Obesity is one of the most prevalent health issues, yet for years, medicine had limited effective treatments available, aside from gastric bypass surgery and other invasive treatments.
That’s why there’s been considerable excitement about a new class of drugs in injectable or pill form that help patients lose significant weight at far lower risk.
Weight loss drugs or anti-obesity medications are prescription drugs that reduce your appetite and food cravings. Are weight loss medications, like Ozempic, Wegovy and Zepbound, right for you?
Consider your Body Mass Index, or BMI. Physicians recommend that candidates for the anti-obesity drugs have a BMI of 30 or more and 27 if you have medical problems related to weight such as diabetes, high blood pressure and sleep apnea, says Dr. John Brebbia, a bariatric surgeon affiliated with MedStar Montgomery Medical Center and MedStar Medical Center at Brandywine.
“To recommend these medications, a doctor looks at a patient’s eating and exercise habits,” Brebbia says.
For anyone struggling with excess weight and finding it difficult to lose despite counting calories and increasing physical activity, there is hope, says Dr. Malek Cheikh, a Baltimore endocrinologist affiliated with both MedStar Union Memorial and MedStar Good Samaritan hospitals.
Cheikh says, “Most of these medications have shown that with the proper weight loss, many of these chronic medical conditions can improve.”
Ozempic and Wegovy are both medications that belong to the GLP-1 agonist class to treat type 2 diabetes. People also use it to help them lose weight. Tirzepatide is the active ingredient in Mounjaro and Zepbound, which also can treat type 2 diabetes and encourage weight loss.
They work in similar ways to reduce appetite. “They act like our natural hormones, simulating insulin production and inhibiting glucose production,” Brebbia says.
“Something to suppress the appetite and help patients adhere to a lower calorie diet have been provided by the medications,” Cheikh says.
“Decrease your caloric intake and increase your activity, however, that’s where the difficultly lies, it’s not easy to change somebody’s habits,” Cheikh says
The medications also slow down your gastrointestinal tract, so your stomach doesn’t empty as quickly. “You get full faster, and you stay full longer,” Brebbia says.
“They definitely can stimulate insulin secretion so your blood sugar doesn’t shoot up. Your body processes the insulin very, very quickly,” Brebbia says.
“These medications work by resembling a natural hormone that the body produces,” Cheikh says. “That hormone connects the gut to the brain. The hormone would tell the brain when the patient is satisfied with food and had enough. The problem with weight gain and obesity, the connection is not there. These medications re-establish that connection and help the brain identify the satiety.”
The medications work very well, Brebbia says. “You can lose 20% of your body weight in a year.”
Weight loss medications can be safe for many individuals when prescribed by a healthcare professional.
“Every medication does have side effects and potential issues, but I think comparatively speaking, they are safe,” Brebbia says.
“You also have to weigh the benefits and the risk of side effects,” Brebbia says. “The benefit of controlling glucose and losing weight is great.”
“The newer medications that we call GLP-1 drugs have common side effects that include nausea, diarrhea, constipation, upset stomach, indigestion and heartburn,” Brebbia adds.
“Less than 5% of my patients that go on these medications are forced to stop them because of the severity of the side effects,” Cheikh says.
The rapid weight loss can cause a loss of muscle mass, says Dr. Sadaf Mustafa, an internist with a fellowship in obesity medicine. She practices with MedStar Good Samaritan Hospital and MedStar Union Memorial Hospital in Baltimore.
“We monitor it throughout the weight loss journey to make sure that there is no change or excessive drop in it,” Mustafa says. “The appropriate protein intake helps with that.”
Data has come out in the past 12 months showing the benefits of weight loss for heart protection and sleep improvement, as well as improvement in fatty liver disease and chronic kidney disease.
“The newest class of medication, called GLP-1, has caused a stir up in the social media world. It’s been used for the treatment of type 2 diabetes for many years,” Cheikh says. Ten years ago, the medication began to be used as a weight loss medication. “They are quite effective,” he says.
The average weight loss is about 15% to 20% of the total body weight, Cheikh says.
The minute patients stop taking the medication, appetite suppression goes away. “That would lead to weight gain. However, in my practice, I have seen patients who followed a better diet and started to exercise and forgot about their old habits,” Cheikh says.
The drugs can be prohibitively expensive for those who don’t have a comprehensive drug plan and insurance coverage. Drugs used for weight loss alone can cost over $1,000 a month without insurance.
Compounded or copycat versions of these medications have become available, and they are less expensive than the brands made by Novo Nordisk and Eli Lilly. Off-brand weight-loss drugs containing the same active ingredients as Wegovy and Zepbound seem to be everywhere on the internet.
They are sold on the internet for as low as $250 a month.
Many physicians don’t recommend them. “Compounded medications typically are not tested or approved by the FDA. So, our issue with it is the quality control. I would not necessarily recommend them,” Brebbia says.
Mustafa agrees. “These medications do not have any oversight, no pre-market review for safety effectiveness or quality.”
With high demand for drugs like Ozempic and a limited supply, dozens of telehealth companies have emerged to cater to customers who can’t access them at the brand name prices.
Compounding pharmacies are selling the drugs at steep discounts compared to $1,000 a month for the brand names without insurance. These alternative drugs come in vials as opposed to pens, with syringes to draw out each dose, and cost hundreds of dollars less than brand-name options.
“The problem there is that compounded medications are not medications that are studied or approved by a regulatory body,” Cheikh says. “So, we are not sure of how safe they are. I cannot safely recommend it because it did not come directly from the manufacturer.”
The good news, Cheikh says, is that the prices are coming down for brands and I hope that in the near future, there will some options that are both safe and affordable for many patients.”
Must you stay on these medications forever? Some patients lose the weight and get off the medication, and others are on a maintenance dose for the rest of their life, Brebbia says.
“You are more likely to be able to get off the medication if while you’re taking it and losing weight, you are making substantial changes to your diet and lifestyle. If you make substantial changes, there is a greater chance you’ll be able to get off them.”
In conclusion, the emergence of new weight loss medications offers renewed hope for those struggling with obesity, providing effective alternatives to traditional methods, Mustafa says.
While these treatments can significantly aid in weight management, it is crucial for individuals to work closely with their healthcare providers to ensure safe and appropriate use, she says.
