What does GLP-1 RA stand for?
Glucagon-like Peptide-1 Receptor Agonists (RAs)
Or Dual GLP-1/ glucose dependent insulinotropic polypeptde (GIP RAs)
What do GLP-1s do?
elicit weigth reduction by 15-20% in obese or overweigth adults
Increase postprandial insulin secretion from pancreatic Beta cells and
suppress glucagon secretion from alpha cells,
slow gastric emptying
Reduce appetite
How do GLP-1s reduce appetite?
Act on peripheral vagal nerve endings in gut mucosa that project to CNS = engage satiation signals
What are some examples of GLP-1s?
Liraglutide
Semaglutide
Tirzepatide (GLP-1/ GIP RA)
Why is Ex essential when using GLP-1 Receptor Agonists (5)?
Prevent loss of msc mass (can be up to 40% of weight lost while on drug)
Reduce regaining weight after cessation of drug
Reduce self-perception of poor health
counteract higher RHR
Improve health beyond weight loss
Who can use GLP-1s?
BMI > 30
or
BMI > 27 < 30 (overweigth) w/ at least 1 weight-related health issue
How much can Ex help msc mass when using GLP-1 RAs?
Reduce 90% of msc mass lost during calorie restricted diet
Prevent atrophy
Importance of msc mass maintenance?
Independence/ strength
Metabolic function
CVD function
How does Ex help reduce weight-regain after termination of drug?
Most patients experience regaining weight after stoppign drug
2/3 of weight lost was regained
People become dependent on the drug rather than changing lifestyle factors
Ex/ PA limits regaining weight
Supervised/ structured Ex program is very helpful(2x better than just Ex) –> helps increase chance of developing Ex lifestyle after drug termination
Higher RMR w/ more msc + increased energy expenditure w/ Ex
Side effects of GLP-1 RAs?
gastrointestinal side effects
–> this is why Ex may be better in some cases
Is Ex advice enough to develop lifestyle changes?
NO
Must be specific and provide direction/ structure to maintain weight loss
What is the best combination of treatment for weight loss?
Pharmacological intervention + Ex
BUT Supervised Ex has elicited similar results to just meds w/ fewer side effects and better long-term outcomes
How does Ex counteract higher RHR from GLP-1 RAs?
GLP-1 RAs slightly icnrease RHR
–> higher RHR is predicotr of mortality and disease development
w/ Ex, negates this increase
How does Ex reduce self-preception of poor jhealth?
Taking lots of meds can make people feel like they are an unhelathy/ sick person –> related to chronic diseases + mortality, and depression, and reduced participation in healthy lifestyle
What are some benefits of Ex beyond weightloss?
Health = phys, mental, social well-being, not just absence of disease
Regular PA contributes to primary + secondary prevention of Chronic disease, CVD, T2D, cancer, bone/ joint disease, depression
Imrpoves health across wide spectrum broader than meds
Increase CRF = protect against disease/ reduce mortality
GLP1s dont improve CRF
