Beyond The Scale: The Truth About GLP-1 Drugs - Insights from the Innersight Podcast #23
- InnerSight AI
- Jun 9, 2025
- 4 min read
Over the past year, GLP-1 agonists have become some of the most talked about medications in weight loss and metabolic medicine. In this blog post, we break down what they are, how they work, the benefits, side effects, and critical safety considerations, especially in the South African context.
This is not hype. It’s a recap of the best science we have to date, from 2021 to 2025, and our clinical experience using these drugs with real patients.
What Are GLP-1 Agonists?
GLP-1 agonists mimic a natural hormone (glucagon-like peptide-1) that plays a key role in appetite regulation and blood sugar control. By slowing stomach emptying, reducing hunger, and enhancing insulin secretion, they help people lose weight, specifically fat, and improve metabolic health.
Newer medications like tirzepatide (Mounjaro) also activate the GIP receptor, offering even more robust results.
We’re primarily using semaglutide and tirzepatide, as these are the most accessible in South Africa today.
It's Not Just About Weight, It’s About Metabolic Health
GLP-1s target visceral fat, the dangerous fat stored deep in the abdomen. This fat releases inflammatory signals that contribute to:
Type 2 diabetes
Cardiovascular disease
Fatty liver
Dementia
Cancer
So while the weight loss is impressive, the real power lies in reversing metabolic dysfunction.
Fat vs. Muscle Loss: Not All Weight Loss Is Created Equal
Semaglutide (Ozempic/Wegovy) users lose an average of 15% of body weight, but up to 39% of that can be lean mass.
Tirzepatide users can lose up to 22.5%, with only 18 -19% lean mass loss, which is far better than most diets or even bariatric surgery.
To preserve muscle, our clinic always pairs treatment with:
Resistance training
Protein optimization
Regular InBody scans
What Is the Treatment Like?
When prescribed, patients receive a pen injector, similar to an insulin pen. For tirzepatide (Mounjaro) in South Africa, things are a bit more hands-on; you’ll use an insulin syringe to measure your exact dose from a vial, under medical guidance.
Injections are subcutaneous (under the skin), once a week.
Injection site irritation can happen, so rotate sites.
Not everyone is comfortable self-injecting, which is why we teach patients how to do it safely in-clinic.
Dosing: Start Low, Go Slow
We usually begin with 0.25 mg or 0.5 mg weekly. If patients do well, we don't push the dose higher, even if higher doses lead to more weight loss in trials. Why? Because side effects like nausea are real and are often the reason people quit early.
Side Effects: What to Watch For
The most common issues patients experience are:
Nausea (up to 50%)
Constipation
Bloating
Reflux
Tirzepatide seems to cause less nausea than semaglutide.
To reduce side effects, incorporate some of the following tips:
Eat small meals
Increase dose slowly
Avoid fatty foods
Stay well hydrated
Psychiatric Effects, Pancreatitis & Cancer Risks
A 2024 study found a possible increase in depression and anxiety. More research is needed, but be cautious, especially if there's a psychiatric history.
Pancreatitis is rare (<5%) but possible.
Concerns about thyroid cancer come from rat studies (medullary type), not humans.
Gallbladder issues can occur, particularly with rapid fat loss.
NEVER Use These Drugs Without Supervision
Black-market GLP-1s are on the rise, and self-medicating is dangerous. Reasons to always involve a doctor:
Proper dosing and titration
Monitoring for complications
Muscle mass tracking
Risk assessment for psychiatric, pancreatic, or thyroid conditions
These are prescription medications that require a full patient assessment, monitoring, and a structured treatment plan.
Microdosing? Not Recommended (Yet)
There’s a trend toward “microdosing” GLP-1s, but it’s risky:
Increases risk of contamination
May exceed the product’s shelf life
Reduces effectiveness
Stick with medically approved minimum dosages. Hopefully, future formulations will offer safer low-dose options.
How Long Do You Need to Take It?
Here’s the reality: Most people regain weight after stopping the drug, often all of it within 1 - 2 years.
Long-term use may be necessary for some patients. This is why we combine medication with lifestyle changes from day one; that way, if the drug is stopped due to cost or tolerance, patients are equipped to maintain results.
Weight Loss Rate: What’s Realistic?
Patients typically lose 1 - 2 kg of fat per week. Not a crash, but sustainable, meaningful progress.
You’re unlikely to drop 10 kg in a month, but over time, the fat loss is substantial and metabolically beneficial.
The Brain & Heart Bonus
GLP-1 agonists may:
Improve cardiovascular outcomes
Reduce risk of dementia (up to 50% in obese patients)
Improve insulin sensitivity and reduce inflammation
We don’t yet know whether these benefits are due to weight loss, improved glucose control, or direct drug effects. But early data is promising.
Who Should Not Use GLP-1s?
Contraindications include:
Allergy to the drug
Family/personal history of medullary thyroid cancer
History of pancreatitis
Gallbladder disease
Severe psychiatric illness (unless well managed)
Always assess risks with a medical professional.
Storage & Travel Tips
Before opening: Store in the fridge
After opening: Can be kept at room temperature (under 30°C) for 21 days
Great for travel but label clearly and plan ahead
In Conclusion:
This is one of the most exciting developments in metabolic health in decades, but it’s not a silver bullet.
Use it as a tool, not a shortcut and pair it with:
✅ Resistance training
✅ Healthy eating (especially protein)
✅ Psychological support (where needed)
✅ Medical supervision
✅ Education about long-term planning
This is a rapidly evolving field; in just six months, we've seen huge shifts in research, approvals, and treatment protocols. There’s talk of oral tablets, sublingual versions, and longer-acting forms coming soon.
At this point, it’s riskier to remain overweight and metabolically unfit than to use these medications under proper guidance.
We’ll keep updating our approach as new data emerges but for now, GLP-1s, especially tirzepatide, look like a major step forward for the right patient, with the right plan, and the right support.