Episode Summary

12% of Americans have tried GLP-1 drugs like Ozempic and Wegovy, but up to 65% discontinue within the first year. This comprehensive deep-dive examines the latest 2024-2025 research to uncover what's really happening with these medications - from remarkable cardiovascular and brain health benefits to the practical realities of side effects, costs, and discontinuation rates.

Key Takeaways

✅ GLP-1 drugs provide 20-25% reduction in heart attacks and strokes, independent of weight loss

✅ Emerging research shows benefits for brain health, addiction, and kidney protection

✅ High discontinuation rates (46-65%) are driven by multiple factors beyond side effects

✅ Success depends heavily on proper patient selection and specialist care

✅ Cost remains a major barrier with medications exceeding $1,000/month

MAJOR TOPICS COVERED

The Science Behind GLP-1

• How natural GLP-1 hormone works in your body
• Why synthetic versions last longer and work as medications
• Difference between GLP-1 drugs and dual agonists like tirzepatide

Research-Backed Benefits

• Weight Loss: 12-22% body weight reduction in clinical trials
• Cardiovascular Protection: 20-25% reduction in major adverse events (SELECT trial)
• Kidney Health: First GLP-1 approved for kidney protection (January 2025)
• Brain Health: Reduced risk of addiction, depression, dementia, and seizures
• Sleep Apnea: FDA approval for moderate-to-severe cases
• Liver Health: Benefits for metabolic liver disease

Challenges & Side Effects

• Gastrointestinal issues affect 40-70% of users
• "Ozempic face" and rapid weight loss effects
• Rare but serious risks: pancreatitis, gastroparesis, kidney injury
• Cost barriers and insurance coverage gaps
• Supply chain disruptions and accessibility issues

Who Should Consider These Medications

• Clear candidates: Type 2 diabetes, obesity with cardiovascular disease
• Emerging candidates: People with addiction issues, dementia risk
• Important considerations: long-term commitment, financial planning
• Why specialist care improves success rates

RESEARCH SOURCES CITED

Major Studies Referenced:

• Nature Medicine 2025 - Comprehensive analysis of 175 health outcomes
• JAMA Network 2025 - Discontinuation and reinitiation patterns
• SELECT Trial - Cardiovascular outcomes in obesity
• Northwestern Medicine 2024 - Real-world benefits and risks analysis
• BMJ 2024 - Comparative effectiveness meta-analysis

• 12% of US adults have used GLP-1 medications
• 46.5% discontinuation rate (with diabetes) vs 64.8% (without diabetes)
• $1,000+ monthly cost without insurance
• 40-70% experience gastrointestinal side effects

MEDICATIONS DISCUSSED

GLP-1 Receptor Agonists:

• Semaglutide (Ozempic, Wegovy)
• Liraglutide (Victoza, Saxenda)
• Dulaglutide (Trulicity)
• Exenatide (Byetta)

• Tirzepatide (Mounjaro, Zepbound)

• Retatrutide (triple agonist in development)
• Oral formulations in development

RESOURCES FOR LISTENERS

Find a Specialist:

• American Association of Clinical Endocrinologists (AACE)
• Obesity Medicine Association provider directory

• Manufacturer patient assistance programs
• GoodRx and prescription discount programs
• Insurance coverage advocacy resources

• Follow FDA drug safety communications
• Clinical trial databases for emerging research
• Professional medical organization guidelines

IMPORTANT DISCLAIMERS

This episode is for educational purposes only and does not constitute medical advice

• Always consult qualified healthcare providers before starting, stopping, or changing medications
• Individual results and experiences may vary significantly
• Cost and insurance coverage information may change frequently
• Research in this field is rapidly evolving

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About Brandon Smitley

Instagram: @bsmitley @team.thirst

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Website: THIRSTgym.com

Brandon Smitley is a world renowned strength coach and athlete for over a decade. He and his wife, Adrian, own Terre Haute Intensity Resistance and Sports Training (THIRST) where they work with youth athletes and personal training clients of all ages. He earned his Bachelor’s degree from Purdue University in Health and Fitness, and his Master’s degree from Indiana State University in Physical Education and Coaching. Brandon has been awarded Personal Trainer of the Year Awards from Purdue University and Indiana State University as well is the 2020 Reader's Choice for Best Personal Trainer in Terre Haute, IN and the Wabash Valley.

Brandon is a sponsored athlete with Elitefts and NutraBio where as a competitive powerlifter he currently holds the all-time world record squat in the 132 pound weight class, with a 567 pound squat. He also holds a 330 pound bench press, and 510 pound deadlift in that weight class, totaling 1377 pounds, ranking 4th all-time. He provides online coaching and programming around the world, and has personally worked with over 200 athletes in the US, UK, France, Italy, Mexico, Canada, and other countries. Brandon’s been published at Elitefts, Muscle and Performance, and Muscle and Fitness magazine.

He holds his Certified Strength and Conditioning Specialist (CSCS), Level One Sports Performance (USAW), Certified Personal Trainer (CPT) certifications, and is educated in PRI for Fitness and Performance.