Under­stand­ing pop­u­lar weight-loss drugs

 

The class of drugs known as GLP-1 receptor agon­ists have become renowned for their effects in help­ing weight loss.

MALAYSIA is the most obese and over­weight nation in Asean.

Over­weight adults form 32.6% of the pop­u­la­tion, while obese adults form another 21.8%, adding up to 54.4% of the pop­u­la­tion.

Not only that, about 29.8% of chil­dren are obese or over­weight.

In addi­tion, about 21% of Malay­si­ans are dia­betic, of which 80% are obese or over­weight.

The Health Min­istry (MOH) is intro­du­cing glu­ca­gon-like pep­tide 1 (GLP-1) medi­cines for “vul­ner­able groups” this year.

Who the vul­ner­able groups are is unclear.

However, it behoves every­one to ensure that patient safety is not com­prom­ised by the use of GLP-1 medi­cines.

How they work

GLP-1 medi­cines are receptor agon­ists that mimic the GLP-1 hor­mone that is nat­ur­ally released in the gastrointest­inal tract in response to eat­ing.

When a per­son eats, the digest­ive sys­tem breaks down car­bo­hydrates into simple sug­ars that enter the blood­stream.

GLP-1 stim­u­lates the release of insulin from the pan­creas.

Insulin, a pan­cre­atic hor­mone, helps get gluc­ose out of the blood­stream into the body’s cells, where it is used for nour­ish­ment and energy.

In dia­betes, the body’s cells are res­ist­ant to insulin, do not pro­duce suf­fi­cient insulin, or both. GLP-I medi­cines stim­u­late the pan­creas to release insulin and reduce the release of glu­ca­gon.

Both insulin and glu­ca­gon con­trol the blood gluc­ose levels in humans, includ­ing type II dia­bet­ics.

GLP-1 medi­cines also act on the brain to reduce hun­ger and delay empty­ing of the stom­ach.

These drugs are used in the man­age­ment of type II dia­betes, and in some instances, obesity in non-dia­bet­ics.

They reduce food crav­ings, increase full­ness (sati­ety), slow diges­tion and can help con­trol blood gluc­ose.

GLP-1 medi­cines were licensed for dia­betes man­age­ment in Malay­sia in 2007, and was approved for obesity man­age­ment in 2019.

As of 2025, there are more than 30 GLP-1 medi­cines registered.

There are dif­fer­ent types of GLP-1 medi­cines.

Some are injec­tions and oth­ers

are tab­lets. Some are licensed for dia­betes, and oth­ers are licensed for weight-loss man­age­ment, or to treat the over­weight with weight-related health prob­lems.

Side effects

Like all medi­cines, GLP-1 agon­ists have side effects.

The com­mon ones are gastrointest­inal, i.e. nausea, vomit­ing and diarrhoea, which are usu­ally mild to mod­er­ate, and of short dur­a­tion.

Some­times, these side effects can be ser­i­ous, lead­ing to severe dehyd­ra­tion that requires hos­pit­al­isa­tion.

A ser­i­ous, but uncom­mon, side effect is pan­cre­at­itis.

Any­one on GLP-1 medi­cine with severe abdom­inal pain that radi­ates to the back should seek imme­di­ate med­ical atten­tion.

Other ser­i­ous, but uncom­mon, side effects include: > Gast­ro­paresis – where move­ment of food out of the stom­ach is slowed or stopped > Bowel obstruc­tion – a block­age that keeps food from passing through the intest­ines > Gall­stone attacks, and

> Bile duct block­age.

Rapid weight loss can cause facial changes that include a hol­lowed look, wrinkles, sunken eyes, sag­ging jowls around the jaws and neck, and changes in the size of the lips, cheek and chin.

This is com­monly called the “Ozempic” face, after the brand name of one of the more wellknown GLP-1 med­ic­a­tions.

If the weight loss is less rapid, the facial changes would not be so obvi­ous.

Sig­ni­fic­ant facial changes can be treated by plastic sur­gery.

The sexual side effects of GLP-1 medi­cines involve both poten­tial improve­ments (through weight loss and hor­monal optim­isa­tion), and declines in libido or arousal, which is vari­able across sex and indi­vidual pro­files.

A full list of the known side effects is found in the product inform­a­tion of the indi­vidual GLP-1 medi­cine.

A recent review repor­ted that

GLP-1 medi­cines may have little or no effect on obesity-related can­cers, i.e. thyroid, breast, pan­cre­atic or kid­ney.

They may also have little or no effect on colorectal, oeso­pha­geal, liver, gall­blad­der, ovarian or endo­metrial can­cer; mul­tiple myel­oma; or men­in­gioma (low cer­tainty).

The effect on gast­ric can­cer was very uncer­tain.

Cur­rent data does not sup­port a causal asso­ci­ation between GLP-1 medi­cines and depres­sion, sui­cidal ideation and sui­cide.

Pre­cau­tions

GLP-1 medi­cines should not be taken in preg­nancy, by those who are try­ing to get preg­nant or by those who are breast­feed­ing, because there is insuf­fi­cient data on the drugs’ safety in such situ­ations.

In the case of those try­ing to get preg­nant, the num­ber of months the GLP-1 medi­cine should be stopped prior to attempt­ing con­cep­tion var­ies, depend­ing on the indi­vidual medi­cine.

Oral con­tra­cept­ive users should use bar­rier con­tra­cep­tion, e.g. con­doms, for four weeks after start­ing GLP-1 medi­cines, and for four weeks after any increase in dose.

The reason is that the GLP-1 medi­cines may reduce the effect­ive­ness of oral con­tra­cept­ives in the over­weight or obese.

Altern­at­ively, a non-oral form of con­tra­cep­tion, e.g. an intrauter­ine con­tra­cept­ive device (IUCD) or implant, which are not as affected by GLP-1 medi­cines, can be used.

Prior to a sur­gical pro­ced­ure, the patient should inform their attend­ing doc­tors and nurses if they are tak­ing GLP-1 medi­cines.

This is because these drugs slow the empty­ing of the stom­ach, thereby increas­ing the like­li­hood of stom­ach con­tents enter­ing the air­ways and lungs dur­ing the sur­gical pro­ced­ure while under gen­eral anaes­thesia or sed­a­tion.

This means that modi­fic­a­tion of the pre-pro­ced­ure instruc­tion and anaes­thetic tech­nique may be required.

The attend­ing doc­tor(s) will also advise on the tak­ing of pre­scribed medi­cine(s).

Be aware

It is vital to remem­ber that GLP-1 medi­cines are Group B pois­ons, i.e. they require a doc­tor’s pre­scrip­tion.

It is illegal to pur­chase them over the counter or through unli­censed online sellers.

Self-med­ic­a­tion is poten­tially dan­ger­ous – a mes­sage that applies not only to GLP-1 medi­cines, but also many pre­scrip­tion medi­cines.

Reports of mis­use of GLP-1 medi­cines for cos­metic weightloss pur­poses are of con­cern.

The global demand for GLP-1 medi­cines has led to the spread of false and sub­stand­ard products, with severe risks to patient safety, eco­nomic impacts and erosion of pub­lic trust.

These coun­ter­feit medi­cines often con­tain incor­rect dosages, harm­ful ingredi­ents or lack the act­ive GLP-1 entirely, lead­ing to inef­fect­ive treat­ment and poten­tially life-threat­en­ing com­plic­a­tions such as hyper/hypoglycaemia and car­di­ovas­cu­lar (heart) issues.

The eco­nomic impacts are con­sid­er­able, with sub­stan­tial costs incurred in man­aging com­plic­a­tions that include hos­pit­al­isa­tion and increased mon­it­or­ing efforts.

Guidelines for doc­tors The frame­work for GLP-1 use in Malay­sia is found in the

Clin­ical Prac­tice Guidelines for the Man­age­ment of Obesity.

GLP-1 medi­cines are recom­men­ded for adults with a body mass index (BMI) more than 30kg/m2 or a BMI more than 27kg/m2 with one weight-related con­cur­rent ill­ness, e.g. hyper­ten­sion (high blood pres­sure), type II dia­betes or dys­lip­id­aemia (abnor­mal fat levels).

The World Health Organ­iz­a­tion (WHO) launched its guideline on the use of GLP-1 ther­apies for the treat­ment of obesity in adults on Dec 1, 2025.

The good prac­tice state­ments in the guideline are:

> “Obesity is a chronic com­plex dis­ease that requires lifelong care begin­ning with clin­ical assess­ment and early dia­gnosis.

“Once dia­gnosed, indi­vidu­als should have access to com­pre­hens­ive chronic care pro­grammes offer­ing sus­tained beha­vi­oural and life­style inter­ven­tions.

“When appro­pri­ate, phar­ma­co­lo­gical, sur­gical or other thera­peutic options may be used to sup­port effect­ive dis­ease man­age­ment.

“In par­al­lel, care should address the pre­ven­tion and treat­ment of obesity-related com­plic­a­tions and comor­bid­it­ies.”

> “In adults liv­ing with obesity, GLP-1 receptor agon­ists or GIP/ GLP-1 dual agon­ists may be used as long-term treat­ment for obesity.”

> “People liv­ing with obesity should receive con­text-appro­pri­ate coun­selling on beha­vi­oural and life­style changes – includ­ing, but not lim­ited to, phys­ical activ­ity and healthy diet­ary prac­tices – as an ini­tial step toward more struc­tured beha­vi­oural inter­ven­tions.

“For indi­vidu­als who are pre­scribed GLP-1 receptor agon­ists or GIP/GLP-1 dual agon­ists, coun­selling on beha­vi­oural and life­style changes should be provided as a first step to intens­ive beha­vi­oural ther­apy to amp­lify and sup­port optimal health out­comes.

> “In adults liv­ing with obesity who are pre­scribed GLP-1 receptor agon­ists or GIP/GLP-1 dual agon­ists, intens­ive beha­vi­oural ther­apy may be provided as a co-inter­ven­tion within a com­pre­hens­ive mul­timodal clin­ical algorithm.”

The jury is out on whether the WHO good prac­tice state­ments will be imple­men­ted in toto or par­tially in MOH facil­it­ies.

Part of a strategy

Recog­nising that medi­cines by them­selves would not by them­selves address the global obesity chal­lenge, the WHO recom­men­ded a com­pre­hens­ive strategy based on:

> “Cre­at­ing health­ier envir­on­ments through robust pop­u­la­tion-level policies to pro­mote health and pre­vent obesity. > “Pro­tect­ing indi­vidu­als at high risk of devel­op­ing obesity and related comor­bid­it­ies through tar­geted screen­ing and struc­tured early inter­ven­tions. > “Ensur­ing access to lifelong per­son-centred care.”

The safe use of GLP-1 medi­cines requires reg­u­lated dis­tri­bu­tion and pre­scrip­tion by doc­tors, strong over­sight, patient edu­ca­tion and stake­hold­ers’ cooper­a­tion to ensure that pub­lic health is pro­tec­ted.

Dr Milton Lum is a past pres­id­ent of the Fed­er­a­tion of Private Med­ical Prac­ti­tion­ers Asso­ci­ations and the Malay­sian Med­ical Asso­ci­ation. For more inform­a­tion, email star­health@the­star.com.my. The views expressed do not rep­res­ent that of organ­isa­tions that the writer is asso­ci­ated with. The inform­a­tion provided is for edu­ca­tional and com­mu­nic­a­tion pur­poses only, and it should not be con­strued as per­sonal med­ical advice. Inform­a­tion pub­lished in this art­icle is not inten­ded to replace, sup­plant or aug­ment a con­sulta­tion with a health pro­fes­sional regard­ing the reader’s own med­ical care. The Star dis­claims all respons­ib­il­ity for any losses, dam­age to prop­erty or per­sonal injury suffered dir­ectly or indir­ectly from reli­ance on such inform­a­tion.

The doc­tor says by DR MILTON LUM 18 Jan 2026

Plaque in the neck, Cleaning out the carotid artery

 

Cleaning out the carotid artery

A carotid endarterectomy is a surgical procedure to remove plaque from this important artery that supplies the brain, without which, a stroke could occur.

A STROKE occurs when an artery that carries oxygen and nutrients to and within the brain is either blocked by a clot or bursts.

The most common type is an ischaemic stroke, which is caused by a blood clot or fatty deposits (plaques) blocking or narrowing an artery (resulting in stenosis).

Meanwhile, an haemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures.

Sometimes, there may only be a temporary disruption of blood flow to the brain.

This is known as a transient ischaemic attack (TIA), where symptoms are momentary and resolve on their own in a few minutes, or at most, within 24 hours.

The symptoms – similar to a stroke – include sudden numbness or weakness in the face, arms or legs on one side of the body, trouble speaking, vision problems in one or both eyes, dizziness, and loss of balance resulting in a sudden fall.

Often referred to as mini stroke, a TIA is actually a warning sign of a future stroke, but because the symptoms are brief, people usually just shrug them off.

A shocking discovery

This is what happened to Indonesian businessman Eddy Giantono, 74, who experienced sudden weakness on his left arm, but felt fine subsequently.

He thought nothing of it, but mentioned the incident in passing to his family members.

While Eddy is not a smoker, he has been on medications to manage his high cholesterol, high blood pressure and diabetes for the past 20 years.

In addition, he suffered a heart attack 12 years ago and had to undergo heart bypass surgery.

Due to his medical history and noting that he was getting weaker, his family immediately took him to consult a doctor in Yogyakarta, where they live.

“The doctor said I had suffered a mild stroke (TIA) and there were many blockages in my carotid arteries (blood vessels that extend from each side of the neck to the skull).

“He recommended putting stents in, but since my heart bypass surgery was performed in Penang, I decided to seek a second opinion there as I have more confidence in the Malaysian healthcare system.

“Here I was told both my carotid arteries were blocked by 95% and 75% respectively, and I needed surgery.

“My doctor then referred me to another private hospital in Klang, Selangor,” recalls Eddy in a recent interview.

Removing the plaque

Treatment options to treat a blocked carotid artery depend on the severity of the blockage.

They typically involve a combination of lifestyle changes, medication, and medical procedures or surgery.

A blockage in the right carotid artery primarily affects the left side of the body.

This is because the brain has a “crosswired” structure, meaning the right side of the brain controls the left side of the body and vice versa.

As Eddy was a high-risk patient, he was advised to do a carotid endarterectomy on the right side.

As the block in the left carotid artery had not caused any symptoms, his doctor, consultant vascular and endovascular surgeon Dr Yow Kuan Heng, decided to take a wait-and-see approach.

A carotid endarterectomy involves making an incision in the neck, opening the carotid artery and physically removing the plaque build-up before the artery is stitched closed, often with a patch to widen it.

“Initially, my father wanted to postpone the operation as I was getting married, but the surgeon firmly said no as he was in danger of getting a stroke that could be fatal.

“So although he is a stubborn man, he had no choice but to agree,” says daughter Anatasya Giantono.

The surgery, carried out in August, was successful, and Eddy was already walking the next day, determined to go home as he didn’t want to change Anatasya’s wedding date.

“Even when he was in the intensive care unit, he insisted on being discharged,” she says, laughing.

“He gets homesick easily and doesn’t like being away for long periods.”

A week after he returned home, Eddy proudly walked his firstborn down the aisle. No one could tell he had recently undergone a complicated surgery.

Today, Eddy says he is “sihat sekali” (very well) except for speaking with a

slight lisp, which Dr Yow has said will normalise in time.

The surgical scars at his neck are fading fast and he has resumed his normal routine.

Thanks to early intervention, Eddy was most likely saved from a major stroke in the nick of time.

Get assessed quickly

Atherosclerosis – the thickening or hardening of the arteries caused by a build-up of plaque in the inner lining of an artery – can affect almost any artery in the body, including those in the heart, brain, arms, legs, pelvis and kidneys.

If the build-up is in the neck, it is called carotid artery disease; in the heart, it is coronary artery disease, in the leg, it is peripheral artery disease, etc.

According to Dr Yow, carotid stenosis from narrowing in the neck area is the fastest rising cause of ischaemic stroke in the world, particularly in the Asian region.

“Traditionally, doctors from this region felt that most strokes were happening in the skull, but that pattern has now changed due to the diabetic pandemic.

“The risk of a stroke is greatest when the narrowing in the neck is higher than 50% (classified as critical carotid stenosis).

“If there is a major stroke, you need drugs to break up the clot, but for TIA, you need to see a vascular surgeon as soon as possible to get assessed by scans,” he says.

A TIA is usually an indication of an unstable plaque in an artery supplying the brain, which can rupture at any time and cause a blood clot to form.

This clot can then break off, travel to the brain and block blood flow, leading to a stroke.

“It is important for the public to know that carotid endarterectomy is the firstline treatment for symptomatic carotid stenosis.

“In surgery, you immediately clamp the artery before opening it up, but in stenting, you have to push a guided wire through a hot zone of clot.

“That process, even with protection devices or filters, has a higher rate of stroke than surgery,” explains Dr Yow.

He adds: “In Eddy’s case, after discussions with my multidisciplinary team, we decided to operate only on the side that was symptomatic because he has moderate heart failure.

“Since he had no symptoms on the left side, we didn’t touch it.

“If he develops symptoms in future, then we have to think about surgery.”

He emphasises that physiotherapy must be done as soon as possible after surgery, and on average, patients are discharged from hospital by day three.

A repeat scan of the repaired carotid artery is carried out six weeks after surgery.

So, if you experience a TIA, head to the doctor as soon as possible and request for a carotid artery ultrasound or computed tomography (CT) angiography.

Don’t delay as every minute can make a difference.

By REVATHI MURUGAPPAN starhealth@thestar.com.my

Related article:

Carotid artery disease - Symptoms and causes

Mayo Clinic

https://www.mayoclinic.org › syc-20360519

24 Jul 2025 — Carotid artery disease occurs when fatty deposits, called plaques, clog the blood vessels that deliver blood to the brain and head (carotid ...

Diagnosis and treatment

Carotid angioplasty and stenting

Why Your Expensive Hearing Aids Aren't Enough!

Many people struggle to understand conversations even with expensive *modern hearing aids* because clinics skip crucial fitting steps. Retraining your *brain and hearing**, not just using a device, is key to **speech understanding* in noisy environments. Discover *better hearing* through comprehensive *hearing care* that addresses more than just amplification.

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More older adults have turned to cochlear implants after Medicare expanded eligibility for the devices.

Kitty Grutzmacher had contended with poor hearing for a decade, but the problem had worsened over the past year. Even with her hearing aids, “there was little or no sound,” she said.

“I was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.”

Her audiologist was unable to offer Ms. Grutzmacher, a retired nurse in Elgin, Ill., a solution. But she found her way to the cochlear implant program at Northwestern Medicine.

There, Krystine Mullins, an audiologist who assesses patients’ hearing and counsels them about their options, explained that surgically implanting this electronic device usually substantially improved a patient’s ability to understand speech.

Kitty Grutzmacher had contended with poor hearing for a decade, but the problem had worsened over the past year. Even with her hearing aids, “there was little or no sound,” she said.

“I was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.”

Her audiologist was unable to offer Ms. Grutzmacher, a retired nurse in Elgin, Ill., a solution. But she found her way to the cochlear implant program at Northwestern Medicine.

There, Krystine Mullins, an audiologist who assesses patients’ hearing and counsels them about their options, explained that surgically implanting this electronic device usually substantially improved a patient’s ability to understand speech.

At Northwestern, Dr. Mullins tells older prospective patients that one year after activation, a 60 to 70 percent AzBio score — correctly repeating 60 to 70 words out of 100 — is typical.

A recent Johns Hopkins study of about 1,100 adults found that after implantation, patients 65 and older could correctly identify about 50 additional words (out of 100) on the AzBio test, an increase comparable to younger cohorts’ results.

Participants over 80 showed roughly as much improvement as those in their late 60s and 70s.

“They transition from having a hard time following a conversation to being able to participate,” said Dr. Della Santina, an author of the study. “Decade by decade, cochlear implant results have gotten better and better.”

Moreover, an analysis of 70 older patients’ experiences at 13 implantation centers, for which Dr. Wick was the lead author, found not only “clinically important” hearing improvements but also higher quality-of-life ratings.

Scores on a standard cognitive test climbed, too: After six months of using a cochlear implant, 54 percent of participants had a passing score, compared with 36 percent presurgery. Studies that focus on 80 and 90-year-olds have shown that those with mild cognitive impairment also benefit from implants.

Nevertheless, “we’re cautious not to overpromise,” Dr. Wick said. Usually, the longer that older patients have had significant hearing loss, the harder they must work to regain their hearing and the less improvement they may see.

A minority of patients feel dizzy or nauseated after surgery, though most recover quickly. Some struggle with the technology, including phone apps that adjust the sound. Implants are less effective in noisy settings like crowded restaurants, and since they are designed to clarify speech, music may not sound great.

For those at the upper end of Medicare eligibility who already understand roughly half of the speech they hear, implantation may not seem worth the effort. “Just because someone is eligible doesn’t mean it’s in their best interests,” Dr. Wick said.

For Ms. Grutzmacher, though, the choice seemed clear. Her initial testing found that even with hearing aids, she understood only 4 percent of words on the AzBio. Two weeks after Dr. Mullins turned on the cochlear implant, Ms. Grutzmacher could understand 46 percent using a hearing aid in her other ear.

She reported that after a few rough days, her ability to talk by phone had improved, and instead of turning the television volume up to 80, “I can hear it at 20,” she said.

So she was making plans. “This week, I’m going out to lunch with a friend,” she said. “I’m going to play cards with a small group of women. I have a luncheon at church on Saturday.”

The New Old Age is produced through a partnership with KFF Health News. 

A version of this article appears in print on Oct. 21, 2025, Section D, Page 3 of the New York edition with the headline: When Dialing Up the Hearing Aid Isn’t Enough. Order Reprints | Today’s Paper | Subscribe

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A Guide to Aging Well

Looking to grow old gracefully? We can help.

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• Knee Arthritis: This uncomfortable condition is increasingly common as you age. But it doesn’t mean you can’t work out. Here’s how to choose the right exercise regimen for you.

• When a Hearing Aid Isn’t Enough: More older adults have turned to cochlear implants after Medicare expanded eligibility for the devices.

• A Simple Approach to Aging Well: For decades, Charlotte Chopin, a 102-year-old yoga teacher, has been bending and stretching in Léré, a village in France. Here’s how she keeps moving.

• Weight Lifting: The logic behind Greysteel, a gym outside Detroit, is straightforward: Stronger muscles and bones are associated with longer life and better health.

• Anemia and Aging: Significant numbers of older people have the condition. Many find relief with an effective treatment that is being more widely prescribed.

• A User’s Guide to Midlife: Here’s a complete guide to midlife, with help on how to navigate its aches and pains, weight gain, perimenopause, low libido, memory loss, chronic diseases and stress.