New Year Goals: Will Weight-Loss Drugs Work for You?Exercise and Nutrition
Who among us hasn’t made a New Year’s resolution to lose weight? Probably most of us, if you’re among the 70 percent of American adults who have obesity or who are overweight.
However, achieving and maintaining a healthy weight can be a lifelong challenge.
That's why FDA-approved weight-loss drugs, along with diet and exercise, can help when lifestyle interventions alone haven't worked in adults with certain health conditions, says Renato Concepcion, M.D., a board-certified endocrinologist with Lee Physician Group Endocrinology.
These medications are specifically approved for weight management in adults with certain health complications linked to being overweight or obese.
How safe are these drugs to use? What are their ill effects if used long-term? What’s the research say?
Dr. Concepcion answers these and other questions.
Q: When should I consider a weight-loss medication?
According to FDA guidelines, non-diabetic people who have tried lifestyle changes and not lost at least 5 percent of their total body weight can consider a weight-loss drug if they meet one or more of the following conditions:
- Have a body mass index (BMI) equal to or greater than 30. BMI is a calculation that estimates how much body fat a person has based on their weight and height.
- Have a BMI equal to or greater than 27 with one or more obesity-related conditions, such asthma, high blood pressure or diabetes.
Lifestyle changes such as exercise and a healthy diet should be adopted when taking these medications.
Q: How do they work?
Prescription weight-loss drugs work by mimicking the hormone GLP-1, which is released naturally by the body after eating to promote feelings of fullness and satisfaction. These drugs activate receptors in the brain that regulate appetite and food intake. This suppresses appetite, helping you feel full sooner and longer after eating.
The medications also slow digestion, keeping food in the stomach longer so less is absorbed into the bloodstream. The combined effect of appetite suppression and reduced absorption of calories and fat leads to weight loss over weeks and months of treatment.
People who are non-diabetic who wish to lose weight and meet FDA guidelines for weight-loss medicines may benefit from semaglutide, a drug used to treat diabetes.
Semaglutide is the active ingredient in three popular medications, Wegovy, Ozempic, and Rybelsus. While all these medications contain semaglutide, only Wegovy is approved by the FDA for weight loss. Ozempic is not approved for weight loss. Ozempic, when used to treat diabetes, causes weight loss as a common side effect. It’s designed to be taken long-term.
A healthy diet and frequent exercise are recommended to optimize the benefits of semaglutide.
Last November, the FDA approved Zepbound, another type of weight-loss drug. The active ingredient in this drug is tirzepatide, which was previously approved under the trade name Mounjaro to help improve blood sugar (glucose) in adults with type 2 diabetes mellitus along with diet and exercise.
Before Wegovy and Zepbound, Saxenda (liraglutude) was the first GLP 1 that was marketed as a weight loss drug. We still use this drug but not to the same degree as the newer ones.
Q: Do they have side effects?
Like most medications, weight-loss drugs can cause side effects. The most common are nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dizziness, and low blood sugar. More serious risks include inflammation of the pancreas, gallbladder problems, kidney injury, and suicidal thoughts. Make sure to discuss your medical history and all side effects with your doctor. Staying hydrated and following dosage instructions carefully can help minimize adverse reactions.
Q: Do I have to take these medications for the rest of my life?
These obesity medications are intended for long-term use but not necessarily lifelong treatment. Your doctor and you will decide when you can stop. Some patients respond well initially but require an adjustment in dosage or frequency to maintain results long-term. Others stop taking the medication after achieving their target weight loss as long as they continue healthy lifestyle habits.
Q: Are they safe?
There were initial concerns that GLP-1s, whether used in medications for people with diabetes or in non-diabetic people, may increase the risk of thyroid cancer, especially medullary thyroid cancer (which are tumors that form inside of the thyroid). However, the European Medicine Agency Safety Committee recently dismissed this link based on a comprehensive review of the data. The guideline still is that you and your health care team should carefully monitor your thyroid for nodules while you’re taking these medications.
When prescribed appropriately and taken as directed, these medications are generally considered safe for managing obesity. However, they do carry some risks and are not right for everyone. Your doctor will evaluate your health status, weight, BMI, other medications, and risk factors to determine if prescription weight-loss drugs are a safe option for you. You have a say in the matter, too. Together, you and your doctor can decide what’s best for you. Be sure to follow up regularly with your doctor so the both of you can monitor any issues.
Q: What about long-term effects?
Because most injectable obesity drugs are relatively new, long-term effects are still being studied. In other words, the long-term effects of these medications remain largely unknown.
However, significant weight loss itself can greatly improve obesity-related complications like diabetes, heart disease, and hypertension. You and your doctor should assess if the benefits of weight loss outweigh the potential long-term risks. Lifestyle changes in eating habits and physical activity are vital for sustaining results over time.
Q: What happens when I stop taking the medication?
Discontinuing these medications may cause weight gain and a return of appetite, especially if you don’t make any lifestyle changes. Any lost weight is likely to come back because the effects of the drugs wear off. This is why adopting healthy eating and exercise habits is key during treatment; your healthy behaviors should continue even after stopping the drug.
Some patients can transition off injectable drugs after losing enough weight, but only if they stick to their improved lifestyles. Others may need to continue at a reduced frequency or dosage. It would be best if you worked with your healthcare team on the safest way to stop.
Lee Health Weight Management Program
The registered dietitians with Lee Health Weight Management Program work one-on-one with patients to craft an individualized approach to nutrition. Learn how to properly fuel and nourish your body and make real, lasting changes for a new lifestyle to reach a healthy weight.
To learn more about our innovative program or to schedule your appointment, call Lee Health Solutions at 239-424-3120.