Kickstart Weight Loss Goals: Evidence-Based Strategies for the New Year
As the new year begins, many patients focus on improving their health, with weight management being a top priority. Pharmacists are in a unique position to guide patients with evidence-based solutions that balance functional medicine root cause principles with traditional pharmaceutical care. This article explores the how glucagon-like peptide 1 (GLP-1) receptor agonists aid in weight loss, the root causes of weight gain to consider and educate patients about, over the counter (OTC) supplement weight loss aids, and pharmacist-led coaching tips for sustainable weight loss.
The Science of GLP-1 Receptor Agonists
Mechanism of Action
GLP-1 receptor agonists, such as semaglutide (Ozempic®, Wegovy®) and tirzepatide (Mounjaro®), mimic the hormone glucagon-like peptide-1 made naturally in the gut to regulate blood sugar and appetite by:
- Enhancing insulin secretion while suppressing
- Slowing gastric emptying, which increases
- Improving metabolic and cardiovascular health through reduced inflammation and oxidative stress.
Comparing Semaglutide and Tirzepatide
- Semaglutide: Approved for type 2 diabetes and obesity, clinical trials show an average weight loss of 15% of body weight over 68 weeks.
- Tirzepatide: A dual gastric inhibitory polypeptide (GIP/GLP-1) receptor agonist that can lead to 20-25% weight loss over 12 months, outperforming semaglutide in head-to-head trials.
- These medications have been showing significant health outcome benefits aside from weight loss and diabetes.
- Reduced Major Cardiovascular Events (MACE): GLP-1 Receptor Agonists (Ras), such as liraglutide (Victoza®) and semaglutide (Ozempic), have been shown to reduce the risk of cardiovascular events, including heart attack, stroke, and cardiovascular-related death, particularly in patients with type 2 diabetes.
- Improved Blood Pressure: They help lower systolic blood pressure, likely through weight loss and improved vascular function.
- Reduced Inflammation and Oxidative Stress: GLP-1 RAs decrease markers of inflammation and oxidative stress, supporting heart health.
- GLP-1 RAs may indirectly improve sleep apnea symptoms by promoting weight loss, reducing the accumulation of fat around the neck, and improving airway
- GLP-1 RAs have shown promise in improving insulin sensitivity, aiding weight loss, and restoring ovulatory function in women with Polycystic ovary syndrome (PCOS).
- Cognitive Function: Preclinical and early clinical studies suggest GLP-1 RAs may reduce the risk of neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, by reducing inflammation and oxidative stress in the brain.
- Mood Disorders: Improvements in metabolic health may positively influence symptoms of depression and anxiety, which are often linked to obesity and
- Exercise: A combination of aerobic and resistance training is recommended for optimal fat loss and lean muscle preservation. When lean muscle is lost and not preserved, future metabolic challenges will arise.
- Stress management: Encourage mindfulness, yoga, or breathing exercises to lower cortisol levels. There are apps for hypnosis and guided meditations that can also be used.
- Sleep hygiene: Highlight the importance of 7-9 hours of quality sleep per night to support metabolic health. There are multiple supplements such as melatonin that can aid in sleep enhancement, and as Pharmacists we should review their medications and the time they take them to determine if any medications are contributing to sleep disturbances or weight gain.
Addressing Barriers to Access
While these medications are effective, shortages, cost, and insurance coverage may limit access. Pharmacists can:
- Recommend patient assistance programs like those offered by manufacturers of Ozempic, Wegovy, and Zepbound has a vial available from Eli Lilly in a direct to patient program that can offer cost savings as well.
- Provide guidance on lifestyle strategies and adjunctive medications, such as sodium-glucose cotransporter 2 (SGLT-2) inhibitors or Dipeptidyl peptidase-4 (DPP-4) inhibitors, to support weight management when GLP-1 agonists are unavailable. I personally like to utilize acarbose as an adjunctive medication that can help support sustainable eating habits and prevent diabetes from developing.
Understanding the Root Causes of Weight Gain
Weight gain is often multifactorial, involving a complex interplay of:
- Hormonal imbalances: Insulin resistance, hypothyroidism, and cortisol dysregulation can impair metabolism. Offering functional lab testing for patients, or recommending which traditional labs they should discuss with their Primary Care Provider can help discover root cause
- Gut microbiome health: Dysbiosis and a lack of beneficial bacteria, such as Akkermansia muciniphila, may contribute to weight There are stool tests available such as Gastrointestinal (GI) Map that can be ordered to determine the particular imbalance. There are also multiple probiotics available to specifically help with metabolic functioning with certain strains of probiotics.
- Chronic stress and sleep deprivation: Both elevate cortisol levels, promoting fat storage and reducing energy Adults need at least 7 hours of sleep per night. There are multiple apps available to help with stress resilience and thought reframing, as well as labs to test their cortisol levels.
- Poor dietary habits: Overconsumption of processed foods, alcohol, refined sugars, and unhealthy fats disrupts metabolic regulation.
Over-the-Counter Weight Loss Aids: Evidence-Based Recommendations
Patients often turn to OTC supplements for weight loss. Pharmacists can guide them toward options with scientific backing while addressing safety concerns:
- Fiber supplements (e.g., psyllium husk): Promote satiety and improve gut
- Green tea extract: Contains catechins that may modestly boost
- Protein powders: Support lean muscle mass preservation during weight L-carnitine is another popular supplement to help with cellular metabolism.
- Caffeine-based products: Enhance thermogenesis but should be used cautiously in those with cardiovascular risks.
- Avoid unproven or harmful products: Warn patients about supplements containing ephedra, synephrine, or excessive stimulants, which pose significant health risks.
Pharmacist-Led Coaching for Sustainable Weight Loss
Goal Setting
- Encourage SMART goals: Specific, Measurable, Achievable, Relevant, and Time-bound.
- Focus on non-scale victories, such as improved energy, improved confidence, an increase in comfort in their body and clothes, or reduced blood sugar levels.
Avoiding Fad Diets
- Educate patients on the pitfalls of extreme diets (e.g., keto, juice cleanses) that are unsustainable and may lead to nutrient deficiencies.
- Promote sustainable dietary approaches, such as:
- Mediterranean diet: Emphasizes whole foods, healthy fats, and lean
- Plant-based eating: Incorporates high-fiber, nutrient-dense
- Intermittent fasting: Supports metabolic flexibility without severe caloric
Lifestyle Strategies
- Exercise: A combination of aerobic and resistance training is recommended for optimal fat loss and lean muscle preservation. When lean muscle is lost and not preserved, future metabolic challenges will arise.
- Stress management: Encourage mindfulness, yoga, or breathing exercises to lower cortisol levels. There are apps for hypnosis and guided meditations that can also be
- Sleep hygiene: Highlight the importance of 7-9 hours of quality sleep per night to support metabolic There are multiple supplements such as melatonin that can aid in sleep enhancement, and as Pharmacists we should review their medications and the time they take them to determine if any medications are contributing to sleep disturbances or weight gain.
Monitoring and Support
- Use tools like body composition analysis (e.g., dual x-ray absorptiometry scan [DEXA]) to track progress beyond the scale.
- Offer personalized coaching sessions to help patients adjust their treatment plans as
- Educate patients on tools that are available, such as Continuous Glucose Monitors (CGMs), in order to empower them to learn how certain foods and drinks affect their levels. Teaching them the levels they should remain between can give them a SMART goal to accomplish.
Functional Medicine and Traditional Pharmacy: A Balanced Approach
Combining functional medicine principles with traditional pharmaceutical care allows pharmacists to address the root causes of weight gain while supporting patients with evidence-based solutions. Key strategies include:
- Optimizing gut health through probiotics, prebiotics, and anti-inflammatory
- Identifying and addressing hormonal imbalances with targeted lab
- Leveraging pharmacologic options when lifestyle changes alone are
Key Takeaways for Pharmacists
- Educate patients on the benefits and limitations of GLP-1 receptor
- Address root causes of weight gain using a functional medicine
- Recommend evidence-based OTC weight loss aids while cautioning against unsafe
- Provide personalized coaching to support sustainable weight loss and lifestyle
- Empower patients with resources, such as patient assistance programs and educational
With the right guidance, pharmacists can play a pivotal role in helping patients achieve their weight loss goals safely and effectively in the new year.