Weight Loss Drugs: Who Can Take Them and Who Shouldn’t?
Obesity and overweight affect increasing numbers of people, and for some, diet and exercise aren’t enough. A broad range of drug interventions can help.
Ozempic, the brand name drug for a medication called semaglutide, is one of the most popular drugs on the market right now. Originally developed to treat type 2 diabetes, the injectable drug has recently boomed in popularity for its off-label use to help people lose weight... fast. Celebrities and public figures have admitted they're taking it. Instagram influencers are showing off remarkable before and after photos. It's been called "TikTok's favorite weight loss drug." As one doctor said, "we haven't seen a prescription drug with this much cocktail and dinner chatter since Viagra came to the market."
But alongside the rise in Ozempic prescriptions come many questions still unknown: Who should be taking it? Is it safe for longterm use? Who is it safe for? Should children be prescribed it to treat childhood obesity, as the American Academy of Pediatrics recently advised? Is Ozempic a permanent solution to the obesity epidemic? Or is it more like a bandaid, a quick fix that does little to address the root causes of obesity? And, to that end, what is the root cause of obesity? Is it a "brain disease," as one Harvard doctor recently declared on 60 Minutes that warrants medication? Or do diet, exercise, willpower and other behavioral lifestyle choices still matter?
Who Can Take Obesity Drugs, and Who Shouldn’t?
While weight loss medications can be effective in aiding weight loss, they are typically prescribed only in cases of obesity or overweight that can lead to severe health problems.
“The clinician can review and follow several published guidelines that have summarized best evidence of when to initiate pharmacologic therapies,” Mary Ann Kliethermes, who holds a doctorate in pharmacy and is the director of medication safety and quality for the American Society of Health-Systems Pharmacists, told The Epoch Times.
The American Gastroenterological Association (AGA) recommends using drug therapy when lifestyle modifications have failed or shown insufficient results, and the patient has weight-related complications, like diabetes, hypertension, or high cholesterol.
“It is inappropriate for people taking these classes of medications purely for cosmetic reasons,” said Dr. Amanda Velazquez, director of obesity medicine in the Department of Surgery at Cedars-Sinai Hospital.
“This is feeding into our societal obsession with ‘thinness,’ and that’s not productive, especially when it comes to health,” she continued.
Common Types of Weight Loss Drugs
Weight loss drugs that are currently available include:
Fat Absorption Inhibitors
Orlistat is a fat absorption inhibitor that reduces our ability to absorb fat in the intestines. It inhibits an enzyme called lipase, which breaks down fat molecules. This prevents the body from absorbing and storing dietary fats.
Side effects of using Orlistat can include bladder pain, ear congestion, and muscle aches.
Appetite Suppressants
Appetite suppressants work by reducing hunger and promoting feelings of fullness.
These drugs work by increasing levels of certain brain chemicals, such as serotonin and norepinephrine, that control hunger and satiety. Some of the most commonly used appetite suppressants include phentermine, diethylpropion, and benzphetamine.
Side effects of these medications can include insomnia, dry mouth, and constipation.
An appetite suppressant recently approved by the U.S. Food and Drug Administration (FDA) is a semaglutide sold under the brand name Wegovy. Injected once per week, it works by mimicking the hormone glucagon-like peptide-1 (GLP-1), which targets areas of the brain regulating appetite and food intake.
Note: Semaglutide, are sold under the brand names Ozempic, Wegovy and Rybelsus.The most common side effects of Wegovy include nausea, diarrhea, vomiting, and constipation.
Another GLP-1 agonist called tirzepatide helps you reduce food intake while blunting metabolic responses that usually occur with calorie restriction, like slowed metabolism. A common side effect of tirzepatide is stomach pain; less common ones include fast heartbeat, heartburn, and recurrent fever.
Other GLP-1 agonists include Saxenda, also called liraglutide (pdf).
Certain classes of weight loss medications, like the GLP1 agonists, offer other health benefits, including improved insulin sensitivity, fatty liver, cardiovascular outcomes, and kidney health.
Possible Severe Side Effects and ‘Lifelong’ Treatment
However, tirzepatide and Wegovy are also associated with a potentially severe side effect.
“Both semaglutide and liraglutide have boxed warnings for multiple endocrine neoplasia type 2 syndrome,” said Kliethermes.
The FDA warns that Saxenda causes thyroid tumors at “clinically relevant exposures” in rats. “It is unknown whether Saxenda causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans,” cautioned the FDA.
These drugs are also intended to be taken lifelong to maintain weight loss.
“This is because obesity is a chronic, complex medical condition, just like high blood pressure and diabetes. Thus, we treat it similarly—lifelong,” said Velazquez.
These drugs aren’t magic bullets.
“It is important for everyone to understand that all medications have a benefit and a risk,” said Kliethermes. Before using them, doctors also need to consider individually whether patients have other medical conditions, other medications, and the cost.
These drugs are typically prescribed together with lifestyle changes, like eating a healthy diet and getting regular exercise.
Natural Metabolism Boosters
Metabolism boosters work by increasing the metabolic rate of the body and thus stimulate the body to burn more calories than it normally would.
Natural metabolism boosters include:
Ephedrine: A systematic review of studies concluded that ephedrine, found in Ma Huang, an herb used in traditional Chinese medicine, is linked to weight loss and increased energy.
Caffeine: This compound gives coffee its reputation as an energy booster. Research finds people who successfully maintained weight loss consumed “significantly” more cups of coffee and caffeinated beverages compared with a control group.
Green tea extract: A randomized, controlled trial found green tea enhanced fat burning during exercise, and a systematic review of studies concluded that green tea extract can help improve glucose metabolism and facilitate weight loss.
Exercise: It’s obvious that the more you move, the more calories you’ll burn. Research confirms that combining weight training with diet reduces body fat while maintaining calorie-burning muscle mass.
For those who don’t have the time for a formal training regimen, one study finds that just walking (at any speed) reduces total body fat.
Certain Foods can help you feel fuller for longer
The nutrients that trigger GLP-1 secretion are macronutrients—simple sugars (monosaccharides), peptides, and amino acids (from proteins) and short chain fatty acids (from fats and also produced by good gut bacteria). There are lots of these macronutrients in energy-dense foods, which tend to be foods high in fat or sugars with a low water content. There is evidence that by choosing foods high in these nutrients, GLP-1 levels can be increased.
This means a healthy diet, high in GLP-1 stimulating nutrients can increase GLP-1 levels. This could be foods with good fats, like avocado or nuts, or lean protein sources like eggs. And foods high in fermentable fibers, like vegetables and whole grains, feed our gut bacteria, which then produce short chain fatty acids able to trigger GLP-1 secretion.
This is why high fat, high fibre and high protein diets can all help you feel fuller for longer. It’s also why diet change is part of both weight and Type 2 diabetes management.
Not so Fast …
However, it’s not necessarily that simple for everyone. This system also means that when we diet and restrict energy intake, we get more hungry. And for some people that “set point” for weight and hunger might be different.
Some studies have shown GLP-1 levels, particularly after meals, are lower in people with obesity. This could be from reduced production of GLP-1, or increased breakdown. The receptors that detect it might also be less sensitive or there might be fewer receptors. This could be because of differences in the genes that code for GLP-1, the receptors or parts of the pathways that regulate production. These genetic differences are things we can’t change.
So, Are Injections the Easier Fix?
While diet and drugs can both work, both have their challenges.
Medications like Ozempic can have side effects including nausea, vomiting, diarrhea, and issues in other organs. Plus, when you stop taking it the feelings of suppressed appetite will start to go away, and people will start to feel hungry at their old levels. If you’ve lost lots of weight quickly, you may feel even hungrier than before.
Dietary changes have much fewer risks in terms of side effects, but the responses will take more time and effort.
In our busy modern society, costs, times, skills, accessibility, and other pressures can also be barriers to healthy eating, feeling full and insulin levels.
Dietary and medication solutions often put the focus on the individual making changes to improve health outcomes, but systemic changes, that reduce the pressures and barriers that make healthy eating hard (like shortening work weeks or raising the minimum wage) are much more likely to make a difference.
It’s also important to remember weight is only one part of the health equation. If you suppress your appetite but maintain a diet high in ultra-processed foods low in micronutrients, you could lose weight but not increase your actual nourishment. So support to improve dietary choices is needed, regardless of medication use or weight loss, for true health improvements.
The Bottom Line
The old quote: “Let food be thy medicine” is catchy and often based on science, especially when drugs are deliberately chosen or designed to mimic hormones and compounds already naturally occurring in the body. Changing diet is a way to modify our health and our biological responses. But these effects occur on a background of our personal biology and our unique life circumstances.
For some people, medication will be a tool to improve weight and insulin-related outcomes. For others, food alone is a reasonable pathway to success.
While the science is for populations, health care is individual and decisions around food and/or medicine should be made with the considered advice of health care professionals. GPs [general practitioners] and dietitians can work with your individual situation and needs.
References:
Related: 6 Natural Alternatives to Semaglutide (2023)
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