I actually have my first experience of serious side effects of WLI- I have one good friend who developed very serious bowel problems after a year of taking GLP-1 medication (Monjuaro). She had a very high BMI of over 40 kg/m2 and was exactly the kind of person these drugs are intended for under current prescribing guidelines. She genuinely loved using them, and they helped quiet the “food noise” she had lived with for most of her life. However, she has recently had her second emergency bowel surgery and will now be living with the effects of that for the rest of her life, despite only being in her late 40s.
While this is obviously an extreme example, the fact remains that one known effect of GLP-1 medications is slowed gut motility. That can increase the risk of constipation, which in some cases may lead to impaction or other serious bowel complications. Those risks to gut health can’t be ignored. I suspect this may become a more common issue over the coming years as more people use these medications.
My biggest concern, though, is the possible long-term impact. Things like osteoporosis and sarcopenia may not show up until years later, especially if people are eating far less without making sure they are still getting enough protein, micronutrients, and doing some resistance exercise. Rapid or sustained weight loss without proper nutritional support can carry risks that don’t always get talked about enough.
The argument that these drugs have been safely used in diabetes for years is less convincing when applied directly to weight-loss use in lower-risk groups. For example, someone with a BMI of 27 and no major metabolic risk factors may have a very different risk-benefit balance than someone with obesity-related disease. If reduced appetite leads to a poor diet, deficiencies in key nutrients or protein intake could develop over time.
All of that said, I do think these medications have an important place. For many people, they can be life-changing and may reduce serious obesity-related health risks. But I think they should come with much stronger dietary guidance, exercise support, and ongoing monitoring of nutritional status and muscle mass.
I wouldn’t rule out using them myself if the need arose, but I’d want to make sure my diet and exercise habits were in a very good place first. I work in nutrition science research, and I suspect a lot of the future direction of my profession will be around how to use GLP-1 receptor agonists safely, effectively, and alongside sustainable lifestyle support.