GLP-1 Receptor Agonists in Obesity Management: Bridging Disease State Expertise and Real-World Insights for Pharmacists

In my early years as a pharmacist, I often found myself counseling patients about weight management, usually focusing on diet and exercise. But it’s clear that obesity is a complex, chronic disease that demands more than lifestyle advice alone. With the advent of glucagon-like peptide-1 (GLP-1) receptor agonists like semaglutide (Ozempic; Novo Nordisk) and liraglutide (Saxenda, Novo Nordisk), we now have a class of medications that can significantly impact weight loss and comorbidity management, offering new hope to patients. This evolution challenges pharmacists to expand our knowledge and embrace a more comprehensive approach to obesity care.

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Obesity is far more than a matter of willpower; it is a multifactorial disease driven by genetics, environment, and hormonal pathways that affect appetite and energy balance. Recent guidelines, including the American Diabetes Association’s 2024 Standards of Care, emphasize treating obesity as a chronic disease that requires comprehensive management.¹ GLP-1 receptor agonists have emerged as a promising option, not only improving glycemic control in patients with diabetes but also promoting substantial weight loss in those without diabetes.² This class of medications mimics theaction of the endogenous incretin hormone GLP-1, enhancing satiety, delaying gastric emptying, and reducing appetite.³

From a clinical perspective, the efficacy of GLP-1 receptor agonists in obesity management has been well established in recent trials. The STEP program, including the STEP 1 and STEP 3 trials, demonstrated that semaglutide at a 2.4 mg weekly dose resulted in an average weight loss of approximately 15% from baseline—a result that many of us could only dream of achieving with lifestyle changes alone.⁴ In the STEP 4 extension study, continued semaglutide treatment was shown to sustain weight loss, while discontinuation led to gradual weight regain, highlighting the importance of long-term therapy.⁵ As a pharmacist, I’ve seen firsthand how patients respond to these medications. Some are thrilled with the results, while others need support navigating side effects like nausea or gastrointestinal (GI) upset.

Our role as pharmacists extends beyond dispensing. I usually begin the interaction by describing how GLP-1 receptor agonists, like semaglutide and liraglutide, work by making people feel fuller and helping them manage their appetite, which supports their lifestyle changes. These drugs enhance feelings of fullness and help control appetite, complementing lifestyle interventions. I have learned that patients appreciate plain-language explanations and real-world examples—like comparing the feeling of satiety to how they feel after a holiday meal. This helps them connect science to their daily experiences.

Patient education also includes setting realistic expectations. Although some patients experience rapid weight loss, others may see gradual progress. Counseling on adverse effect management is essential, as nausea and GI disturbances are common. Encouraging patients to start with lower doses and gradually titrate, as recommended in prescribing guidelines, can make a significant difference in tolerability. I often remind patients that their journey with GLP-1 therapy is a marathon, not a sprint.

Beyond the clinic, real-world data provide invaluable insights into how these therapies perform outside of clinical trials. Recent observational studies from 2023 and 2024 have confirmed that adherence rates can be challenging, with discontinuation sometimes exceeding 40% within the first year.⁶ Pharmacists play a critical role in addressing these challenges by identifying barriers, such as cost, side effects, or misconceptions, and providing ongoing support. Moreover, pharmacoeconomic analyses have shown that despite their higher upfront costs, GLP-1 receptor agonists can be cost-effective in the long term by reducing complications like cardiovascular disease and type 2 diabetes.⁷ This type of evidence empowers us to advocate for therapy access, whether in formulary discussions or 1-on-1 with payers.

Reflecting on my experience, I am convinced that pharmacists are ideally suited to bridge the gap between clinical evidence and real-world practice in obesity management. We translate the results of landmark trials into practical advice, help patients navigate challenges, and ensure that therapies are both clinically effective and economically sustainable. As we move toward more personalized, value-based care, our role will only expand. By staying up to date with the latest research and embracing our role as educators and advocates, we can transform obesity care for countless patients who struggle with this complex disease.

References

1. American Diabetes Association. Pharmacologic approaches to glycemic treatment:Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1): S125-S143.

2. Wilding JPH, Batterham RL, Calanna S, et al. Once weekly semaglutide in adults withoverweight or obesity. N Engl J Med. 2021;384(11):989-1002.

3. Nauck MA, Quast DR, Wefers J, Meier JJ. GLP-1 receptor agonists in the treatment oftype 2 diabetes—state-of-the-art. Mol Metab. 2021;46:101102.

4. Rubino DM, Greenway FL, Khalid U, et al. Effect of continued weekly subcutaneoussemaglutide vs placebo on weight loss maintenance in adults with overweight orobesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414-1425.

5. Wadden TA, Bailey TS, Billings LK, et al. Effect of subcutaneous semaglutide vsplacebo as adjunct to intensive behavioral therapy on body weight in adults withoverweight or obesity: the STEP 3 randomized clinical trial. JAMA. 2021;325(14):1403-1413.

6. Lingvay I, Sumithran P, Cohen RV, le Roux CW. Obesity management as a primarytreatment goal for type 2 diabetes: time to reframe conversation. Lancet.2023;401(10377):1219-1231.

7. Davidson MH, Tonstad S, O’Neil PM, et al. A systematic review and meta-analysis of the economic evaluation of anti-obesity medications. Obes Rev. 2024;25(2):e13566.