Measuring the Right Data for GLP-1 Patients

By Matt Phillion

GLP-1 drugs are the talk of the industry, but clinicians are facing an overlooked issue: Patients aren’t just losing fat, they’re also losing muscle and vital body water, highlighted in a study published by the Journal of Clinical Endocrinology & Metabolism. These changes can quietly weaken metabolism, strength, and long-term health. This has led many clinicians to ask: Are we measuring the right things for this patient population?

“These drugs have been around a long time, but as the public finally hears about some of these things, there’s a transformational effect,” says Maureen McBeth, senior medical affairs liaison at ImpediMed. “It’s been a synergy of a few things happening. The awareness piece has exploded. I can’t go to a conference without hearing about it, but we’ve been talking about these issues for years, for things like diabetes, or cancer where people are losing too much weight.”

Part of the rise of GLP-1 as a weight loss product comes as part of the tail end of COVID, as physical therapists like McBeth addressed a patient population that found new struggles with their weight due to decreased activity, eating differently, lack of exercise, and even the not-fully-explored impact of COVID and weight gain.

“The conversation has exploded, but these are really powerful drugs that mimics what your body already does and can help people so much,” says McBeth. “Just looking at type 2 diabetes, these drugs immediately act on the pancreas and liver, impacting your gut/brain access and turning off the ability to want to eat.”

But until recently, it hasn’t been a conversation people wanted to have. The stigma has faded and the hesitation to mention you’re taking it for medical reasons has faded and as the stigma fades, conversation grows.

“Now, you can’t watch TV without ads for it. It’s still really targeted for diabetes, but we’re hearing more about weight loss in general and that you don’t have to be clinically obese to take it. It’s also beneficial for obstructive sleep apnea,” says McBeth.

What we need, McBeth says, is for more clinicians to become medically educated on GLP-1, its uses, and its impact on the patient to ensure that they are monitoring their patients using it for the right data points.

Right screenings, right patients

McBeth is curious about how the role of insurance companies will evolve with regards to GLP-1 drugs.

“My own insurance company, when my BMI got over 30, bombarded me with things in the mail—a free tablet for exercise. I’m post-menopausal so they suggested four or five different programs they were running if I wanted to do something to help with that. They offered all these other programs but would not pay for the drugs. They could probably use the massive amounts of data they have to find the patients who may be applicable,” says McBeth. “Patients who could be properly screened. I can’t imagine a patient going to their doctor and not at least having a conversation about it. I think doctors are willing to write a prescription for it, but don’t have the necessary level of education or counseling at the very beginning. Patients are on their own to navigate the process.”

The screening and testing component is a concern, McBeth notes.

“We use our device to screen for lymphedema, and for a clinical trial using GLP-1 to manage lymphedema. The test is similar to body composition assessments used in fitness settings, but it provides more detailed clinical insight into fluid and muscle changes,” says McBeth. “I had seen results from patients on GLP-1s where body composition raised red flags, particularly unintended loss of muscle mass.”

This can be a significant concern, especially for patients whose muscle mass might start out low already.

“We need to get this conversation going, so healthcare providers can do a true body composition on someone that’s not just letting the scale decide,” she says. “Just looking at weight hides the loss of water weight, and skeletal and muscle mass.”

The patients are rarely aware that they need to keep an eye on these factors, McBeth said.

“One patient I tested had already lost 100 pounds, which is exceptional and kudos to her, but when she saw her muscle mass and fat mass, she was shocked,” says McBeth. “She wasn’t really eating or exercising, and the way she’d been losing weight was to just let the pill do the work. We can’t let that happen. There needs to be guardrails.”

Benefits now and later

It’s somewhat surprising, McBeth notes, that insurance companies know about a drug that can help with expensive conditions but aren’t necessarily covering it.

“The problem with health insurance is it’s not a long-term game. They don’t look and say we want you to be healthier in 10 years,” she says.

As opposed to private insurance, Medicare is a different story, and that is where we’re seeing earlier changes.

“Medicare does have this philosophy now, as once someone is on Medicare they’re going to always be on Medicare. They have skin in the game,” says McBeth. “But very few insurance policies feel that way and unless you can show an outcome in a certain time frame, they’re probably not going to pay for it.”

The shift needs to come from a change in conversation, understanding that these drugs are about more than just weight loss. That conversation is blossoming now, McBeth says. In the interim, there are certain risks the industry needs to be more aware of, she notes.

“For one, not enough of the right people are on the drug. Worldwide, the number of people who could benefit from these drugs not being reached is high,” McBeth explains.

Some of that is the way the drugs are discussed and marketed, and much of it is the pop culture lens they are viewed through now.

“It’s funny though that because of that pop culture lens, more people are talking about it and creating a safer space to discuss the good uses of these drugs,” she says.

McBeth is herself a patient using GLP-1, specifically for preventive cardiac care.

“Once I mention I’m on it, other folks will say they are as well!” she says. “My own story starts with my mom who, at age 84, needed a double bypass. She was in really good shape for her age, but her heart was 90% blocked, and she asked her cardiac surgeon, ‘What could I have done, and when?’ Well, that journey should have begun 30 years ago. So, I looked at myself and said, ‘That’s me!’”

After some testing to assess her own cardiac health, the option of GLP-1 came up and how it has a strong cardiovascular profile.

“It’s not just for people with excess weight—it’s a whole metabolic connection,” she says.

It was that life-changing use case for herself before GLP-1 became a household name that brought its potential to the forefront for McBeth.

Still, the barriers to reaching the patients who can benefit from a prescription are scary, she notes.

“Many of us have to self-pay for these drugs. If you don’t meet the criteria they’re using for it, it can be pretty scary,” says McBeth. “And the number of people who, in the next five years, will be obese in our country is staggering in the way it’s increasing. This puts a huge burden and impacts everything. It can limit someone’s ability to work, and cardiovascular disease is neck and neck with cancer as the number one killer in our country.”

And often, both conditions are not mutually exclusive.

“There’s a lot of connections between cancer and cardiac conditions. In my space as an oncology physical therapist, we talk to our patients about how you’ve survived cancer, and now you need to exercise not just for the cancer but because you’re at risk for heart disease,” she says.

This leads back to the media and perception of the drugs and its current perception.

“Get it out of Hollywood and back to how it’s about your body being healthy from the inside. That’s what I’m so impressed about with these drugs. They help with so many chronic conditions,” says McBeth. “There are plenty of people with type 2 diabetes who are not overweight, and they might be on one of these drugs because it impacts their diabetes and their ability to manage that.”

Patient advocacy has a large role to play in changing the conversation, McBeth says.

“We work with cancer care, and these areas have been greatly impacted by these drugs – I’m just trying to get the world out there,” she says. “And it’s also really important that we look at some of the abuses of it, where it’s being marketed toward a culture of being super-thin.”

The right drug for the right patient can change lives, McBeth says.

“I have patients whose bodies have changed because of illness or accidents, and we want everyone to have the ability to optimize the health they have and move it in the right direction,” she says. “It’s not a moral failure. There’s a lot of complex reasons these conditions exist. Let’s start by looking at the body and how we can make improvements with the right data to make the right decisions.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.