GLP-1 Medications: Setting Patient Expectations with Your Information

Writing is not my only job. My other job as a nurse practitioner still involves clinic work. One of the most frequently asked about topics by my patients for the last year is the GLP-1 weight loss medications, like Wegovy. This is not surprising given all the press these medications receive. At this point, I'm more surprised when a patient tells me they just learned about the medications.

It can take a lot of mental preparation for a patient to come in and ask for help, especially with a sensitive topic like obesity. Having reasonable expectations about weight loss treatment is vital for them to feel good about asking for help while having an informed conversation with their healthcare provider. Organizations publishing articles or information on these medications can help set realistic expectations for patients before they walk into my office or anyone else's by publishing balanced information. Here are some suggestions to better inform the patients.

Cost of GLP-1 medication

Occasionally, I see an article that talks about price, but more can do a better job of addressing this. When a patient has come ready to talk about the amazing weight loss medication they've heard about, they are excited. Then I burst their excitement bubble by telling them the cost. It's heartbreaking to watch their faces change into shock and disbelief. With a base price of about $1350 for a 28-day supply of Wegovy (semaglutide), these medications are out of reach for many. Even with insurance. Many insurance carriers require a patient to try and fail other methods before qualifying for a GLP-1 prescription. In my practice, many of my patients are on Medicare or Medicaid. Medicare does not cover the cost of weight loss medications, and Medicaid coverage is variable depending on the state. Just hearing the cost alone is a turn-off for many patients. Which then leads to the follow-up question: what else is there?

Alternative medications

The growth of compounded equivalents to the GLP-1 medications has grown as quickly as the popularity of the weight loss drugs. Patients are becoming more aware of this option, but don’t quite understand the differences with compounded drugs. Explainers would help with informing them about compounded drugs and compounding pharmacies, along with why this may or may not be worth pursuing as an alternative.

Other weight loss medications are not new. They just haven't gotten the press that the GLP-1 medications have. That is, except for the ones that cause dangerous or unpleasant side effects, like anal leakage. I'm looking at you fen-phen and Orlistat. Organizations can educate on the spectrum of weight loss medications by writing separate articles or Including information about alternatives in along with the GLP-1s. This will help the patient speak with their healthcare provider from a place of knowledge and not just popularity. Knowing about other options is also helpful for patients who are not good candidates for the GLP-1s due to side effects or other health issues.

Setting patient expectations

The medications work well for many people, but not everyone. They are also not magic. Fat will not just melt off the body. Educating patients about the slow ramp-up of the GLP-1s and anticipation for gradual weight loss will help better align expectations for those starting treatment. People need to hear this little bit of information many times on repeat instead of having only stories about extreme weight loss highlighted. I educate my patients about gradual weight loss at each visit and still have patients say, "I thought I would have lost more by now." As if by magic. This is medicine, not magic.

Patients should also know they still need to address lifestyle. They must establish healthy eating habits for multiple reasons:

• The body still has nutrition requirements. If they are eating less food overall, that food needs to provide a bigger nutritional value.

• If they come off the medication and haven't established a healthy eating plan, they will likely gain their weight back. I've had patients go on a GLP-1 with great success but ignore this piece of advice only to gain all their weight back and more when their insurance no longer covered the medication. This also applies to patients who don't want to take weight loss medication forever. Providing details on establishing healthy habits will make the transition easier.

• Healthy food choices help minimize side effects. Because the GLP-1 medications slow gastric emptying, constipation becomes a problem for many. Food options high in fiber can help reduce constipation.

Health information not only informs patients but also helps to set expectations on treatment options. By publishing content that strikes a balance between hope and realistic ideals, organizations arm patients with the knowledge to have better shared decision making with their healthcare team.