The number of Americans taking tirzepatide and semaglutide – the active ingredients in GLP-1 medications such as Wegovy, Zepbound, Mounjaro and Ozempic – has increased rapidly in just a few years. First approved to treat diabetes and now prescribed to address obesity-related health complications, GLP-1 drugs have transformed the lives of many patients who have struggled with losing weight by mimicking a natural hormone that controls appetite and feelings of fullness.
However, several factors may hinder successful medication results, according to John Morton, MD, medical director of Bariatric Surgery at Yale New Haven Health and professor of Surgery (Bariatric, Minimally Invasive) at Yale School of Medicine. Dr. Morton, who is board-certified in obesity medicine, is also co-director of the Center for Weight Management at Yale New Haven Health.
“Patients may have to stop taking GLP-1 medications because of side effects, affordability or lack of insurance coverage,” Dr. Morton said. “However, it’s not a good idea to stop suddenly.”
Side effects of GLP-1 medications
GLP-1 medications can have effects on the gastrointestinal (GI) tract that include nausea, vomiting, stomach pain, bloating, diarrhea and constipation. For many people, these side effects are temporary and improve over time. However, in rare cases more serious side effects have also been reported. Examples include gastroparesis (a condition where the stomach takes longer to empty food than it should), gallbladder problems, bowel obstructions and pancreatitis.
Approximately 10 percent of patients have no treatment response to GLP-1 medications at all, according to Dr. Morton. “They get frustrated, blame themselves when the drugs don’t work and just stop taking them,” he said. “However, obesity is a difficult condition and not every treatment works for every patient.”
Why you shouldn’t suddenly stop taking GLP-1 medications
If you’re taking a GLP-1 medication to treat diabetes, it can be dangerous to stop suddenly. “If you’re diabetic, it can cause issues with your blood sugars,” Dr. Morton said.
When it comes to treatment for weight loss, there may be a “rebound effect” when the medications are stopped. In other words, you may start to put back on the weight you’ve lost – and more. “The weight regain often occurs faster than the weight loss, and you may regain in 4 months what it took you a year to lose,” he said. Patients may also experience a significant amount of gastrointestinal upset after a sudden halt.
The benefits of specialty pharmacists
So, if you experience side effects while taking GLP-1s or your insurance ceases coverage for the cost of the medication, what can you do? Dr. Morton recommends a consultation with your doctor or pharmacist, who can help you deescalate gradually or transition you to another medication. That’s why the team at the Center for Weight Management includes clinical pharmacists from Yale New Haven.
“Medication dosages are patient-specific, and we can work with you to find a dose that you can tolerate without too many side effects,” said Veronica Arceri, PharmD, a clinical pharmacist at Yale New Haven Health who specializes in metabolic disorders. “Or if one particular brand of medication causes unpleasant side effects that can’t be resolved by adjusting the dosage, we can substitute another type or brand of medication that will treat your specific condition.”
Special populations such as elderly patients, pregnant women and those who are trying to conceive may require additional support – and pharmacist assistance in supporting these populations is a priority for the Yale New Haven Health program.
According to Arceri, it’s more likely that people are forced to stop taking GLP-1 medications due to a lack of insurance coverage. Outpatient Specialty Pharmacy Services has established a Center of Excellence for Metabolic Health and Weight Management to support patients on weight management medication, providing the highest levels of expertise, pharmacy practice, medication safety and comprehensive pharmacy services. This expert team also helps support insurance coordination and other administrative needs to ensure access.
Alternatives to GLP-1 medications
So if you are unable to take GLP-1 medications due to side effects or lack of insurance coverage, what other options are there for you?
According to Dr. Morton, the good news is that the treatments are better than ever. The Center for Weight Management brings together experts in the field of medical and surgical weight-loss, endocrinology, behavioral health, nutrition and exercise physiology to provide the best comprehensive care.
“We provide a number of safe and effective treatment options and services, including medications, endoscopic treatments, choices of surgery, support for lifestyle changes, behavioral health consultations, exercise classes and our state-of-the-art Teaching Kitchen,” he said. “Our specialists can work with you to decide which interventions are best for you. The program is a lot like what we have for cancer or heart disease, where it's not one single therapy, but multiple therapies that we can combine – and that's really where you see a difference.”
