Beyond Ozempic: The GLP-1 boom - Mayo Clinic Press (2025)

Ozempic. Wegovy. Mounjaro. Zepbound. You’ve probably heard the name of one of these drugs in the past few years—maybe you’ve even thought about taking them. Every day, more Americans are taking these drugs known as GLP-1s, either for chronic conditions like diabetes or, increasingly, for weight loss. So do these drugs deliver on the promise of easy weight loss? And are they right for everyone? This episode, we talk with Mayo Clinic dietitian Tara Schmidt about the drugs that have taken weight loss culture by storm.

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Kristen Meinzer: This is “Health Matters,” a podcast from Mayo Clinic where we discuss the latest medical advice, news, and research to help you live a happier and healthier life. My name is Kristen Meinzer, I’m a writer and journalist. This episode, we’re talking about GLP-1s. Our guest today is Tara Schmidt, a registered dietitian and instructor of nutrition at Mayo Clinic in Rochester, Minnesota. She’s the host of the Mayo Clinic podcast “On Nutrition.” Tara is also Medical Editor of the Nutrition & Fitness channel and co-author of “The Mayo Clinic Diet: Weight Loss Medications Edition.” Well, Tara Schmidt, thank you so much for joining us today.

Tara Schmidt: Thanks for having me, Kristen. I’m excited.

Kristen Meinzer: We are so excited to have you here. This is a topic that is so buzzy right now, and that so many people have questions about. Let’s start with the basics, shall we? What exactly are GLP-1s?

Tara Schmidt: GLP-1 is an acronym for Glucagon-Like Peptide-1s. Receptor agonists, if you want to add on those extra words. We all have GLP-1 in our body. This is a naturally occurring hormone and it‘s released in the gut after we eat. The function of GLP-1 is to kind of boost the amount of insulin that our bodies make to keep our blood sugar within a healthy range and also provide the sensation of fullness after a meal. This is why they originated as diabetes drugs and are now in the weight loss market as well. Because we saw in studies, “Okay, these are not just having an impact on blood sugar.

These are really helping people lose excess weight.” When we say GLP-1, it sounds so technical,and it doesn’t really match with the way we’ve heard them in advertisements, the media, or just hearsay. What are some of the brand names that people may have heard floating around?

Tara Schmidt: If you think about hearing about Saxenda, that is for obesity, which is the same thing as Victoza for diabetes in different amounts, or different dosages. Wegovy is for obesity, whereas Ozempic or Rebelsis is for diabetes. ZepBound is for obesity, where Monjaro is for diabetes, Trulicity. That’s a long list and a lot of times I’ll admit that the lay media will get it wrong because they’ll list a diabetes drug when they’re talking really about an anti-obesity drug. These are essentially the same thing but have different dosing and are for different populations or different indications, I should say.

Kristen Meinzer: Got it. All of these are GLP-1s, but have different configurations and are for different purposes.

Tara Schmidt: Exactly. There are different formulations or dosages depending on what your diagnoses are.

Kristen Meinzer: How exactly do GLP-1s work?

Tara Schmidt: I always tell my members and my patients, they’re working in the brain and in the gut, or in the stomach. They are helping to decrease our appetite, increase our satiety, or feeling of fullness; decrease gut motility, or sometimes we’ll say slow gastric emptying, keeping food in the stomach longer or decreasing food noise.

Some people are aware of what this is and some have not experienced it, but think about that buzzing in the back of your head of what you want to eat next, or you’re thinking about food a lot, or you feel like grazing, or you feel like snacking. They can really kind of quiet that noise.

Kristen Meinzer: How is that different from appetite?

Tara Schmidt: That’s a good question. Sometimes I will talk to patients about, “Do you feel hungry? If your stomach is growling, you haven’t eaten in a number of hours, you have a physical sensation of hunger that your body is telling you? Or do you have an appetite? Like, “hey, that donut in the break room sounds pretty good right now.”

There is a difference between hunger, which I think is more physiological, and appetite — which I believe is more psychological. These drugs can really help to decrease the appetite centers in the brain, especially for people who struggle with cravings and even people who struggle with binge eating disorder.

Kristen Meinzer: Got it. Alright. What else are these drugs doing? You said they’re working on the brain, the gut, they are slowing the digestive process, they are quieting the food noise. What else are they doing?

Tara Schmidt: Well, they’re helping people to eat less. By doing all those things, those are truly the main mechanisms of action, as well as the insulin that we talked about earlier. By doing this, it’s a lot easier for people to eat less, therefore to be successful with weight management. Now we have this whole host of other benefits outside of weight management that they are helping with.

That’s why they’re actually, with time, being approved for more than just these indications, because the medical field is recognizing, “Hey, these are really meaningful, not only for people’s diabetes or for their obesity, but for their heart health, maybe for dementia in the future. etcetera.

Kristen Meinzer: I’ve even read studies about possibly being useful for addiction.

Tara Schmidt: Yes, especially when you think about those craving centers in the brain. Absolutely.

Kristen Meinzer: Wow. I do have to say though, it feels like five or so years ago, no one was talking about these drugs. Maybe they were, but I just didn’t hear it. It wasn’t in the headlines every day. Nowadays, these drugs are all over the internet. What happened?

Tara Schmidt: That is the time when more of these drugs became specifically FDA-approved for weight loss and not just for diabetes. Many of these have been around for years for people with diabetes, and we did have some weight loss drugs on the market and available, which they still are, that were oral agents for weight loss.

But what really boomed was the meaningfulness of these drugs, so how much weight people are truly losing. We’re looking at a pretty significant percentage of total body weight, which is how we calculate that, and some of them are even getting close to, if not at bariatric surgery, weight loss percentage.

Kristen Meinzer: Do these drugs work differently for someone who has a chronic condition like diabetes versus someone who’s taking them to lose weight?

Tara Schmidt: They were initially developed to help people with Type 2 diabetes and control their blood sugar, but further studies revealed that they had the potential for weight loss, so they’re actually the exact same. They may be different dosages or the formulation may be different, but they’re all working for people in the same fashion.

Kristen Meinzer: Now, you mentioned in passing oral usage of drugs, What form do most of these drugs come in? Pills, injectables, patches?

Tara Schmidt: Most of them are injections, so there is one diabetes specific GLP-1 that is an oral agent, but the weight loss drugs we’re talking about that are FDA-approved at the time of this conversation are injectables.

Kristen Meinzer: How often are they injected? Is this something that’s done daily, weekly, monthly?

Tara Schmidt: It depends on the drug. It could be daily or weekly. But there’s a pretty strict dosing schedule, that’s important for everyone to follow, if I can say, my little PSA. Depending on the drug, it could be daily or weekly.

Kristen Meinzer: GLP-1s are actually naturally occurring hormones that the body releases after we eat. As drugs, they were initially created to treat diabetes, by boosting the amount of insulin the body makes and keeping blood sugar within a healthy range. GLP-1s work in the brain and in the gut to decrease appetite, food noise, and keep food in the stomach longer —while increasing satiety. Basically, helping people to eat less overall.

As an added benefit, GLP-1s can also help with heart health, addiction, and possibly even dementia. After the FDA approved them for weight loss, GLP-1s grew in popularity. Now, the drug is available in various forms, from Wegovy to Trulicity to Ozempic and more, and can treat diabetes or obesity, depending on its configurations and dosages. Most GLP-1s are administered through injections, and depending on the drug, should be taken daily or weekly.

Next, let’s find out who might benefit from using GLP-1s —and who might not be the best fit. Let’s talk about the people who are taking these drugs. Who would you recommend GLP-1s for and who wouldn’t you recommend them for?

Tara Schmidt: If you are considering a GLP-1, first, of course, I need you to qualify medically. You are qualifying with either a specific BMI, which tends to be 30 or more, and or a comorbidity-related to excess weight — a BMI of 27, and you also have a comorbidity that may improve with weight loss. I would love for everyone to have at least tried lifestyle first.

It’s not necessarily appropriate for someone to just jump into a weight loss drug if they haven’t tried lifestyle medication in terms of weight loss before, but that’s not to say that they won’t be a candidate or it’s not appropriate for them to have a medication. I would just like a little bit of healthy dieting history to be there. We know that that wasn‘t successful for them. Because of course we know that people can be successful with just diet and exercise. I would love to have a lifestyle tried first.

I need you to be willing to do the work. Not only the work of taking the medication as scheduled, but also following up with your medical provider and lifestyle. I need you to be eating well. I need you to be exercising. I need you to be managing your stress well. Just in a realistic fashion, are you potentially willing to use and/or pay for them long term? These are not short term medications. This is not for, “Hey, I want to lose 10, 15 pounds before ‘insert event here.’ These should be seen as long-term use drugs.

Kristen Meinzer: When you say long-term, do you mean lifetime? Decades?

Tara Schmidt: Potentially. We don’t know, because the studies haven’t been active for that long. But you can think of it as any other medication. If you’re using a tool to help your body do something, and you take that tool away, you’re likely to revert.

If you’re on a blood pressure medication and then we take that blood pressure medication away and you have chronic blood pressure, you have chronic hypertension, your blood pressure is probably going to go back up. It’s important to think of them as long term. Of course, having that conversation with your physician is most important. But there’s a risk that if you do not continue the medication, you will regain some weight.

Kristen Meinzer: Now, you mentioned that ideally somebody who is going to be prescribed GLP-1s, they’ll have a BMI of 30 or higher, or comorbidities with a BMI of 27 or higher.

Tara Schmidt: Exactly.

Kristen Meinzer: But a lot of what we hear about are celebrities who are taking GLP-1s, who certainly are below 27 on the BMI chart. Maybe they are taking it for that special event that you mentioned. Maybe just to lose 15 or 20 pounds. Are there risks involved when people are taking GLP-1s under those circumstances?

Tara Schmidt: There’s always risk, right? There’s risk with any medication, good, bad, or otherwise. It’s not my favorite scenario, if I can say that. It’s inappropriate, because that’s not what these drugs are designed for, and it’s not what they’re FDA approved for.

Kristen Meinzer: Of course, we’re at Mayo Clinic, so we abide by the rules. We’re rule-followers here. What are the risks if somebody is using these GLP-1s not under the recommended circumstances?

Tara Schmidt: Well, anyone taking the medication has to understand, of course, the risk of the medication itself, but especially if there is less excess weight, or no excess weight, as we can call it, to lose, now we are further putting people at the risk of things like malnutrition, or loss of muscle mass, loss of bone, even happens with weight loss, so we see that in our patients with excess weight. We see a loss of lean tissue. I worry about that even more, I would say if someone doesn’t have a lot of fat tissue to lose – that they’re going to be at higher risk of more muscle mass loss if they’re not really careful.

Kristen Meinzer: Let’s say we can take a drug like this to lose weight. Does that mean we finally don’t have to count calories or exercise stringently? What exactly does it mean – we take this drug and then what?

Tara Schmidt: I know that I would be everyone’s favorite dietician if I agreed with that statement, but I wouldn’t be a very good one. There are guidelines for diet and exercise related to these drugs, not necessarily from a weight loss standpoint, because we know they work. We can be happy with that.

These are going to be life-changing for a lot of people. But for minimizing side effects, for keeping people nourished, and promoting that improvement in body composition —thinking less muscle loss, more fat loss —yes, there are still nutrition and exercise guidelines to abide by, but they‘re not that much different than the average. We’re still talking about strength training. We’re still talking about adequate protein, fruits and vegetables, nutrition, high water or fluid intake to prevent dehydration.

It’s nothing crazy, but the good thing is that if you have a little less of that food noise, a little less cravings, ideally, in a perfect world, you can focus more on nutrition and having this really well-balanced diet because you’re not bothered by all of these, let’s call them low-nutrient, ultra-processed foods, that make it really easy for you to overeat.

If you don’t have those signals in your brain saying, “Hey, we want more of X, Y, and X, you can have the mental capacity to eat a really well-balanced meal and then feel satisfied by it. I think that’s a lot of positives right there.

Kristen Meinzer: You said even on GLP-1s, patients have to pay attention to exercise and dietary health and so on. Why not just do the exercise and dietary health? Why add the GLP-1 to the equation?

Tara Schmidt: Because it’s an additional tool, right? Think about any diagnosis out there. Think about depression, anxiety, high blood pressure, high cholesterol, diabetes.

We can all be doing all of the wonderful things and all of the lifestyle changes for those diagnoses and hopefully be a little bit successful. But there’s going to be people who continue to struggle and who still have their health at risk, even though they’re doing the lifestyle things —what we call medications and surgeries or procedures are another tool for your toolbox.

You’re going to do the lifestyle thing and we’re going to add in whatever it may be, a medication in this case, to help you. When we’re talking about GLP-1s in the clinic, we’re talking about health risks. We’re talking about years of someone’s life, or healthy years of someone’s life, or keeping their organs healthy. We’re not talking about fitting in your prom dress.

Kristen Meinzer: Now, unfortunately, due to supply, demand, and the high cost, it’s just not easy for everybody to have access to GLP-1s. That means some folks, they’re turning elsewhere. For example, compounded versions of these drugs. Can you explain what those are?

Tara Schmidt: Yeah, these are alternatives. They’re either altered or mixed or different combinations of ingredients to make a medication, and that’s necessary in some cases. If someone has an allergy to an ingredient in a drug, a compounded version is absolutely appropriate. But in the weight loss space, what we’re more often talking about is non-FDA approved medications.

The concern with that is that we just don’t know about quality or safety. That’s an important conversation to have with your physician, like “Do you think a compounded version of this drug is appropriate and or safe for me? How do I know about the quality of it?”

Kristen Meinzer: You’ve been prescribed GLP-1s for weight loss. In addition to muscle loss, what are some of the other side effects?

Tara Schmidt: A lot of them that we see are GI-related. Think about that delay in gastric-emptying or food staying in the gastrointestinal tract longer.

We see a lot of nausea. Some vomiting, some constipation, reflux, which can, I’ll say, be minimized or mitigated by good nutrition, but there’s always going to be a risk there. Most of my patients will say, “I’m really experiencing fatigue, diarrhea,” etcetera, all of the GI things when they start taking the medication or when they increase their dose.

Kristen Meinzer: Can you explain increasing the dose? Why would that happen?

Tara Schmidt: A lot of these medications are titrated up with time. You start with X, and then you move to Y, then you move to Z, and that’s actually just a dosing schedule to get someone to an appropriate dose. You may go up to Z and go back down to Y, but there’s very clear guidelines from the drug companies.

There’s a little bit of wiggle room that you may be able to have success on a lower dose, and some people need a higher dose. Most of the GI side effects are seen when you’re starting or when you’re increasing your dose.

Kristen Meinzer: Another side effect beyond the gastrointestinal issues, we read a lot about what’s called Ozempic face.

Tara Schmidt: Yes.

Kristen Meinzer: Can you explain what that is? What does that even mean?

Tara Schmidt: This started when we started to see people, and likely celebrities, of course, because those are the faces we see in the media, who, these are simply people who lost weight in their face and, for whatever reason, we started calling it Ozempic face, appropriate or not. This is just a result of weight loss, right?

Especially if you think about a lot of people who lose weight from the top down, not everyone, but many people, when they start to have especially significant weight loss, they kind of lose weight starting at the head and going lower. We, of course, see someone’s face more than we see their chest or their stomach or their arms.

My knowledge is that it’s simply this notion that someone has lost weight in their face, and when you lose fat tissue, but your skin is still there, it has to go somewhere. That’s what that’s referring to, especially if it was a quick or dramatic weight loss in a short period of time.

Kristen Meinzer: This isn’t specifically because of Ozempic, it’s because of weight loss. If somebody lost a great deal of weight quickly without Ozempic, their face would probably also have some sagging as the fat left their face.

Tara Schmidt: Yes, or as we age, but yes, exactly.

Kristen Meinzer: Yes, magic aging. We’re lucky to get older. We are lucky to do that. Before you go down the GLP-1 route, know that these are not short term medications. it’s good to trial lifestyle changes and build up a healthy dieting history to see if that approach might work for you first. Plus, because these drugs are long term, consider if you are willing to use them for an extended period of time — and… if you can afford to do so.

Who are GLP-1s meant for? Up top, it’s important to make sure you qualify medically for them. That means having a specific BMI — which tends to be 30 or higher — or a BMI of 27 with another condition that may improve with weight loss. Once you do start using GLP-1s, there’s still a lot of work to be done: there are guidelines to follow, relating to diet, exercise, and managing stress.

These are to help with minimizing side effects, keeping people nourished and promoting improvement in body composition. It’s also important to be aware of the possible risks that come with taking GLP-1s: For patients with excess weight, for example, there can be a loss of lean tissue.

Kristen Meinzer: For those using GLP-1s for a non-intendeduse, like a short-term weight loss: please don’t: You could experience malnutrition, loss of muscle mass, and even loss of bone. Lastly, make sure you’re using a safe version. Compounded versions of the drug can be good if you have an allergy to a certain ingredient — but they’re often not approved by the FDA, so we can’t always be sure of their quality or safety.

Next, let’s look into what GLP-1s can mean for the future of the obesity epidemic. There’s speculation from some people that, due to these drugs, obesity is going to be a thing of the past. Is there actually any possibility of that happening? Are these drugs possibly a solution to the so-called obesity epidemic?

Tara Schmidt: I’m skeptical, maybe these drugs are going to be absolutely meaningful; that we are going to possibly see less bariatric surgery, we’re seeing a little bit of that already, which is higher risk, of course, than a medication in most cases. But I’m skeptical that they are a solution because of the food environment that we live in, and the rates of obesity continuing to climb in adults and in children, especially.

Have you ever seen those pictures or maps of America where they start out as green and then they just get more and more and more red because they’re representing rates of obesity in the different states? Those have never gotten better. They just keep getting scarier and scarier. They’re put out by the CDC. We live in a really challenging food environment. You could also even call it an obesogenic environment. We are not half or nearly as active as we used to be as I sit at my desk right now.

I’m not on my treadmill desk because otherwise I couldn’t talk to you without losing my breath. We are not doing as much physical work or labor in any way, shape, or form. Our access to food has increased. Our access to highly palatable foods has increased, and we have brilliant food scientists out there making food taste really, really good. A lot of those foods are very, very cheap, and there’s a lot of marketing around them. Like, you’ve probably never seen a commercial for broccoli before, unfortunately.

Kristen Meinzer: But I’m seeing lots and lots of advertising for high calorie, low nutrient, highly delicious, some might say addictive, things to put in my mouth.

Tara Schmidt: Exactly. Because we know how to do that. We know how to make foods kind of melt in our mouth. We know that perfect combination of salt and sugar and fat, which is absolutely delicious. Like, have you ever had a cookie before? We know all of these things. That just makes our food environment more challenging.

Kristen Meinzer: On top of the food environment, there’s also the environment of pharmaceuticals and how accessible they are. We’ve already talked about GLP-1s not being fully available to everyone, so how can we wipe out an obesity epidemic when a very large percent of the population can’t even get their hands on GLP-1s?

Tara Schmidt: Their cost is nothing to blink at right now. They’re pretty expensive in many, many cases. The realistic nature of people staying on them and paying for them long term, unless they’re fully covered by insurance, is a concern for many.

Kristen Meinzer: Just to be clear to the listeners who may not know what we mean by a lot of money, we’re talking about thousands of dollars a year. It’s not hundreds of dollars a year, it’s many thousands.

Tara Schmidt: It’s a lot. Yes.

Kristen Meinzer: Yeah, a lot. Now people who use GLP-1s are often accused of taking the easy way out or you’re just trying to take the shortcut. Why is this backlash so harmful?

Tara Schmidt: It reminds me that – and I would like to say, this is especially true in women, if I can — that we can never get it right. If we have excess weight, we’re likely to be shamed. But now I’ve lost my excess weight, and I’m a healthier weight, and now I’m being shamed because I used a tool that was meant to support me in doing exactly that?

Like, what’s the right answer here, people? What I like to do is bring up, again, other diagnoses. I don’t think people shame people with diabetes for taking metformin or insulin. I do not think people have ever shamed my grandfather for taking high blood pressure medication, or high cholesterol medication, or again, an anti-anxiety or antidepressant.

I am not saying that we don’t need to also do the lifestyle work that goes into these diagnoses. That is hugely important and should be the first line of defense, if that is safe, of course. But I hope that we can look a little bit more outside of just the weight conversation and look at these medications as improving someone’s health.

Kristen Meinzer: If someone is considering GLP-1s for weight loss, what should they take into account when they’re making that decision?

Tara Schmidt: Logistically, cost. Just assume that you should know that there may be a cost associated with that long term usage, risk of side effects, which there comes with every drug. Putting in the effort from a nutrition, a psychology and from an exercise standpoint.

Kristen Meinzer: For those who are interested in GLP-1s and now thinking, after listening to our conversation, actually, I might have some reservations, what alternatives should they consider?

Tara Schmidt: We should always start with the lowest risk option and the lowest risk in weight management is diet and exercise. We like to think of it actually as this pyramid. If you can think about the bottom or the foundation of the pyramid is healthy eating, exercise, etc. Then as we move up the pyramid, we can talk about maybe some psychology involvement or group classes. We can talk about weight loss medications.

Then weight loss procedures, and that’s the very top of the pyramid is weight loss surgery. What we like to tell our patients is that as you move up the pyramid, your percentage or your success with weight loss is likely to go up. Surgery outcomes are more significant, of course, than lifestyle, but the risk also goes up.

Surgery is a lot more risky than dieting and exercise in most cases. Where are you with that foundation? Do you want to have a conversation about one of the other tools? Or if you want to think about a corny analogy, think about an actual toolbox. Do you have the nutrition down? Do you have the stress management down?

Do you have the sleep down? Do you have the exercise down? Do you have the hydration down? Think about all of the things that come into play with managing a healthy lifestyle. Maybe it’s your sleep that needs to be addressed. Okay, great. There’s a big role in that.

There’s a connection between excess weight and sleep. Let’s get your sleep addressed, or let’s get your stress. Or are you wearing your CPAP when you’re supposed to be? Do you have nutrition down? Do you have hydration? There’s so many things that we don’t have to jump to anything. Check the foundation of your lifestyle and see if there’s any additional support you need in that realm.

Kristen Meinzer: Do you have any predictions, Tara, for where GLP-1s or weight loss drugs may be in the future? In the near future or the far future?

Tara Schmidt: Define near. But what we know is that there are many, many studies ongoing. I mentioned that they will not all be injectable moving forward, which may significantly decrease the cost.

Because now we’re not paying. For the injectable, the pen, whatever they may be, the device itself. When we’ve been talking about most of the GLP-1s today, we were talking about dual agonists.

Think about two different parts of the drug that are working. In the future, we will have what’s called triple agonists. These will work even better. We’ve got things to look forward to. In all honesty, from a medical standpoint, these are going to be good evolutions.

With time, more information always comes. I know that that can be scary, of course, but we’ll know more about the risks. We’ll also know more about other disease states that these are beneficial for.

We talked a lot about diabetes and weight management, but we’re seeing some things with fatty liver and with kidney disease, with heart disease, with lifespan, with what we’d call a cardio protectiveness. In terms of health risk, we’re hoping, of course, that the benefits of these drugs just continue to outweigh the risks.

Kristen Meinzer: Wow. That’s so encouraging. Any final words? What else should our listeners know about GLP-1s?

Tara Schmidt: Science is always evolving. If something’s not working out, or you have reservations, or if something’s not accessible to you right now, this is not the last year of weight loss drugs, this is just going to continue to boom. We have time. We have time to assess what’s best for you.

Kristen Meinzer: Yes. In our particular universe that we live in, there are always going to be evolutions and new medications available.

Tara Schmidt: We’re not very patient, though.

Kristen Meinzer: When it comes to weight loss. Yes. But you’re right. We’re not very patient.

Tara Schmidt: Do I have abs? I just did six sit ups.

Kristen Meinzer: Hold on, have you been spying on me?

Tara Schmidt: Oh, we’ve all done it. We’ve all done it, Kristen.

Kristen Meinzer: Well, Tara Schmidt, thank you so much for joining us today. It has been such a pleasure, so illuminating talking with you today.

Tara Schmidt: Oh, Kristen, it was so nice to chat with you.

Kristen Meinzer: If you’re interested in taking GLP-1s, first start with the lowest risk option – diet and exercise. Then, address your lifestyle: How’s your nutrition? Stress management? How about your sleep, and exercise? Are you good on the hydration front?

Once those pillars are taken care of, GLP-1s can be an additional tool. Are GLP-1s our solution to the obesity epidemic? Well, they can’t fix the food environment that we live in, or the increasing rates of obesity in adults and children in our country. On top of that, the drug is expensive and out of many people’s reach.

That said, they are a really potent tool. It’s the kind of medication that can improve health: the same way diabetics take insulin, or people might take an anti-anxiety or antidepressant. We’re also learning in what other ways they can help address other health issues, like fatty liver, kidney disease, heart disease, and even lifespan. Stay tuned for more updates – science is always evolving.

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