Ozempic® - and similar medications Wegovy®, Mounjaro® and Zepbound® - is a household name, whether seen in television commercials with celebrity endorsements featuring firsthand accounts of the GLP-1 (glucagon-like peptide-1), or in news stories announcing the approval of further drug indications.
The GLP-1 medications - both semaglutide (which works on one receptor) and tirzepatide (with two receptors, glucose-dependent insulinotropic polypeptide (GIP) and GLP-1) - mimic a natural gut hormone that helps control blood sugar and promote weight loss by slowing digestion and increasing the feeling of fullness.
While it’s not the first batch of medications targeting those with glucose-based conditions - Type 1 and Type 2 diabetes - or obesity, patients were struggling to source the medications with their rise in popularity. As a result, compounding pharmacies began to produce the semaglutide and tirzepatide formulas until the Food and Drug Administration (FDA) halted the practice in spring 2025. Despite the reduction of off-brand producers, the medications continue to make headlines and physicians are recognizing the additional benefits of the drugs.
Chadi Richeh, MD, Board Certified in Endocrinology, Diabetes and Metabolism, as well as Obesity Medicine, works with patients with diabetes in addition to those who struggle with obesity. Recognized by the Centers for Disease Control and Prevention (CDC) as a chronic disease, obesity has been noted as an epidemic by the CDC with a prevalence of 1 in 4 individuals in the United States in 2024. Richeh says that researchers warn that by 2030, nearly half of all Americans will be obese, leading to myriad harmful health conditions.
“When we worry about obesity - not because of the aesthetic or cosmetic part of it - we worry about the complication in metabolic disease,” Richeh explains. “Obesity and diabetes go hand-in-hand, as well as fatty liver, cirrhosis, joint pain and 19 different types of cancer, including pancreatic, stomach, uterine, breast and prostate. Multiple cancers have been directly linked to obesity and being obese itself will reduce the lifespan of a human by five to seven years per a British study. That alone can tell you how damaging and devastating obesity is to health.”
Obesity starts at childhood, warns Richeh. “The way we feed our kids is the key. Most fat cells start forming between 5 and 7 years old.”
Rather than rewarding children with treats such as cookies, he encourages parents to introduce vegetables and meat and healthy eating habits at an early age. “We [as parents] could be part of the problem creating that obesity,” he warns. “The culture of comfort food should be eliminated.”
“GLP-1s are really the silver bullet. On the brain, they increase satiety, stimulating the satiety center in the hypothalamus,” he explains. “They reduce hunger and food rewarding and hedonic [pleasure-seeking] hunger, and they primarily drive weight loss. At the level of the stomach, they slow the gastric emptying and hence you get early fullness and they slow the postprandial glucose spike, preventing high sugar after you eat. For the pancreas, they improve the post-meal glucose control with minimal hypoglycemia and they improve the glucose-dependent insulin secretion. On the liver itself, they reduce the gluconeogenesis [process of creating glucose in the liver and kidneys from non-carbo-hydrate sources, which help maintain blood sugar levels when dietary intake is low], reducing hepatic fat formation and metabolic dysfunction associated with fatty liver disease.
“On the adipose [body fat] tissue, they reduce the lipogenesis, the production of extra fatty cells, and preferential visceral fat loss, and they improve insulin sensitivity. On the muscle, they enhance the glucose uptake and improve insulin sensitivity. On the cardiac system, they reduce blood pressure. They work like a diuretic, reducing the inflammation and the atherosclerotic [buildup of fats and cholesterol] formation of the artery, with proven major adverse cardiac events reduction in a high-risk patient. On the kidney, they help as a diuretic reducing albuminuria [protein in the urine].”
Amanda Rittenberg, MD, is Board Certified in both Family Medicine and Obesity Medicine. Completing her residency in Family Medicine at the Eisenhower School of Graduate Medical Education in July 2025, Rittenberg joined the staff as a practicing physician as well as faculty for the residency program. She is also witnessing the benefits of GLP-1s with patients.
“I’m seeing excellent results,” says Rittenberg. “It’s motivating my patients to make healthier choices because the medication makes it easier to make those right choices. It makes you have fewer cravings. You’re not eating when you’re bored. You’re only eating really when you need to. And, because you are investing in your health, you’re making better choices.”
Rittenberg asks patients to keep a food log and works with them on changing their habits.
“You’re adding a medication for weight gain,” she says, “which is a chronic lifelong condition. Growing up, I remember going to the doctor and I was heavier and the doctor would say, ‘Eat less, exercise more.’ And that’s just not the reality.”
“Your body has a set point,” she explains. “Let’s say you’ve been 300 pounds in the past. Your body’s constantly trying to get back to that point. I’m seeing excellent outcomes. I’m taking people who were on three or four blood pressure medications and now they’re barely on one.”
Notwithstanding the risks, the FDA continues to evaluate the treatment of conditions using GLP-1s. Newly approved treatments include the use for fatty liver, cardiovascular disease, and most recently, sleep apnea. Addiction medicine may be the next frontier and is already being studied. Recently, the FDA-approved oral GLP-1 in a daily pill alternative to injections for weight loss.
An ever-evolving field, there is no standard practice for either discontinuance or titration down of the medications.
“It is a lifelong condition,” explains Rittenberg. “You wouldn’t remove someone’s blood pressure medications just because their blood pressure is well controlled. Their weight is well-controlled on the medication.”
Those interested in discussing GLP-1s, or other weight-loss medications, in their care plan may speak with their primary care provider, says Rittenberg.
“Every primary care provider should at least be offering patients the ability to treat their weight because it is the gold standard and it’s the standard of care,” says Rittenberg.
“This is such a revolutionary and changing field,” she adds. “There’s so much stigma with weight; we want patients to realize not only is it about the number on the scale, but truly about their health.”
Tips for Success
Chadi Richeh, MD, Board Certi?ed in Endocrinology, Diabetes and Metabolism, as well as Obesity Medicine, and Amanda Rittenberg, MD, Board Certi?ed in both Family Medicine and Obesity Medicine, are well-versed in medications that could assist in weight-related conditions. It’s a piece of the puzzle, however, and must be part of a larger health plan to lose and keep the weight off. Read on to ?nd some tips that could help along the way.
Mediterranean, Atlantic, paleo and ketogenic diets and calorie de?cit are successful in weight loss. “The key is to stick to a diet because without diet, medication is useless. If you are putting on a Band-Aid®, you’re not ?xing the problem. Don’t consider this diet temporary, but a lifestyle, because the moment you drop it, you’re going to get the weight back,” says Richeh.
150 minutes of moderate-intensity exercise each week -60 to 70% of your goal heart rate, calculated 220 minus age (dependent on what the patient can do). “The ‘talk test’ provides a practical way to gauge moderate intensity: a person should be able to talk but not sing during the activity. This distinguishes moderate from vigorous intensity, where conversation becomes dif?cult beyond a few words without pausing for breath,” says Rittenberg.
Substitute soft drinks with water. “Water is your best friend,” says Richeh. Half a gallon daily is a standard, especially when living in the Southwestern United States.
40% of your meal is based on protein, and it doesn’t
have to be animal protein. Plant-based protein is healthy, especially for people who have kidney problems.
Choose 30% complex carbohydrates and eliminate re?ned sugar. Complex carbs take time to break down and have ?ber, which helps to avoid absorption of all the carbs. A healthy fat should be around 30% of the meal, such as avocado or olive oil, nothing hydrogenated.
For more information about Eisenhower Health primary care providers or board certi?ed obesity medicine specialists, call 760.773.1460.
