Weight Loss Drug Use: Effects in the Workplace

 

New Year, New Health Goals

As the new year begins, many employees are re-engaging with personal health goals, and for some, that includes conversations around GLP-1 medications. Originally developed to support diabetes management and now more widely prescribed for weight loss, these medications are becoming increasingly visible in the workplace. For employers, this raises practical questions that extend beyond benefits coverage, including safety considerations, job performance, accommodations, and how to respond appropriately without crossing into medical decision-making. This blog addresses frequently asked questions about GLP-1 drugs through a workplace lens, helping employers understand what matters from a workforce health, safety, and compliance perspective as new-year wellness initiatives take shape.

GLP-1: Potential and Precautions

When appropriately prescribed and monitored, GLP-1 drugs are considered safe and effective. They are believed to have the potential to reduce cardiovascular disease risk, improve cognition inpeople with certain diseases that affect brain function, and produce other significant health benefits. However, scientists say ongoing research is needed to fully understand their mechanisms and long-term effects.

The importance of behavior modification, diet, and exercise in conjunction with qualified medical guidance cannot be overemphasized for those seeking ways to manage type 2 diabetes and/or weight loss. These drugs are not recommended for the treatment of type 1 diabetes. Care should be taken when used in combination with other diabetes medications to avoid hypoglycemia and potential interactions with other prescribed or natural remedies.

There are also some other downsides associated with the popularity of GLP-1 drugs, including supply and demand. According to a study published in the Annals of Internal Medicine, the number of new GLP-1 medication users increased by approximately 1 million between 2011 and 2023 in the U.S., with a twofold increase in the number of users without type 2 diabetes. Other potential impacts include higher costs, counterfeit drugs in the supply chain, and the potential for misuse by those seeking a “quick fix” as an alternative to making a commitment to a consistent, monitored weight-loss, nutrition and exercise regimen.

Answers to Frequently Asked Questions

Q:   We are hearing a lot about drugs that people are taking to lose weight. What are they?

A:   The drugs in question are glucagon-like peptide-1 receptor agonists (GLP-1 RA). GLP-1 medications that are prescribed to treat type 2 diabetes and/or help people who are obese or overweight lose weight. Some GLP-1 medications are prescribed for the management of high blood pressure, prediabetes, or blood vessel disease.

Q:   How do these drugs work?

A:   They mimic a hormone in the body that helps control blood sugar and appetite. GLP-1 prompts the body to produce more insulin, which reduces blood glucose (sugar). GLP-1 also interacts with the brain to suppress appetite and signal a feeling of fullness.

Q:   What are their brand names and active ingredients?

A:   U.S. Food and Drug Administration (FDA)-approved GLP-1 drugs include Ozempic®, Wegovy® and Rybelsus® (semaglutide); Mounjaro® and Zepbound® (tirzepatide); Trulicity® (dulaglutide) and Saxenda® (liraglutide).

Q:   Why are these drugs getting so much attention now?

A:   An estimated 42 percent of the adult U.S. population is obese and 32 percent is overweight. Excessive weight increases risk for the development of diabetes, cardiovascular disease and other chronic conditions, and serious symptoms associated with contagious illnesses. Recent clinical trials have demonstrated superior weight loss results and a safer side effect profile when GLP-1 drugs are compared to other types of weight-loss drugs. These drugs are being widely advertised, promoted via social media, and endorsed by celebrities.

Q:   How are they administered?

A:   Each medication has unique properties, dosing schedules, and indications that provide a range of choices for personalized treatment plans. Depending on the type of medications, most are self-injected daily or weekly. Rybelsus is an oral medication. Proper training on how to administer subcutaneous injections is crucial for efficacy and safety.

Q:   How is their use monitored?

A:   GLP-1 medications are prescribed and monitored by a physician or other qualified provider following a telemedicine or in-person consultation to determine whether the person is a candidate for them. Some GLP-1 drugs for type 2 diabetes may be used off-label for weight loss in certain cases. The FDA has approved Saxenda, Wegovy, and Zepbound for weight loss without a diagnosis of type 2 diabetes. They should not be used by anyone other than the person for whom they are prescribed.

Q:   Which drugs are approved for weight loss without a diagnosis for diabetes?

A:   Some GLP-1 drugs for type 2 diabetes may be used off label for weight loss in certain cases. The FDA has approved Saxenda, Wegovy, and Zepbound for weight loss without a type 2 diabetes diagnosis. Mounjaro is approved for people who are overweight or obese and have at least one weight-related health condition, such as high blood pressure. A 2024 study published in Hypertension found that people with obesity who took tirzepatide for nine months had lower blood pressure than those who took a placebo.

Q:   What are some of the potential side effects of GLP-1 drugs that could impair an employee’s physical or mental function or ability to work safely?

A:   Common side effects of GLP-1 drugs include nausea, vomiting, diarrhea, constipation, and abdominal pain. Other reported side effects include headache, fatigue and injection site reactions such as skin irritation. More serious, less common side effects may include inflammation of the pancreas, hypoglycemia (especially when used with other diabetes medications), and potential effects on kidney function, the gallbladder, or thyroid gland. The status of investigations into potential connections with risk for depression and suicidal ideation are discussed in this JAMA Network Open article, published on Aug. 20, 2024.

Q:   How are side effects managed?

A:   Under the supervision of a physician, the dose may be gradually adjusted. The patient may be advised to drink plenty of fluids and eat smaller portions of easy-to-digest foods more frequently. Common side effects typically resolve on their own.

Q:   What precautions are advised for employees who plan to start taking a GLP-1 medication?

A:   An employee may confer with their provider for guidance to determine the best time to start treatment, keeping in mind their lifestyle, personal responsibilities and work schedule. It’s advisable for employees to postpone starting a new GLP-1 medication before traveling for an extended period of time, visiting a remote area or starting an assignment away from home, such a two-week stay on an offshore platform. It’s advisable to be close contact with the prescribing provider while adapting to the medication. In the workplace, onsite clinicians may assist with the management of side effects.

Q:   Can we require employees to notify their supervisor if they are taking a GLP-1 medication so we can be prepared to respond appropriately should a related medical event occur?

A:   The Americans with Disabilities Act (42 U.S.C. § 12112(d)(4)(A) limits inquiries about medication usage. The Equal Employment Opportunity Commission’s Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA explains that employers may only ask about medication use if the inquiry is job-related and consistent with business necessity. The employer must have a reasonable belief, based on objective evidence, that the medication use may impair the employee’s ability to perform essential job functions or that it could pose a direct threat to the health and safety of the employee or others.

Q:   Can employees self-report medication use?

A:   Yes, employees may choose to inform their employer for safety and health reasons when they are taking a medication that could cause impairment and/or affect safety on the job. Their personal health information is protected under provisions of the Health Insurance Portability and Accountability Act.

Sources for these answers to frequently asked questions include WorkCare’s board-certified occupational health physicians and Harley, an intelligent AI agent that functions as a medical copilot and patient navigator.