Everything you need to know about GLP-1 agonists

What are GLP-1 agonists?

The media often report on Wegovy, Mounjaro and Ozempic, or even the descriptive term ‘skinny jab’, but these are all brand names. The active ingredient in most of these medications are compounds that work to antagonise Glucagon-like Peptide 1 receptors (hence the name GLP-1 agonists). The active ingredient in Ozempic and Wegovy is called semaglutide, while Mounjaro is tirzepatide. While you’ll look cool in your interviews if you get this right, it’s not worth getting too bogged down in this as they all do the same thing. 

GLP-1 receptors are found all over your body, so these medicines tend to have systemic effects. In general, they promote being full, absorbing nutrients, and using calories rather than storing them as fat. They encourage your pancreas to release insulin, so they improve sugar (glucose) regulation in people living with type 2 diabetes mellitus (T2DM). T2DM is a medical condition where, over time, your body becomes resistant to the insulin you produce naturally, so you are less able to store sugar and it accumulates in your blood. Excess blood sugar levels can damage small, fragile blood vessels, causing eye disease, nerve damage and kidney damage.  

Because of this, GLP-1 agonists are really great medications to treat T2DM! They also often cause weight loss, including in people without T2DM, so many people who are not living with T2DM, or even any health conditions, may want to take these drugs too to lose weight. This get quite complex quite quickly, as we’ll discuss. 

What are the ethical considerations with these medications?

GLP-1 agonists have grabbed the public consciousness and are some of the most talked about new medications in the world. However, like any medication, they have pros, cons and side effects. Some of the ethical issues you might need to think about are: 

• People taking medications who don’t ‘need’ them. Because GLP-1 agonists can cause weight loss, lots of people who would not need these drugs to manage T2DM want to take them to lose weight. As doctors, we have to weigh up the harms and benefits to patients of taking a medication, rather than just prescribe what patients ask for. GLP-1 agonists can cause side effects like pancreatitis, a dangerous inflammation of the pancreas, and gallstones, and they can make you feel nauseous. 

• Fair access to medications. Because lots of people want to take GLP-1 agonists, that means there can be less medicine for the NHS to buy for people who need it, leading to shortages or rationing within the NHS. Some people who can afford it might buy GLP-1 agonists for personal use, but this means the medicine is being distributed according to who has the most money. 

• Patient choice and access to medications online. Some patients choose to buy GLP-1 agonists online, often from abroad, bypassing NHS systems. However, when things go wrong, they will often come to the NHS for emergency care, which can feel unfair when an NHS clinician would not have prescribed the medication for them. 

• Advertising of medications. GLP-1 agonists have been extensively discussed in the media. While advertising medication is illegal in the UK (although not in other countries), this does effectively amount to free publicity for drug companies, and may encourage people to ask their doctors for medication. 

• Obesity and health. While being overweight or obese can lead to health issues later, the links between obesity and health are more complex than people often think. For many people, losing weight is very difficult and it can be much more helpful – and better for their health! – to think about healthy and sustainable changes to diet and exercise, regardless of if they make someone lose weight or not. Equally, being underweight, or having an eating disorder or a disordered eating pattern, are likely to be much worse for someone’s health than being overweight. GLP-1 agonists may help people lose weight at the expense of other healthy lifestyle changes. They are not a magic bullet. 

What interview questions might I get asked about GLP-1 agonists?

Because GLP-1 agonists offer such a rich seam of relevant and complex ethical issues, and interviewees should be familiar with them as they are so commonly discussed in the media, they may well come up at interview. Some questions you might want to practice are: 

• What are ‘skinny jabs’?  

• Should Ozempic be offered to everyone on the NHS? 

• Should the NHS care for someone who becomes unwell after buying medicine illegally online? 

• Should anyone who wants it be able to buy Mounjaro to lose weight? 

• What are some of the pros and cons of GLP-1 agonist drugs? 

• Should newspapers be able to run stories about whether celebrities are using Ozempic? 

What to consider when answering a question on GLP-1 agonists?

When you’re answering any ‘hot topic’ interview question, you want to take a balanced approach. You want to show that you can understand both sides of the argument for and against something and come to a reasoned conclusion. There isn’t a right answer – if there was, what would be the point asking you the question? 

Lots of people find a ‘four pillars’ approach to ethical questions, evaluating how something fares across the domains of beneficience, non-maleficience, autonomy and justice, helpful to answer these questions. However, this isn’t required: any structured answer showing an understanding of the ethical principles involved can demonstrate your skills and knowledge.  

The key thing is not to make anything up: if you’re moving beyond what you know, acknowledge the uncertainty. With an exciting new technology like GLP-1 agonists, it can be tempting to feel like you have to show in depth medical knowledge, but the interviewer will always know more than you do. Avoid phrases like ‘studies have shown’ if you couldn’t give the interviewer a reference!