- Over the last few years, the popularity of taking GLP-1 medications for weight loss has greatly increased.
- More than half of Americans taking GLP-1s say it was difficult to afford.
- Online health platform Noom recently launched its Noom Microdose GLP-1Rx Program to reportedly address barriers to GLP-1s, including medication cost.
Industry researchers estimate that while about 12% of United States citizens have used a GLP-1 medication for weight loss, 54% of adults who have taken GLP-1s say it was difficult to afford, and 53% say it was still too expensive even if they received insurance coverage for the medication.
Medication cost is just one of the reasons why online health platform Noom recently launched its Noom Microdose GLP-1Rx Program, which, according to the company, also helps lower potential side effects and helps with creating sustainable behavior changes.
Medical News Today spoke with five GLP-1 medical experts to find out what exactly is microdosing and how it is different from taking normal amounts of GLP-1 medications, as well as its safety and efficacy.
According to Maria Cecilia C. Asnis, MD, FACE, DABOM, director of The Center for Weight Management at Stamford Health and assistant clinical professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, GLP-1 microdosing is the new “buzzy” term circulating in the conversation regarding these tools for weight management.
“However, the concept of flexibility in dosing and personalization of medication management is not new in the clinical space,” Asnis explained to MNT. “Every individual person has unique needs and goals — and the ‘dose’ they need to achieve and maintain those goals is also unique. In that same vein, the dose people respond to and tolerate without side effects is also individual.”
Babak Orandi, MD, PhD, obesity medicine specialist and transplant surgeon at the NYU Langone Weight Management Program, and associate professor in the Departments of Surgery and Medicine at NYU Grossman School of Medicine, said that for many doctors who prescribe this class of medications frequently, microdosing is something they have already been trying.
“When I counsel my patients, I tell them that the study sponsors have to escalate the dose monthly in clinical trials but that doesn’t mean I have to practice medicine that way,” Orandi explained to MNT. “Some patients are more responsive to lower doses than others and pushing them to a dose faster or higher than is necessary just leads to side effects.”
Similarly, Kayley George, MS, RD, LD, a registered dietitian, and founder of the Ditch the Diet coaching program,told MNT that microdosing through Noom or any other platform is not necessarily different from what doctors prescribe with, for example, Ozempic — the active ingredient, semaglutide, is still the same.
“What Noom is offering, however, is a lower dose than the traditional FDA-approved dosing regimen,” George explained. “The traditional Ozempic dosing starts at 0.25 mg [milligrams] once weekly and is escalated typically every four weeks. In contrast, Noom states that their dosing starts at 25% or less of the standard 0.25 mg dose and escalates at a personalized rate.”
While microdosing GLP-1 medications may provide a more personalized experience, there are still questions regarding the safety of this practice as there are currently no published studies on the process, and the microdoses may come from a compounding pharmacy.
Jennifer Cheng, DO, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center in New Jersey, told MNT that, right now, GLP-1 microdosing is an experimental approach.
This means that is not well studied currently, there is no reliable information on the safety and side effects of microdosing GLP-1, and there are no guidelines on how microdosing should occur.
“Safety is unknown; [it remains] unknown if [this approach] is good or bad,” Cheng continued. “It still may trigger the side effects of GLP-1. Giving a smaller dose of Ozempic or any other GLP-1 can still produce these side effects such as nausea, vomiting, muscle loss, upset stomach, headaches, and slowing of bowel movements potentially leading to ileus or obstruction.”
George said that microdoses of the drug are only as safe as the pharmacy producing it:
“To access these custom doses, Noom must use a specialized compounding pharmacy. “Their website claims to work with a ‘leading 503B FDA-inspected pharmacy to dispense compounded semaglutide medication.’ They also highlight that the compounding pharmacies are U.S. Pharmacopeia (USP)-compliant.”
“Although they’ve taken extensive measures to ensure safety, it’s still important to understand that compounded medications are not FDA-approved,” she continued. “This means the final product is not reviewed for safety or efficacy the way commercial drugs are. In addition, compounded medications are typically not covered by insurance.”
Mir Ali, MD, a board-certified general surgeon, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, told MNT that while it is usually not harmful to microdose GLP-1 medications, they may be less effective.
“Though some patients may feel the effect of these medications at lower doses, most patients require a higher dose to see significant results,” Ali explained. “It may be useful in patients who have achieved their goal weight and are using lower doses to maintain their weight.”
However, “early data and clinical experience suggest that it is an effective strategy,” Orandi commented. “People with diabetes, particularly severe diabetes, tend to lose less weight with GLP-1s than people without diabetes, so microdosing is less likely to be as effective, though their dose should only be increased as they tolerate it.”
George said that in her professional opinion, microdosing is a potential option for patients with smaller amounts of weight to lose or as a bridge to start, or wean off, regular GLP-1 medications.
“It may also be used as a maintenance dose after significant weight loss has already been achieved,” she added. “I would not recommend microdosing GLP-1s for individuals with significant amounts of weight to lose or known metabolic dysregulation.”
The bottom line is that there are still questions regarding the effectiveness and safety of microdosing GLP-1 medications, and this type of regimen is not for everyone.
“I would like people to know that microdosing is not the normal way these medications are used, though it may be feasible in those who have achieved the desired results or have much less weight to lose,” Ali added.
“Microdosing is a big trend in the weight management space but still not FDA-approved. Noom hit the nail on the head — patients need access to more affordable versions of GLP-1 medications with more tolerable side effects. As more generic, low-cost versions of Ozempic become available and medication innovations improve, I believe we’ll see more solutions rolled out in the near future. Compounded microdosing is a good interim solution, but patients considering this option need to be very cautious on where the medication is sourced.”
Experts also stressed the importance of having medical oversight while using GLP-1 medications.
“It is essential that people be medically evaluated and followed on these medications in the long term — not just when they are paying to subscribe to a program,” Asnis said. “In the end, if we can increase access to these tools while maintaining oversight, and put patient outcomes over profits, that is what will ultimately move the needle on the proverbial scale in the pandemic of excess weight.”
And Cheng noted that: “It is better to use FDA approved treatments rather than experimental and unproven treatments.”
Moreover, “it is important to speak with your healthcare professional regarding the use of GLP-1 or microdosing,“ he emphasized. “There are risks, benefits and possible side effects to medications and, if discussed, they can help you navigate through the possible effects.”
Finally, Orandi offered strategies to help minimize side effects that people should follow when taking GLP-1 medications in general. “Eat slowly,” he advised. “Avoid heavy, fatty foods, particularly in the first 24–48 hours of the injection. [And] don’t force yourself to eat when you’re not hungry.”
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