Metabolism · Praxis Dr. Romanos
Weight Loss Injections: What GLP-1 Therapy Does — and What It Doesn’t
Few medicines have been discussed as much in recent years as the “weight loss injection”. The effect is real and well documented in large trials. But it is not a lifestyle product. It is a treatment with a clear indication, side effects and a question that is rarely asked: what happens afterwards?
How GLP-1 works
GLP-1 is a gut hormone released after eating. The medicines mimic it and act much longer. They slow stomach emptying, increase the feeling of fullness and dampen appetite via the brain. Newer products also act on a second gut-hormone receptor (GIP). The injection is given under the skin once a week.
The result: people eat less without constantly fighting hunger. In the large approval trials, participants lost on average around 15 to 20 percent of their body weight over a little more than a year, alongside changes in diet and exercise. Individual results can be much higher or lower.
Who the treatment is for
The weight treatment is approved for adults with a BMI of 30 or more — or 27 or more with a weight-related condition: prediabetes or diabetes, high blood pressure, a lipid disorder, sleep apnoea or cardiovascular disease.
It is not meant for losing a few kilos for cosmetic reasons. It is not suitable during pregnancy or breastfeeding, when planning a pregnancy in the coming months, after pancreatitis, or with certain thyroid tumours in your own or your family’s history (medullary thyroid cancer, MEN 2). It is also not the right route for an eating disorder.
We prescribe when there is a medical indication, not on request.
What should be checked first
Excess weight has causes, and some are treatable: an underactive thyroid, insulin resistance, medicines that raise weight, sleep apnoea. Before starting treatment we therefore measure blood sugar and HbA1c, fasting insulin, lipids, thyroid, liver and kidney values, and record blood pressure and other conditions. This baseline workup is done through our Metabolic Analysis.
Side effects
The most common are nausea, bloating, constipation or diarrhoea — mainly in the first weeks and after each dose increase. That is why the dose is raised step by step. Gallstones and pancreatitis are less common. Severe, persistent upper abdominal pain needs medical attention straight away.
Muscle loss is underestimated. Rapid weight loss is not only fat. Enough protein and strength training are part of the treatment, not the small print.
What happens after stopping
The medicine dampens appetite while it is working. When it is stopped, appetite returns. In trials, participants regained on average about two thirds of the lost weight within a year of stopping.
Obesity is therefore better treated like high blood pressure: as a chronic condition that needs long-term care. Anyone starting GLP-1 therapy should know beforehand what comes next — a maintenance phase, dose reduction, and diet and exercise as the foundation.
Costs and health insurance
The medical workup for obesity or weight-related conditions is covered by basic insurance. Basic insurance pays for the weight-loss medicine itself only under strict conditions: severe obesity, prescription by specialists or obesity centres, for a limited period and only with a proven response. In a GP practice the treatment is therefore usually self-pay.
How we supervise this treatment, including the process and prices, is on our Weight Management page.
Next step: In the initial consultation we check whether treatment makes medical sense for you.
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