Taking GLP-1? Doctors say do not forget about movement and mental health.

by Emily Siner, Nashville Public Radio and Anthony’s way and Blake Farmer, Nashville Public Radio, for KFF

Severe ankle pain led Jelon Smart to start weight loss injections a year and a half ago.

Smart was 285 pounds and worked as a caterer in Savannah, Georgia. After he stood on his feet for hours, his ankles would “swell like a football,” he says. He walked slowly. The orthopedic doctor diagnosed him with Achilles tendinitis and recommended losing weight to reduce the symptoms. Smart first took the brand name GLP-1 Ozempic.

Appetite suppression caused him to shed pounds quickly, at first.

“I lost 30 pounds at first without changing anything,” said Smart, 48. But then she found herself unable to shed extra pounds.

GLP-1s have quickly become one of the most popular types of weight loss drugs in America. Almost 1 in 5 people have taken them at some point, according to research from KFF, a nonprofit health information that includes KFF Health News. But doctors say it takes more than a regular shot for patients to achieve their long-term weight goals.

The Old-School Rules of Weight Loss and Health Still Apply

Regular exercise, smart food choices, lots of sleep – those basic, healthy lifestyle choices will not only help you lose weight on weight loss drugs but also help you keep it off, said Dafina Allen, an obesity medicine doctor who runs a clinic in Saginaw, Michigan. For example, some people find that they eat less in GLP-1, “but they’re not improving their health because they’re not exercising. They’re not improving the quality of the food they’re eating,” said Allen. The path to weight loss is also guided by hormones, metabolism, and genetics.

After his weight loss on Ozempic plateaued, Smart realized he had to start moving his body, too. “I’m in the gym now six days a week,” he says. “I went from 285 to 175” pounds. The swelling and pain in her ankle went away as well.

Mental Health Issues, Too

Mind and body are very connected. Food and body image can be emotionally charged, Allen says. “I can tell you about patients that I helped lose 50 pounds, that I helped lose 100 pounds, and they still look in the mirror and are not happy.”

The key is to seek mental health help along the way, says Gerald Onuoha, who practices internal medicine in Nashville, Tennessee. “Making sure you’re talking to people about your concerns, whether it’s a family member or a licensed professional, I think goes a long way,” he said.

Work with a Doctor to Monitor Your Dosage

Onuoha says people can experience serious problems if they increase their GLP-1 dose too quickly or don’t follow the recommended schedule. He sees patients come to the hospital with pancreatitis, gallstones, or acute kidney injury. “I always ask patients who are on GLP-1s: How long have they been on it?” he said. “Did they follow the instructions? Because those things determine whether you’re going to have those complications or not.

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Part of the problem, Allen said, is that GLP-1s are relatively easy to access — and often cheaper — through online pharmacies or websites, but those providers can’t educate patients about their dosage or side effects. “So they can be online, looking for a random company that will deliver to their home, where they don’t know what dose of medicine they’re taking, or if the medicine is safe for them as a patient with a medical condition,” he said.

People and Policy

GLP-1 drugs can be expensive, and most insurance programs – public or private – do not cover weight loss medications. Medicaid, a government program that covers 69 million Americans, covers GLP-1 for medically accepted conditions such as diabetes, but only about a dozen states’ Medicaid programs cover GLP-1 for the treatment of obesity, according to KFF. For older Americans with Medicare, the federal government plans to allow temporary coverage of GLP-1s for weight loss starting in July.