There are plenty of myths surrounding GLP-1 medications, and it is important to set the record straight. As someone who has worked closely with these medications, I have seen first-hand how helpful they can be in weight loss and managing blood sugar. However, misconceptions persist that can confuse patients and lead to unnecessary fears.
In this article, we will break down the top 15 myths about GLP-1s, covering everything from concerns about muscle loss to myths about heart disease. Let’s bust these myths once and for all and help you understand how weight loss injectables really work, so you can make informed decisions about your treatment.
1. Myth: GLP-1s Cause Small Bowel Obstructions
GLP-1s slow down the movement of food through the gut, which can lead to side effects such as constipation, nausea, and vomiting. This can be worse if you are a fast eater, so it is essential to focus on eating slowly. These side effects are lessened if you take the injection at night and eat the next day to keep food moving through the gut, even if you feel nauseous.
That said, if you already experience issues with constipation, use extra caution. These medications can reveal or worsen conditions like gastroparesis—a condition where the muscle contractions needed to move food through the gut are impaired. If constipation lasts more than a few days, or if you need anti-nausea medication regularly to tolerate GLP-1s without dose increases, this medication may not be for you. Make sure to inform your physician, as they may need to adjust or stop the medication.
In addition to the above symptoms, small bowel obstructions (SBOs) involve severe pain at the site of the blockage. Although SBOs are rare, they can happen, so you should stop all medication immediately and get medical help if needed, as they can be life-threatening.
In summary, SBOs are extremely rare on these medications, but always keep an eye on your bowel movements, severe nausea with vomiting that doesn’t resolve on its own, or intense belly pain that doesn’t go away.
2. Myth: GLP-1s Cause Extreme Muscle Loss
It is important to understand that muscle loss is not caused by the GLP-1 medication itself, but by the nutritional plan that accompanies it. Many people view GLP-1s as a “magic bullet” and believe that any weight loss is beneficial, leading them to push for more weight loss by undereating, which results in muscle loss.
These drugs are very powerful and can completely turn off hunger signals. This is why it is so important to follow a high-protein nutrition plan alongside the medication. As we have mentioned before, to maintain your muscle mass during weight loss, you should aim to consume at least half your weight in pounds in grams of protein, and even more if you are very active. For many people, this can be hard to do and requires a structured plan, often with documentation. My patients who follow their established plans are not having these issues.
3. Myth: If You Stop Your GLP-1 Medicine, You Will Gain All the Weight Back
There is a risk of regaining weight after stopping GLP-1 receptor agonists, especially if underlying lifestyle changes, such as diet and exercise, are not maintained. “Metabolic Adaptation” occurs regardless of how you lose the weight, making it difficult to keep a significant amount of weight off long-term, no matter the method.
As we lose weight, some muscle loss is inevitable, even with careful management. The key is to minimize this loss through strength training, staying active, and keeping protein high in your diet. Additionally, as weight is lost, hunger hormones (like Ghrelin) increase while fullness hormones (such as GLP-1, CCK, and Leptin) decrease, leading to increased hunger.
All of this causes our body to return to its “set point” weight. Using an appetite suppressant and focusing on a high-protein diet and regular exercise during maintenance can help counter this effect, ultimately working to “reset” our set point.
In summary, long-term use of GLP-1s may be necessary for sustained weight management, just as ongoing treatment is required for other chronic conditions like hypertension or diabetes. (We don’t stop those medications once conditions are under control, so why stop GLP-1s?)
4. Myth: GLP-1s Cause Cancer
Some early animal studies suggested a potential link between GLP-1 medications and thyroid cancer, specifically in rodents. However, these findings have not been confirmed in humans. Current evidence suggests that the cancer risk associated with GLP-1s is very low, and ongoing studies continue to monitor their long-term safety.
It’s recommended that patients with a personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) avoid GLP-1 medications. For the majority of people, however, the risk remains minimal.
5. Myth: GLP-1s Cause ‘Ozempic Face,’ ‘Ozempic Butt,’ and Other Unwanted Changes
When someone loses weight quickly and isn’t eating enough—especially protein—they can start to look malnourished. Sometimes, this even shows up in bloodwork with low albumin levels. The media has coined terms like “Ozempic face” or “Ozempic butt” to describe this look.
In reality, it all goes back to getting enough protein to support muscle mass during weight loss. I can’t emphasize enough how powerful these drugs are; they can completely turn off hunger—something that isn’t always beneficial without close monitoring by a medical team.
6. Myth: GLP-1s Cause Pancreatitis
Pancreatitis is an inflammation of the pancreas, causing sharp pain in the epigastric region (typically above the belly button). Clinical trials and observational studies have not consistently shown a strong link between GLP-1 agonists and pancreatitis, so the risk is considered relatively low. However, in general, it is advised against prescribing GLP-1s to anyone with a history of acute pancreatitis.
One exception could be gallstone pancreatitis; if the gallbladder has been removed and the cause is resolved, GLP-1s may still be an option. In my personal experience, I haven’t encountered any cases of pancreatitis among the hundreds of patients I’ve treated with GLP-1s. However, I generally avoid prescribing these medications to anyone with unexplained pancreatitis in their past.
7. Myth: GLP-1s Are Dangerous
For most people, GLP-1s are not considered “dangerous” when prescribed appropriately and monitored by a healthcare provider. The benefits, particularly for controlling blood sugar and promoting weight loss, often outweigh the risks. However, they may pose higher risks for certain individuals, especially those with a history of pancreatitis, thyroid cancer (medullary, which is extremely rare), Multiple Endocrine Neoplasia, or severe gastrointestinal issues.
That said, my greatest concern with this class of drugs is not the inherent danger of the medications themselves, but rather the way they are prescribed—often with minimal follow-up, an inadequate nutrition plan, and wrong doses. There are so many nuances to these medications that patients must be followed very closely. The fact that these medications completely turn off appetite at higher doses and prevent people from not only eating but drinking water creates a danger that many do not realize.
Dosing availability can also be inconsistent, which forces patients to start, stop, and adjust doses in ways that are not medically appropriate. It is also extremely important to obtain these medications from a reliable source (there are many counterfeit products out there) and to have regular follow-ups throughout the process.
8. Myth: GLP-1s Have Scary Needles, So I’m Afraid to Inject Myself
The needles for Semaglutide and Tirzepatide are very small—about the size of an insulin syringe (32 gauge, 4mm), which is roughly as thin as a strand of hair. With the pen design, you simply push a button, so you won’t see the needle and will barely feel it. In our office, we guide patients through their first injection to ensure they feel comfortable. From my experience, once patients see how easy it is, even if they’re initially nervous, they often feel confident enough to continue the medication long term.
9. Myth: You Can Easily Stop and Restart GLP-1s After Missing Doses
GLP-1s can be tricky to manage if doses are missed. Every time you skip a dose, your body needs time to readjust. It is recommended to take your weekly dose at the same time each week for this very reason. Titrating too quickly, or resuming the previous dose after missing several, can lead to severe side effects, including nausea and vomiting. Missing even a single dose can disrupt the balance, and missing multiple doses without adjusting downwards can sometimes lead to hospitalization.
Supply chain issues make it difficult to stay on a regular schedule, so if you miss a few doses and cannot get the next lower dose, discuss alternatives with your provider. Cases where you hear about people having intractable vomiting are often related to some sort of dosing issue.
10. Myth: GLP-1 Agonists Cause Heart Issues
There is no evidence showing that GLP-1s cause heart disease. In fact, several studies have demonstrated that GLP-1 receptor agonists can reduce the risk of major cardiovascular events, especially in people with type 2 diabetes. These medications have been shown to help protect against heart attack, stroke, and cardiovascular death, particularly in patients who already have pre-existing cardiovascular conditions.
11. Myth: GLP-1s Cause Extreme Fatigue and Weakness
As I have mentioned previously, it is not the medication itself that causes fatigue and weakness, but rather the fact that GLP-1s can turn off hunger and thirst, which leads to these side effects. These symptoms are often related to hypoglycemia, dehydration, or both.
It is crucial to follow a proper nutritional plan while on these medications. Without the natural stimulation to eat or drink, the dose will likely need to be decreased (I have done this several times with my patients). Fatigue and weakness while using these drugs are almost always caused by something else. If this happens, make sure to consult with your physician to determine the cause.
12. Myth: GLP-1 Medications Are a Quick Fix for Weight Loss
While GLP-1 receptor agonists can support significant weight loss, they are not a magic bullet. These medications help by reducing appetite, slowing gastric emptying, and improving insulin sensitivity, but they need to be used alongside lifestyle changes like healthy eating and regular exercise for sustainable, long-term results.
It is important to remember that the goal is to lose fat, not muscle. The number on the scale does not tell the whole story. Fat loss, not just weight loss, is key to achieving lasting health benefits.
13. Myth: GLP-1 Drugs Work the Same for Everyone
The effectiveness of GLP-1 receptor agonists can vary greatly between individuals. Some people experience substantial weight loss or better blood sugar control, while others may not respond as dramatically. Genetics, lifestyle, and individual metabolic factors play significant roles in how someone responds to these medications.
I have had patients who lost very little on one drug, then experienced significant weight loss with another. It is important to understand that the process of finding the right medication and dosage can be highly individualized.
14. Myth: GLP-1 Medications Are Unsafe for Long-Term Use
As discussed previously, long-term studies on the safety of GLP-1 receptor agonists are ongoing, but current data from clinical trials suggest that they are safe for extended use when properly monitored by a healthcare provider. Like any medication, side effects are possible, but most are manageable and tend to diminish over time.
It is important to note that these medications have been in use for nearly a decade for diabetes management. Semaglutide, for example, has been available since 2015, providing almost 10 years of data showing its safety for long-term use.
15. Myth: Most People Who Start GLP-1s Stay On Them Because They Are So Easy to Take
This is where medical weight loss clinics shine! Most of our patients who start GLP-1s stay on them long-term, while the general abandonment rate for GLP-1s used for weight loss is about 50%.
As mentioned above, there are many nuances to these medications that can make it difficult to use them effectively without proper guidance. For this reason, I urge you to find an Obesity Medicine Specialist in your area with a comprehensive medical weight loss practice to guide you through the process. With the right support, you can avoid becoming a statistic and successfully continue on your weight loss journey.
Clearing Up the Confusion Around GLP-1s
By addressing these common myths, you now have a clearer understanding of what GLP-1 medications are really all about. It is important to take a well-rounded approach to weight loss, one that includes not just the right medications but also balanced nutrition, regular exercise, and the proper medical guidance.
Remember, sustainable weight loss is about finding what works for you. GLP-1s can be a helpful tool, but your long-term success relies on a thoughtful, personalized plan. Here’s to making informed choices and achieving your health goals with confidence!
