss of 15-20% in patients over a 68-week period when used for weight management (1). Additionally, it was shown to significantly lower HbA1c levels (a marker of long-term blood sugar control) in people with type 2 diabetes, reinforcing its dual benefits for both weight management and glycemic control (2).


Nutritional Considerations: Are You Getting the Right Nutrients?


While these medications may support weight loss, they also raise important questions about nutrition. For example, nausea is considered a common side effect of GLP-1 receptor agonists, and may further reduce food intake. Combined with the appetite-suppressing effects of the medication, this may make it even harder for some people to eat enough, potentially leading to nutrient deficiencies.


Research suggests that deficiencies in micronutrients such as vitamin B12, vitamin D and calcium may be more common in people using GLP-1 receptor agonists (3-5). A study published in the Journal of Clinical Endocrinology & Metabolism, for example, found that patients using these medications had significantly lower levels of vitamin B12 and folate compared to those not using them. This may be due to the delayed gastric emptying and changes in gut motility, possibly leading to potential nutrient malabsorption and gastrointestinal side effects (5). This shows the potential value in monitoring and supporting the nutritional status of those taking these medications.


The Importance of Protein Intake

For those on GLP-1 receptor agonists, ensuring adequate protein intake is another important consideration. Protein is not only essential for maintaining muscle mass but also plays a crucial role in many other bodily functions. If appetite is reduced and food intake decreases, it's essential to ensure protein is being consumed to preserve muscle mass, especially during weight loss (6). Furthermore, optimising gut health through targeted nutritional strategies such as consuming fibre-rich foods may not only contribute towards improved glycaemic control, but may also enhance nutrient absorption and support other metabolic processes in the body. Fibre has in fact been shown to affect the composition of the gut microbiome, possibly contributing to improved gastrointestinal function and reduced inflammation (7).


Let's not forget about what motivates us

While medications like GLP-1 receptor agonists may help to reduce hunger and promote weight loss, maintaining good levels of motivation is another important factor in achieving long-term success. Think about this - many people may begin using these medications with clear goals in mind, perhaps it’s weight loss, maybe improved blood sugar control, or just simply feeling better physically. However, once the medication is stopped, will those same motivations remain?


This is where sustainable behaviour change comes into play. If the underlying habits and behaviours that may have initially contributed to weight gain or poor nutrition aren’t addressed while using the medication, it may be difficult to maintain results once normal appetite and cravings return.


Understanding and acting on the underlying motivations for change – whether it’s long-term health, maintaining weight loss, or simply gaining confidence – may help people stay on track and committed to their goals, even after they stop using the medication.


I hope you found this article informative. If you're interested in learning how I can support you in sustainably achieving your long-term goals, let's talk!


References:

  1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. Lancet. 2021;398(10294):224-237. doi:10.1016/S0140-6736(21)01278-3

  2. Marso SP, Daniels GH, Brown-Frandsen K, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834-1844. doi:10.1056/NEJMoa1607141

  3. Maggioni, A., et al. (2020). The role of GLP-1 receptor agonists in glucose control and weight loss: A systematic review and meta-analysis. Diabetes, Obesity and Metabolism, 22(10), 1519-1534. https://doi.org/10.1111/dom.14035

  4. Aroda, V. R., et al. (2019). Long-term metformin use and its association with vitamin B12 deficiency and neuropathy in patients with type 2 diabetes: The Diabetes Prevention Program Outcomes Study. The Journal of Clinical Endocrinology & Metabolism, 104(2), 758-764. https://doi.org/10.1210/jc.2018-01793

  5. Christensen MB, Broch M, Madsen JC, et al. Impact of GLP-1 receptor agonists on vitamin B12, folate, and other nutritional status markers in patients with type 2 diabetes. J Clin Endocrinol Metab. 2021;106(4):e1513-e1523. doi:10.1210/clinem/dgab065

  6. Slater G, et al. (2017). Effect of a high-protein diet on lean mass preservation during weight loss. The Journal of Clinical Endocrinology & Metabolism, 102(5), 1834-1841. https://doi.org/10.1210/jc.2017-01991

  7. Reynolds A, Mann J, Cummings J, et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet. 2021 May 1;397(10294):1565-1586. doi: 10.1016/S0140-6736(20)32507-3.

 
 
 

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