Questions about GLP-1 medications: What to know before starting one

Tonia Vinton, M.D., Medical Director of the UT Southwestern Weight Wellness Clinic at Texas Health Dallas, Assistant Professor of Internal Medicine in the Division of Endocrinology, and a physician board-certified in obesity medicine, talks about the use of medications in the treatment of obesity.

While glucagon-like peptide 1 receptor agonist (GLP-1) medications have been available for more than 20 years for diabetes management, they burst on the scene in a big way in 2021 after semaglutide was approved for chronic weight management.

Since then, this class of medications now has FDA-approved uses beyond glucose and weight management, including reducing cardiovascular risk, slowing the progression of diabetic kidney disease, and treating obstructive sleep apnea and metabolic dysfunction-associated steatohepatitis (MASH) – previously known as fatty liver disease. Research is also exploring other potential uses, including substance use disorders.

As uses of GLP-1s such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound) evolve, new questions and misperceptions are being raised by patients and physicians alike: What’s new with these medications? What’s the truth about symptoms, expectations, and duration of treatment?

Here are some of the latest questions patients are asking about these medications and where the research is headed.

Q: Will I have to take a GLP-1 forever?

A. Maybe, because obesity is a chronic disease.

Man with obesity talking with a therapist — Obesity is a chronic disease. It took time to gain weight, and it takes time to lose it in a healthy, sustainable way.

Obesity is a chronic, biologically based disease, not a failure of willpower. It not only affects people’s weight but also their long-term physical and emotional health.

However, it can be difficult for patients to accept this as truth after they’ve faced stigmas about obesity throughout their lives. Because of the ingrained untruths associated with obesity, patients often view obesity as an acute health problem and not as a chronic disease.

So, while a patient may be fine with taking medication for life for hypertension or high cholesterol, they may be concerned about the possibility of taking a GLP-1 long term. Out-of-pocket costs can also be challenging for families if the medication is not covered by health insurance.

In the UT Southwestern Weight Wellness Program, we explain up front that most patients should plan to be on medication for a long time and see how they respond to treatment. It often takes longer than people expect to reach a healthier weight and improve their overall health.

Clinical studies show that weight regain is common after obesity medications are stopped. In the STEP 1 extension study, participants regained approximately two-thirds of the weight they had lost within one year after stopping semaglutide. This is consistent with the chronic biology of obesity and does not mean that the medication or the patient “failed.”

Obesity is a chronic disease, and everyone’s experiences with weight management and medications will be unique. To see a sustainable health change, we need to treat obesity with long-term lifestyle changes and comprehensive care – including medication, nutrition support, physical activity, sleep care, and behavioral support – that can help patients sustain improvements in health.

Q: Are GLP-1 medications purchased online safe and effective?

A: That depends on the prescriber and product.

Listen to the radio or scroll on social media, and chances are you’ll get an ad for a GLP-1 medication. Some telehealth services appropriately prescribe FDA-approved medications and provide ongoing follow-up. However, compounded semaglutide and tirzepatide are not FDA-approved and do not undergo FDA premarket review for safety, effectiveness, or quality. The FDA has also warned about dosing errors, fraudulent labeling, and products marketed as unapproved alternatives to FDA-approved medications. Use only medication prescribed by a licensed clinician and dispensed by a state-licensed pharmacy. Ask whether the medication is FDA-approved or compounded, which pharmacy will dispense it, and what monitoring and follow-up are included.

Online stores that sell GLP-1s generally don’t provide the wraparound care patients need for long-term success. Patients tend to see better results when they take medications that are approved by the FDA and work with a team of experts who provide supportive care, including:

Dose selection, adjustment, and monitoring
Nutrition counseling
Individualized physical activity and resistance-training guidance
Screening and treatment for sleep disorders when indicated
Behavioral health and eating-behavior support when needed

Addressing these foundational pillars of obesity care will give you the best chances of achieving your goals – and sustaining them long term.

Q: What health symptoms are caused by my GLP-1?

A: Gastrointestinal symptoms are most common, but new, severe, or persistent symptoms should be discussed with the prescribing clinician.

There are some known side effects with GLP-1 medications. Some of these include:

Woman raising arm in celebration in front of a mirror — People should be talking with their physician about any side effects they might experience while taking a GLP-1 medication.

Gastrointestinal symptoms: GLP-1s alter stomach emptying, which can result in acid reflux, nausea, constipation, or diarrhea. Symptoms are often most noticeable during dose escalation and may improve with time, more gradual dose increases, and dietary adjustments. Contact your clinician if symptoms are severe or persistent or if you cannot maintain adequate hydration.
Reduced interest in alcohol: Some patients report less interest in alcohol, and clinical trials are investigating whether GLP-1-based medications may eventually have a role in treating alcohol or other substance use disorders. This is not currently an approved indication.

Substantial or rapid weight loss, regardless of how it is achieved, can be associated with temporary hair shedding, menstrual changes, loss of facial volume, and loose skin. These are not necessarily direct medication effects and may also reflect reduced energy or nutrient intake, hormonal changes, or another medical condition.

Weight loss may also improve ovulation and fertility. Patients who could become pregnant should discuss pregnancy plans and contraception with their clinician. Tirzepatide may reduce the effectiveness of oral contraceptives during treatment initiation and after dose increases.

However, some symptoms may be coincidental and are not yet proven to be associated with GLP-1s. If you have new or worsening symptoms after starting any type of medication, talk with a doctor to determine the root cause.

Q: Can GLP-1s help with conditions beyond diabetes and obesity?

A: There are many new indications for these drugs – talk with a doctor about your options.

There have been several new FDA approvals for GLP-1 medications in recent years. Outside of obesity and diabetes:

Wegovy (semaglutide) is approved to reduce the risk of cardiovascular death, nonfatal heart attack, and nonfatal stroke in adults. People who have had certain types of heart disease, stroke, or peripheral vascular disease may benefit from the medication.
Ozempic (semaglutide) is approved to reduce the risk of sustained kidney-function decline, end-stage kidney disease, and cardiovascular death in adults with Type 2 diabetes and chronic kidney disease.
Wegovy (semaglutide) is also approved to treat adults with metabolic dysfunction-associated steatohepatitis, or MASH, previously known as fatty liver disease.
Zepbound (tirzepatide) is approved to treat moderate-to-severe obstructive sleep apnea. With treatment, patients may have significant improvement in sleep apnea symptoms such as snoring and fatigue.

GLP-1s have been shown to reduce inflammation throughout the body. Research is examining many other potential uses, but patients should not use these medications for an unapproved condition without consulting an appropriate clinician.

Fruits on white table next to blue hand weights

Weight Wellness Day 2026

Learn practical, science-based information about achieving and maintaining a healthy weight at UT Southwestern's annual Weight Wellness Day. The free event will be from 9 a.m. to 2:30 p.m. Saturday, Oct. 10, at the UT Southwestern campus in Dallas. 

Find out what’s fact and fiction about medications for weight management and other emerging therapies from UT Southwestern physicians, researchers, and other healthcare professionals. Also, enjoy a cooking demo, featuring tips and practical ways to eat healthy, nutritious foods.  A complimentary lunch will be served. RSVP is required. Register here.

Q: How should I handle comments or stigma around taking a GLP-1 medication?

A: Remember that obesity is a chronic disease, and using evidence-based treatment is nothing to be ashamed of.

After starting a GLP-1 medication – or any weight-management lifestyle change – some patients are disappointed by reactions from their loved ones.

Friends and family members who encouraged them to lose weight may make comments such as “You’re so skinny now!” or “So, you took the ‘easy’ route with medication?” – tropes that are also common with bariatric surgery. While likely well-intended, such comments can be hurtful, especially for people who’ve struggled with the stigma of obesity in the past.

So, let’s clarify a few facts to dispel some of the hurtful or stigmatizing comments you might hear during your weight-loss journey:

Your goals may include improvements in glucose, blood pressure, sleep, mobility, physical function, and quality of life – not just the number on the scale.
Obesity is a chronic health condition, and it is OK to use proven tools such as medication to take care of your mind and body.
Body size alone does not define health, and meaningful health improvements can occur even when changes in appearance are modest.
Losing weight, and thereby physical size, is a big change for you and the people around you. Stick to your plan and ask your doctor for tips on how to gently rebuff food offerings or comments from loved ones who may not understand the complexities of obesity care.

What every patient should know before starting a GLP-1

It’s not a silver bullet

GLP-1 therapy is meant to support the weight-loss journey, not replace healthy lifestyle strategies. Good nutrition, mood management, sleep hygiene, and physical activity are foundational to obesity treatment and long-term weight wellness.

Woman talking with therapist — Patients may find that behaviorial support can help as part of their wellness journey.

The medications can help to reduce food noise, lessen cravings, and curb appetite. Some patients also benefit from behavioral health support for emotional or disordered eating, body-image concerns, or adjustment to rapid changes in weight.

Protein is your nutrition foundation

In our first consultation, we’ll discuss your daily nutrition plan. Your clinician or registered dietitian can help you plan regular meals or snacks that provide adequate protein, fluids, fiber, vitamins, and minerals despite reduced appetite.

If food intake becomes too low or nutritionally incomplete, people may lose more lean mass along with fat, which can contribute to reduced strength, energy, and physical function.

A practical starting target for many adults is 20-30 grams of protein at each meal, but needs vary based on age, body size, kidney function, physical activity, and total food intake. Prioritize protein and include vegetables, fruit, and other fiber-rich foods as tolerated. A registered dietitian can help establish an individualized target.

Behavioral health support can help

Obesity is a complex chronic disease, and emotional health and eating behaviors can affect, and be affected by, treatment. Participating in cognitive behavioral therapy or other behavioral support can help patients identify triggers, develop coping strategies, and address emotional eating, disordered eating, or body-image concerns.

It can be difficult to discuss painful experiences and new feelings that surface as your relationship with food shifts. But addressing the emotional aspects of obesity will give you a better chance at long-term success.

Taking a GLP-1 medication is a personal decision. Treatment should be individualized. Some patients use lifestyle intervention alone, while others benefit from medication, metabolic or bariatric surgery, or a combination of treatments.

Talk with an obesity specialist when you are ready to take the next steps in your weight-management journey. We can help you choose the best path forward for today and in the long term.

To talk with an expert about GLP-1 medications for weight loss, make an appointment by calling 214-645-2800 or request an appointment online.