GLP-1 Medications: Maybe You’ve Heard of Them, But How Much Do You Know?
September 8, 2026 | Episode 70
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Katie Lowe, Guest: by Dr. Tom Sonnanstine, OhioHealth Bariatric Surgery Program director
And welcome back to the Wellness Conversation, an OhioHealth podcast. We are tackling all those important health topics for you and your family. I'm Marcus Thorpe.
And I'm Katie Lowe. Today we are talking about a topic that has been hard to miss over the last few years, GLP-1s.
Yeah, Ozempic, Wegovy, Zepbound, chemical mixing and all these kind of things. I mean, it truly is everywhere and online commercials, you can't miss it.
Yeah, but with so much information and misinformation out there, it can be difficult to understand what these medications actually do, who they're intended for, and whether they're the right option for everyone. So today we are joined by Dr. Tom Sonnanstine, medical director of the Ohio Health Bariatric Surgery Program, to answer some of the biggest questions surrounding GLP-1. So Dr. Sonnanstine, thank you so much for being here.
My pleasure. to be here. Thank you.
I'm excited about having you back. You've been kind of one of my go-to guys over the years when it comes to all topics, but GLP-1s is certainly one of them. Let's start. Just talk a little bit big picture about GLP-1s and what these medications are all about.
There's a conception out there, and it's really a misconception that GLP-1s are a new medication. In fact, they were identified back in the 1970s. They've been on the market varying degrees and different generations the first generation over 10 years ago originally developed as a treatment for type 2 or non-insulin dependent diabetes and then it's been really over the past three to four years that so many other benefits of these medications have been identified the second now third generations have come out more patients have been on them so the safety benefits of them and the efficacy, the health benefits of them have been more and more recognized to the fact where, as you talk, there's a lot of attention about them and I think we're going to see lots of changes in the next several years. Yeah.
I have so many questions. I'm so excited to dive in. But first, let's get into more of this science. How do these medications work inside the body?
These medications are called peptides. That's kind of the basic building block of them. And then the current ones that are out work on either one or two different hormones. And these hormones are the GLP-1 hormone and the GIP hormone. The next generation that'll be coming out in the next 12 to 18 months will actually work on 3 hormones. So as you can tell, there's more and more advancement and this advancement is happening very rapidly. There's over 100 types of these medications currently in development and planning and testing. They work on a hormonal level and it's been identified that virtually every organ in our body has receptors for these hormones. So while it was originally thought they just worked on the GI tract, In the metabolism, hormones, and things like that, it's been actually learned that they work on the brain. They work on bones and muscle and all different organs in the body.
Yeah. So such a complex pill or shot or however people take it. Everybody says appetite suppressant, right? We've heard about that for years. People have taken different appetite suppressants to help lose weight. Is there a component of that inside of GLP-1s that really kind of makes the brain maybe think it's not hungry all the time?
Yeah, there definitely is. And it works on the brain, but also works on the intestine, on the stomach, on the pancreas. on the secretion of insulin which helps regulate believe it or not just our blood sugars but our hunger and our appetite and our cravings and I think there's last count there's 40 plus different hormones that our GI tract secretes in response to starvation or food being readily available or when we think about food when we start eating food when we smell food and all those things interact with the organs that are surrounding the pancreas, the intestine, the stomach, but also our brain. So that I think is something that isn't talked enough about is that these aren't just gut hormones and gut medications. They're also brain medications.
Yeah, full disclosure, I have been on a GLP-1 for a while, then I stopped and now I'm getting back onto something else just from obviously insurance. Everybody has some challenges with that. But food noise is a very real thing. And I can just tell you from my own personal perspective, I know this probably isn't for everybody, but when I was taking Wegovy, the food noise quieted to something where I couldn't ignore it. I couldn't be like, oh, it's not in the brain because I stopped driving around and being like, oh, that looks good or I need a snack here and there. So.
Or I'm just bored.
Or I'm just bored and I need to eat something. It was crazy.
It's liberating, right? It is.
I felt like a different person.
Right. You're not consumed by when's my next meal, three meals from now or tomorrow or later this week, but it's you almost forget to eat, which can be an issue in and of itself and something that we have to counsel patients about. But I do hear all the time, you know, this head hunger, these cravings, this food noise. goes away or at least is significantly dampened down with these meds.
That's what these medications seem to be known for, but we were talking a little bit and you had just mentioned how many other organs are affected. I want to hear about that. What else can these medications lead to?
Well, it's been demonstrated scientifically, and of course, hear the stories from patients. It seems to be less arthritis. Their muscles, their bones, their joints don't ache as much. We hear from a lot of patients, and this is bearing out in the science, less addiction, maybe less of a craving for nicotine, less of a craving for alcohol. You know, the same reward centers in our brain for nicotine, alcohol, different sorts of drugs, illicit, non-illicit. also work with food. So if you're affecting one, you can certainly affect the others. And what kind of impacts that that's going to have on our patients is significant.
Yeah. You see so many commercials and there's so many different versions of a GLP-1. Can you talk about the differences between all of the product that you hear? Some seem to be targeted more for weight loss or sleep apnea. Some are talking about more of the diabetes route. How do we know the difference and how do you know what's going to work best for you if this is the route you go?
So in the world that I live in, and that's in helping people who suffer from obesity and morbid obesity, there's really two main chemicals or medications, semaglutide and tirzepatide. Now, semaglutide has two trade names within that. There's Ozempic, which is the FDA approved treatment for type 2 diabetes. And then there's the weight loss version of semaglutide, which is known as Wegovy. Then you take tirzepatide, and tirzepatide is the drug that works on two different hormones, whereas semaglutide works on one. Tirzepatide is the newer generation. There's Mounjoro, which is the diabetes form of tirzepatide, and there's Zepbound, which is the weight loss version of tirzepatide. Now within that, there's more idiosyncrasies. You have FDA approval of Zepbound for treatment of obstructive sleep apnea. Also certain kidney disease. And so there's more and more indications for these medications. And you asked a few minutes ago, Katie, about what other organs do they affect? Well, the function of the heart is actually affected. Decreased cardiovascular disease with these medications, which is why you can imagine some of your biggest fans of this are your cardiologists. And what is a comorbidity of obesity or disease that goes along with obesity? Heart disease. Did I tell you he'd be a great guest?
I mean, just like the ability to pull that is amazing.
I love it. There are, from what you just said, there are so many things to consider and so many different medications. How do you decide which medication is best for a patient? And is there one that may be better than the other?
Yeah, that's a tough question to answer. It's controversial and we didn't even mention the GLP-1 type medications such as Trulicity that primarily affect diabetes but have less of an indication for weight loss. So nuance of the patient is the patient, are you treating a multitude of diseases? Are you treating a diabetes as well as obesity or morbid obesity. And if you are, then maybe that medication, the Trulisti isn't quite what you need. So you would step that up into the Ozempic. But then we're also kind of hamstrung a little bit by cost and what insurance will bear and what insurance approves. And as I'm sure has been on these talks before, and if not, might be a good one for us to talk about sometime, is A lot of how we practice medicine and surgery is dictated by the payer, whether it's private health care or a government payer. So that comes into our decision making of what does the patient even have available to themselves? Can we give them the medication that we think is superior but may cost more money?
Interesting.
I think that is a big challenge. And I think it's why you see so many pharmacies that are now making their own that is not FDA approved. And so I think it's a great opening for us to talk about that, right? What advice would you give for somebody who says, well, I want this, but I can't pay full price for what my insurance won't cover. But I do see all these things that tell me for $89 I can get this, for $149 I can get this, but you don't really know who they are or where they're coming from.
Right, good question. And you mentioned we can't watch television anymore without saying something about these medications. And literally in a back-to-back commercial, you might hear from the manufacturer of the medication. And then the next commercial, hear from one of the popular online compounding pharmacies from which you can get the medication. And patients will choose to do that oftentimes if they don't have coverage and don't want to pay the list price, which can be very, very expensive, $800 or more in some cases. and will choose to resort to an online compounding pharmacy. That's controversial. It's controversial in my field and we all as practitioners have to make a decision and my philosophy is that it's about helping the patient and while I would like to be able to write the prescription and have them get it from the manufacturer of the medication, if the patient simply doesn't have a means to do that, meaning they don't have coverage for it or don't have the disposable income to pay for that medication, and the next best or really the only option is to go to an online compounding pharmacy, I will provide them with that information of the online compounding pharmacy that I trust, that I've seen the product of, that I've seen patients work through with good results, dependability, and I feel that's better than just doing without.
That's great. Do you think if a patient can only get their hands on the non-FDA approved medications, but their doctor such as you, you're not familiar with the one that they can get their hands on, what should they do in that instance?
So I think it's important that these medications, whether it's semaglutide or tirzeptide, they are FDA approved. So if they're getting it from an online compounding pharmacy, it's still an FDA approved medication. It's just manufactured by somebody different. So there's a little bit of nuance there. is a the next generation called Retatrutide, which we're going to be seeing next year or a year and a half from now. We're not quite sure when the FDA is going to give their approval for it that you can get here in the United States and or over from overseas that is not FDA approved yet. So that's a little bit of nuance there. But yes, at the end of the day, I do think it's okay for a patient in conjunction with a physician or their provider that they trust, that also has a philosophy that it's okay to use a well-vetted and trusted online compounding pharmacy. But there's probably, we could probably do a Google search right now and find hundreds if not thousands of online compounding pharmacies. And being in this field, you kind of learn quickly which ones you can trust and maybe which ones might not be so trustworthy.
It's a big business. Somebody's going to each one of these because they wouldn't be in business if it wasn't working. Correct. Let's talk, you know, people think to themselves. I've been on the fence about GLP-1s. I've heard about side effects. Can we talk about side effects? Because for some people, this isn't an easy Rd. And there are some things like nausea or vomiting or diarrhea or constipation. There's a lot that can come from something like this if you're not drinking enough water, changing your diet a little bit. Talk about some of the pitfalls that can come with some of this that people don't always know are coming.
Right. I think every patient needs to understand anything that you're putting in your body, even if it's a placebo sugar pill, has a potential of having a side effect or a consequence or an action. And certainly powerful medications like this that do so many things to the body, to the brain, can have some real side effects. And nausea is the number one that we see.
That's what I had. It was bad.
And that's why you start out on a low dose. That's why you allow several weeks typically to pass on that low dose. Your body and you, your brain, gets accustomed to it. Hopefully those side effects decrease. Though I will argue, I think rightfully, that Wegovy or Ozempic has more nausea than what the alternative of Mounjoro or Zepbound does. And as these medications get more sophisticated, we think we're seeing fewer side effects. So talking to the patient and being aware of that and how to work through that, whether it's with nausea medications, it's working really, really hard on keeping your hydration, which also helps to decrease or prevent the constipation that almost inevitably happens with these medications, though some people do suffer from diarrhea. It's just going slow with it. It's doing it in conjunction with your physician or provider and just making sure you're very deliberate about it and you're working at it. And I think that's the key is you've got to still work. These medications do so much and they help people lose weight and they help people get healthy. But that's not to say that you don't have to work on the other things at the same time.
It's not a magic bullet. It is not something we're without doing some other things. It's gonna go away and then stay away, right? I think that's a big part of this. is a lifestyle change if this is where you're going, in my opinion.
Talking about lifestyle, I know some people feel that by taking these medications, they don't have to do anything else because they're losing weight. I have heard that you can lose a lot of muscle mass. Can you speak to that and how important it is to still strength train?
Very important. So by trade, I'm a bariatric surgeon. So for 25 years now, I've been doing these great big operations on thousands of patients in order to get them healthier. And we recognized in the world of bariatric surgery over 20 years ago that just the surgery in and of itself isn't the fix. Without doing what I call the head work, the preparation work before surgery, and then staying with all that head work and body work after surgery, you're not going to be as successful. And in fact, you can suffer from complications. So yes, you need to exercise. Muscle wasting anytime you lose a significant amount of weight is real. And the way we typically think about it, for every pound you lose, about 3/4 of that pound is fat, but 1/4 is also muscle. So having some muscle waste or loss is inevitable. which puts the onus on the patient to work that much harder on getting enough protein, getting in the gym, and it might not have to be free weights and things like that, but resistance exercises. And of course, every day we're talking to our patients about the importance of aerobic exercise. That's for young patients, middle-aged patients, old patients, all of those things, along with keeping an appropriate amount of muscle mass is very, very important to overall health.
Can you talk a little bit about who in your opinion would be kind of an ideal candidate to explore the GLP-1 route? And then if there's a group of people that you would think to yourself, this is probably not the right route for you and what would be the appropriate path for somebody in that situation?
Lots of levels to that. I think fundamentally anybody who's considered to suffer from obesity or morbid obesity, which would be a BMI or a body mass index of 30 or higher, that's an automatic yes, you should look into this. But I would argue all day long we should probably pull that number down to 27 into the overweight category as well, especially when we look at the long-term impact of what being overweight and obese has with years and decades of suffering from that. So I really think we're at the point where that entire broad category, now we're talking about over 50% of our population, adult population, should be considering these medications. But that's also to be said that nobody gets there overnight as far as at that weight. So presumably you've tried to move more, you tried to exercise more, you tried to clean up your eating and eat less and watch your carbs and things. So by no means am I saying just jump in and take your medication. You get there on a long track everybody's tried things and usually hasn't been successful at least long term but at least have that conversation with your physician with your provider and make sure it's somebody who's adept and able to have that conversation about here's some things to consider here's some things that you might want to do and then take it to that next level if that interest is there.
What about the people who maybe they are really not a good candidate for GLP-1s? I know people who have struggled with eating disorders. That has been a concern.
Yeah, it's our job to make sure that if you are suffering from an eating disorder that you're getting therapy for that. That's not to mean that GLP-1 medications can never be an option for you. It's just I would want you to get concurrent or along the same time mental health therapy for that. There's very few absolute no, you cannot be on these medications. There's for patients who have had recurrent and chronic pancreatitis or inflammation of their pancreas. Those are patients that you really need to think about long and hard. Is this the right patient to be on these medications? And there's certain very rare thyroid cancers in which you wouldn't want to be on these medications. But that's a small, small, small portion of patients who fit into those groups.
That's not to say that for some people, bariatric surgery is not the right choice. It is the right choice for some people. There are some people who who need that route. Talk about that if you could. This is your bread and butter. I mean, this is what you've kind of grown up doing and you're super passionate about it. I know that. And you're really specific and careful. about making sure somebody goes through that process to make the right decision for them. It's not just, hey, I want bariatric surgery. Okay, here you go in two months, you're going to have it. There is a process for you. Can you talk about that a little bit?
Yeah, patients get to us really two different ways. They come in knowing or thinking they know that bariatric surgery is what they want. Our process and our program is deliberate. It's several months of doing that work that we talked about. Of course, you've got to do a lot of that for insurance approval, but even when you don't have that burden, it's still important to prepare patients. And some patients will decide, maybe I don't want bariatric surgery. Maybe I don't need it. They're able to, with that therapy, with that extra help, with that work, lose their weight. Bariatric surgery is still here and it's here to stay at least for the next decade or more, I think, and probably longer for different kinds of patients. At least as of now, there are patients who don't have the ability to get these medications, be it cost or simply no connection to the healthcare system to get it, or don't want what they see as the burden of either the daily pill or the weekly injection of these medications and the lifelong of doing that. Or maybe they've been on these medications and they were not as effective as they are for a lot of people or even most people. So bariatric surgery is their best option. Or perhaps they have so much weight to lose, 200, 300 plus pounds, that the medications probably aren't gonna get them there. So those are patients that we still want to see and to help. But also something that we're seeing more and more, and this is where I got involved with the GLP-1 medications, is how can we help our patients after the fact, after we've done surgery. And they either didn't get to the finish line or they've had what we call weight recidivism. They've regained usually a significant amount of weight. And that's still a pretty small percentage of our patients that happens to. But how can we help these patients? Well, rewind four or five years ago. rough office day would be sitting with these patients and trying to come up with, well, how do we help you? And we didn't have really any good options for us. The dieting and exercise we know didn't work for years or decades. Right. But now we have these medications. It's been absolutely wonderful. It's taken me out of the operating room, an extra day a week or whatever. But now at our disposal, we have this tool, these medications that we can truly help people with after the fact and get them reengaged and get them that help that they need. And that's when you consider how this has affected my livelihood, it has. But in many ways, most ways it's more rewarding now because I've got more tools in my toolbox to help patients with.
I love it looking at it that way too. It's still impacting people just in a different way and connecting with them in a more personal level of, hey, you're not stuck. You're not up against the wall. We've got some other options now.
I think that's awesome.
I'm so bummed that we're running out of time because I still have so many other questions that I wanted to get to. But just before we go, if someone is interested in learning more about this, what is that first step that they should take?
First step is probably the easiest step and that's to everybody does their Google search and they get their information they do their own research that's a good way to start be careful as we all know on what you read on the internet you can kind of model anything to the author of what's on there or what you want to find but also talk with your medical doctor engage with somebody who specializes in the field of the treatment of obesity you know they're going to have that whole breadth and depth of knowledge to really be able to answer questions, give some opinions, give some direction.
Okay, thank you.
And then my last question is, what's your feeling on people who are microdosing? We've heard that a lot too, right? People who. maybe just want to lose a few pounds here or there, or somebody who's already in pretty decent shape but is going on a vacation and wanted to kind of just firm up or thin up a little bit. What's your feeling on some of those kind of things?
Yeah, those are a couple of different things. I think microdosing can mean lots of different things. It can mean either a sub dose below what the FDA originally or the manufacturers of the medications originally intended. But it can also mean spreading out how often you take the medication. Instead of every seven days, you take it every 10 days or 12 days or 14 days. So it can mean a couple of different things. I think the jury's still out on that. I'll go on record as saying I think the majority of us are going to be on these medications in the next 10 years. It's going to be a matter of who's paying for the medications, which I also think will change dramatically here over the next several years once the payers realize the downstream, meaning 10 and 20 year from now benefits of these medications and our ability to improve cardiovascular health, addiction health, obesity, metabolic health, all those things. So I don't really have a criticism of the quote unquote normal or average weight person being on these medications on a small or even micro dose. I think there could be some benefit to it.
you've been awesome. And so appreciative of you spending some time with us. This is probably one of the episodes I think we get the most questions about is like, hey, when are you going to do a full GLP-1? So we knew you're going to be our guy for this. And I think you've answered so many questions. And I know people probably have more. So we're definitely going to have you back. And we'll dig in a little bit deeper. So thanks, Dr. Sonnenstein. We appreciate it.
Thank you. My pleasure. Always enjoy this.
I was going to say, part 2.
Part 2, my opinions may have evolved even more by then, and I'm sure they were All right.
Well, you're on the books then. We're going to make sure it happens. We appreciate it.
Well, thank you to everyone here for listening to the Wellness Conversation in OhioHealth podcast. If you are curious about whether a GLP-1 medication may be right for you, start by again having that conversation with your primary care provider or another qualified healthcare professional. Together, you can discuss your health history, your goals, and the treatment options that make the most sense for you. So to learn more about weight management services and other health resources, visit OhioHealth.com. We'll see you next time on The Wellness Conversation.
Thanks for joining us.