April 16, 2023

Understanding Weight Loss Medications

Ozempic, the latest diet world craze, has taken over the celebrity weight loss world. If you’re following pop culture, you might be wondering if this latest trend is the real deal and if it could work for you. Semaglutide, marketed as Ozempic, Wegovy, and Rybelsus, is an FDA approved medication that is approved for both diabetes and weight loss. This medication works by mimicking our body’s naturally occurring GLP-1 (glucagon-like peptide-1) hormone. GLP-1 is a gut hormone released after you eat. This hormone stimulates insulin release, inhibits glucagon release, decreases appetite, and slows digestion. By increasing the effect of this hormone, you can improve diabetes and enhance weight loss. An even newer drug, tirzepatide, increases the effect of both GLP-1 and GIP (gastric inhibitory polypeptide, a hormone that induces insulin secretion) and was shown to be even more effective for weight loss. This medication, marketed as Mounjaro, is currently approved for treatment of diabetes and is under fast-track review by the FDA for approval as a weight loss medication.

Having these medications available to treat diabetes and excess weight is an amazing option for patients. The health and quality of life benefits cannot be overlooked. Unfortunately, for many people these medications are just too expensive. Despite obesity being classified as a disease by the American Medical Association in 2013, insurance coverage for weight loss medication is not available for many people. Even if people can afford the medication temporarily, once the medication is stopped, many will regain the weight they lost. There are other options. Contrave (bupropion/naltrexone), Qsymia (phentermine/topiramate), Lomaira and Adipex P (low and higher dose phentermine respectively), Xenical and Alli (orlistat) are also FDA approved for weight loss. While on average when looking at the whole population they do not produce the same degree of weight loss as semaglutide and tirzepatide, for an individual patient they may be effective and much more affordable. Also, depending on the individual there may be enhanced benefits. For example, bupropion can help you stop smoking and topiramate is also used to treat migraines. Other medications commonly used off-label, such as metformin, may also be beneficial for people who have both obesity and insulin resistance (commonly associated with obesity).

With all these options, why aren’t more people taking these medications? In addition to cost, many people and even many doctors still treat obesity as a behavior problem instead of a disease. While you may be able to lose some weight through a big effort to change your diet and exercise in the short-term, most people (not all) will regain weight over time despite their best effort. Why is this? The ability to gain and hold onto weight when food was available was critical to surviving food shortages in most of human history. Our bodies have adapted to avoid weight loss at all costs! When we lose weight, our metabolism automatically slows and hormonal changes occur that increase our appetite. It is nearly impossible to overcome these physical changes, and most people end up regaining weight and then internalize this regain as their own personal failing. The more we learn about the disease of obesity, the more we learn about the many changes in the body regarding weight that are not under people’s conscious control.

Another reason these medications are not used more commonly is that people often feel like taking a medication is “cheating.” Once again, this sentiment comes from the long-standing view that if you just exercise more and eat less you wouldn’t have a weight problem in the first place, but this belief is misguided. In an environment of readily available food, many people are inclined to put on weight based on their genetics, gut bacteria balance and even factors affecting them when they were growing as babies inside their mothers’ uterus! More and more research is uncovering reasons for why some people gain weight more easily than others. Because of these reasons, taking weight loss medicine can be thought of as “leveling the playing field” by allowing those inclined to easily gain weight to have a similar biology to those that are naturally thin.

With all these great medication options, what role does a healthy lifestyle have? Can we now forget about a healthy diet and exercise and just pop a pill or injection? Unfortunately, or maybe fortunately depending on your current mindset, adopting a healthy lifestyle is absolutely essential! Physical activity has been shown to help people live better and live longer. Physical activity, while not as effective for weight loss, is critical for weight loss maintenance. Physical activity can also improve body composition to make sure you maximize weight loss from fat instead of muscle. Good nutrition is also key to improving your health and will enhance your weight loss from medications. In fact, in studies on weight loss medications, nutrition counseling was incorporated as part of the treatment. Ensuring you have the right composition of macronutrients will help you minimize hunger and feel full longer. Quality nutrition will also provide the necessary vitamins and minerals, which is especially important when trying to lose weight. Other components such as good sleep and emotional health are also incredibly important for both weight loss but even more importantly, good quality of life.

So yes, some of the hype is true. Semaglutide is a breakthrough medication and can help many people, but like any medication it will work better for some than others and there are risks and side effects. Speaking with a physician with expertise in obesity who provides comprehensive weight care can help you learn what all your options are and put you in position for long-term success. If you qualify and do decide a medication is right for you, taking a medication under the guidance of an expert with close support can help you minimize or prevent side effects, minimize loss of muscle mass, and ensure you are given the option that is safest. If you are not interested in medication or do not qualify, there are still ways to work with your doctor to improve your nutrition and lifestyle behaviors. With the help of your medical provider, you can also ensure you do not have an undiagnosed medical condition such as binge eating disorder or depression that must be addressed first and review the medications you are currently taking to check if they are causing weight gain.

If you want to learn more, contact Dr. Parisi at DrParisi@mdweightcare.com or book a free consultation. Dr. Parisi has had extensive training in obesity medicine and believes in getting to know each patient she treats to provide personalized, long-term care.

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