Weight loss drugs are certainly not a new phenomenon. The concept of taking medication to lose weight has been in development for almost a century. The drugs currently on the market, however, including the widely known Ozempic, have gained our attention both locally and nationally—and not just for the advertising jingle that tends to get caught in your head.
For nearly 20 years, these drugs have been used to treat diabetic patients. They are now being prescribed to non-diabetic patients looking to achieve weight-loss goals quickly. In clinical trials, these drugs have shown other benefits, like reducing cardiovascular events such as heart attacks. This may all sound pretty miraculous, but we also know that these drugs produce some uncomfortable short-term side effects. More time is needed to understand the long-term side effects.
While it is important to closely monitor potential side effects, these drugs are certainly having a dramatic effect on people—both physically and emotionally. There are “countless reasons [why] some people struggle with weight and others don’t,” says Dr. Stephanie Ortiz Page, director of Bariatric and Metabolic Medicine at Nuvance Health. Fluctuating hormones, health issues, injuries, medications, insulin resistance and genetics can all contribute to weight issues. “Having to live with the stigma that comes with being overweight can take a tremendous toll on one’s physical and emotional well-being,” she adds.
Being overweight increases the risk for numerous health issues ranging from heart disease to cancer. The rate of obesity in Connecticut currently stands at 30 percent and soars up to 42 percent nationally. Dr. Neil Floch, director of bariatric surgery at Greenwich Hospital and associate professor of surgery at Yale School of Medicine, has been working with patients to fight the obesity battle for several years. He claims that 86 percent of people with diabetes are treated with medications, yet only two percent of people struggling with obesity are treated with medication. “The medications are extremely helpful for patients struggling with weight and also for patients who have had bariatric surgery and regained weight,” he says. “This is a real game changer.”
HOW THEY WORK
As the U.S. Food and Drug Administration continues to approve these medications, demand for them is skyrocketing. In addition to Ozempic, you have likely heard the names Wegovy and Mounjaro (now also being sold under the brand name Zepbound).
All of these drugs are said to suppress one’s appetite and reduce cravings for unhealthy and fatty foods using the active ingredient semaglutide. Semaglutides mimic the effects of the naturally occurring hormone in your body called GLP-1. This hormone helps to control blood sugar by increasing the release of insulin by the pancreas and lowering the release of glucagon. By reducing blood sugar, the body can shed pounds more quickly.
Ozempic and Wegovy are essentially the same drugs, with both being distributed through at-home injections. The differences lie in the dosage levels and what health issues the drugs are prescribed for. Ozempic was given FDA approval to treat patients with type-2 diabetes. Wegovy, which is prescribed at a slightly higher dosage, is intended for the management of chronic weight issues.
“Traditionally, the American Diabetes Association used metformin as the first line of defense for insulin resistance issues,” says Dr. Maria Ceclia Asnis, director of the medical weight-loss program at Stamford Hospital, “but recently amended their recommendation and GLP-1 receptors are now being used for the same purpose and have a similar level of efficacy in reducing blood sugar and improving cardiovascular health.”
MORE WEIGHT LOSS DRUG OPTIONS
A drug called tirzepatide first received FDA approval for treating diabetes in May 2022 and more recently was approved for weight loss in November 2023. This new and possibly even more-effective drug is sold under the name Mounjaro (for diabetes) and Zepbound (for weight loss). It works by activating not only the GLP-1 receptors, but also those of another natural hormone called GIP.
And these are not the only drugs that are being used for weight loss these days. There is Qsymia and the seizure medication Topamax. There is also Contrave, a combination of the smoking-cessation antidepressant found in Wellbutrin and Naltrexone, a medication used to treat alcohol and opioid disorders.
Some of these, like Naltrexone, have shown to be effective for smaller amounts of weight loss, but “if someone has 30 or 40 pounds to lose, I would prescribe a GLP-1 agonist such as semaglutide or tirzepatide,” Dr. Floch says.
ARE THEY FOR ME?
“This is not a one-size-fits-all approach,” says Dr. Page, who believes these drugs are a major advancement in the management and treatment of weight loss. “However, it is not the right drug for everyone struggling with obesity.”
As with any medication, there are side effects and risks. Some people may have little to no reaction, while others may suffer from much more uncomfortable side effects. It is important to seek the guidance of a specialized and well-informed physician who will help you weigh the health implications that come with being overweight versus the negative effects that can potentially arise when being on a weight-loss drug.
Unfortunately, there are numerous online providers that are not doing their due diligence and are prescribing medications in unsafe ways. Each patient’s personal physical and emotional health history needs to be carefully considered by a professional, especially when it comes to a background of disordered eating. The same way these drugs can help to quiet cravings and speed up metabolism, they can also trigger those with a history of anorexia.
“Working with a mental health professional to develop insight into what core issues might be feeding into weight struggles can help create awareness into the thoughts, feelings and behaviors that are contributing to the larger issue,” says Ellen Arcamone, a licensed clinical social worker at Bluestone Psychiatry in New Canaan. “Once identified, work can begin toward creating effective strategies and solutions to make changes for the long term.”
For perimenopausal and menopausal women, hormonal imbalances and a slowing metabolism can often make weight-loss goals feel unattainable. “Even for those who might just have five to ten pounds to lose, if they are gaining weight steadily, even just one or two pounds a year is going to add up over time,” says Dr. Shieva Ghofrany, a board-certified OB/GYN at Stamford Hospital. “We do know the numerous long-term health implications of weight gain and they can be really profound. But should we consider these medications for everyone at this point?”
Ghofrany believes that time will tell, but stresses the importance of considering each patient’s specific situation to decide the risks versus the rewards.
THE GOOD, THE BAD, AND THE UGLY
The most common side effects include abdominal pain, constipation, nausea and vomiting. The more rare but also more severe side effects can be kidney failure, gallbladder issues, thyroid tumors, pancreatitis, bowel obstruction, gastroparesis, hypoglycemia, heart palpitations, vision changes and depression.
This list of possible side effects can seem daunting, so it’s also important to note that for many patients, doctors are also seeing significant health benefits—like lower cholesterol (as much as 13 percent in diabetics) and blood pressure, better liver function numbers and improvements in blood sugar and fasting glucose. They have also seen improved cognitive repair, better quality of sleep and a reduction in heart failure symptoms. Early research has shown that these changes in some patients have enabled them to lower their dosage or even stop taking previously prescribed medications altogether. In addition to physical improvements, patients are also seeing emotional benefits.
One local female patient in her mid-40s (who asked to remain anonymous) has been on one of these medications for about a year and a half and has had negligible side effects from the start. “For most of my life, I would look in a mirror and hate what was staring back at me,” she says. But the effects of the drugs have had on her body has improved her self-confidence. “I don’t feel like my weight is all anyone sees when I walk in a room,” she adds. “All of the food noise is gone, I no longer constantly think about food, about what I will eat next, about why I ate more than I know I should have. Some days I literally feel like I’m free.”
Another female patient in her mid-50s says, “This medication allows me to generally eat healthily without thinking as much about it. I can have half of a cookie and not the whole box.” Some patients who have been put on restricted diets but still have difficulty losing weight have found themselves able to up their caloric intake and finally move the dial on the scale. They are suddenly able to eat normally for the first time in their lives.
NOT AN EASY FIX
While there are obvious health risks and rewards, there are also other crucial factors to consider when deciding whether these medications are right for you—namely accessibility, cost and commitment.
Some patients find they are facing difficulty obtaining their prescriptions and frequently show up to pharmacies only to be told that their needed medication is out of stock. Many others are paying anywhere from $600 to $1,400 out of pocket per month. The hope is that as the FDA approves more of these drugs, these challenges will improve. “The great demand for this class of medication supports the need to manage and treat obesity and diabetes,” says Dr. Page. “My hope is that more health insurance companies will cover medications to treat obesity and then supply will improve.”
These hurdles will need to be resolved in order for people to continue on these drugs long-term. While some patients who only needed to lose a small amount of weight have been successfully able to wean down their dosages or get off the medications altogether, these drugs are not intended for short-term use. Two-thirds of those who stop taking the meds will gain back the weight that they initially lost, especially if lifestyle and dietary changes haven’t been diligently implemented.
One of the side effects that is of concern with the long-term use of these drugs is muscle loss, which has been reported among many patients. While any type of rapid weight loss can impact muscle density, it can be amplified among patients being treated for diabetes and obesity. It is extremely important that anyone taking these drugs makes the proper lifestyle changes in regards to nutrition, exercise and mental health.
“We really need multidisciplinary intervention in addition to medication,” says Dr. Ghofrany. “People should ensure that they are getting adequate mental health support about potential food-addiction issues, and that they are moving their bodies, especially with weights, because we know that there is a significant amount of muscle loss with rapid weight loss.”
Sarah Swanberg, doctor of Acupuncture and Chinese Medicine and cofounder of Indigo Wellness Group of Westport and Stamford, has worked with patients looking to achieve major weight loss for several years. “Weight is so much more than calories in vs. calories out, and we often see big changes just focusing on stress reduction, protein intake, hydration and mindful eating,” Swanberg says.
Before attempting these drugs as a quick fix, one should consider that there are a number of foods that can help the body react in a similar way to the weight-loss drugs.
Fiber, for instance, helps stimulate the GLP-1 hormone because it breaks down slowly as it moves through the body. That makes you feel full, therefore reducing cravings and suppressing the appetite. The best type of fiber for this effect is fermentable fiber, the kind found in oats, rye, barley, beans, peas and lentils. Pectin—which is found in fruits like green bananas, apples and pears—can also trigger weight loss.
Dr. Katherine Wehri Takayasu, Darien-based functional medicine practitioner, explains that some patients experience “more satiety when increasing fiber (with psyllium husk most recently making a social media splash) because fiber increases a sense of fullness” and others have seen results using herbs like berberine. “It’s important no matter where you are on your journey that you need to balance fiber, fat and protein in the diet so that you are keeping yourself full, satisfied and in metabolic balance,” she adds.
PROCEEDING WITH CAUTIOUS OPTIMISM
All the professionals we spoke with ultimately feel that these drugs can be very helpful for people struggling with type-2 diabetes and obesity and will continue to monitor both short-term and long-term side effects. They also all stress the importance of making changes in your diet and exercise routine, as well as addressing any mental health issues you may be struggling with. Dr. Maria Ceclia Asnis likes to begin discussing this topic with her patients by talking about the science of weight. “I explain to my patients that there are things that are and are not completely in their control,” she says. “We don’t talk about what weight someone should be; we talk about what weight would be healthier. We talk about lifestyle, exercise and diet… and, yes, medications when appropriate. These drugs can be highly effective if prescribed the right way.”