Navigating the landscape of weight loss medications often feels like wandering through a maze of uncertainties. What’s safe? What’s not? Are these shortcuts undermining the journey? We’re here to cut through the confusion and offer clarity. Dr. Celia Egan has a decade of experience in obesity medicine and a vast knowledge of the latest advancements in weight loss medication. She presents evidence-based facts and explores the potential of these safe and effective medications to support women’s health and weight management. Discover the truth behind these new medication options that could be the missing piece in your wellness journey.
Obesity is a disease. It is not a choice. It is not an individual choosing to eat more food every day. It’s a disease that is intertwined with signaling between the brain, fat cells, and many organs, including the liver, GI tract, muscles, and gynecological organs.
There are many reasons why individuals take weight loss medications, including:
Adipose Tissue Loss
Adipose tissue, or fat cells, push on our organs and joints, which can cause many types of disease. Reducing adipose tissue and weight to relieve pressure throughout the body is the most recognizable reason to use medications. We look at BMI, weight, and orthopedic symptoms as a marker of success.
Energy Imbalance
Some patients might have extra weight while others do not. It is possible to have a patient with a BMI of 23 or 24 who also has fatty liver disease. Energy imbalances such as extra blood sugar or fat build-ups in the liver limit the body’s ability to function correctly and predispose individuals to chronic disease. In these cases, we would consider using an anti-obesity medication.
Food Cravings
We’ve all experienced cravings (especially around menstrual cycles), but for some, the urge to eat sugar and highly processed foods is uncontrollable. Cravings are really uncomfortable and can start to affect day-to-day activities. They are similar to delusions in that your brain thinks it won’t survive unless it has a particular treat, such as a cookie or bag of chips. While logically, we know this isn’t true, it can be extremely difficult to turn down sugar, fat, or highly processed foods. For patients struggling to control cravings, we recommend trying a weight loss medication.
Many older anti-obesity medications have been on the market for 10+ years. These include:
Contrave: This is a combination pill of bupropion (commonly used for depression and nicotine addiction) and naltrexone (an opioid blocker more widely known as Narcan). This medication can help curb cravings and emotional eating.
Qsymia: This is a combination of phentermine and topiramate. This medication works as an appetite suppressant that works really well for some patients, though less effectively than the new class of weight loss medications.
Over the past few years, the FDA has approved a new class of weight loss medications called GLP-1 Receptor Agonists. These drugs mimic a natural hormone in the GI tract. When we eat, particularly protein and fat, our GI tract secretes glucagon peptides that alert different organs to start processing food and tell the brain to stop thinking about food. GLP-1 medications help the liver process sugar and fat, assist muscles in moving glucose from the blood into muscle cells, and help the body better utilize energy overall. These medications also help keep the heart safe from blockages by lowering cholesterol levels.
The first drug to be FDA-approved was Saxenda. Patients experienced 5% body weight loss for the first time in a short period. Semaglutide was the following type of weight loss drug to hit the market and is the active ingredient in both Ozempic and Wegovy. Patients using these medications saw 16% body weight loss over a year. Last year, data on Tirzepatide was presented at the Obesity Medicine Conference and recently became FDA-approved under the brand Zepbound. Patients using these medications saw almost 21% body weight loss compared to the placebo group (3% body weight loss) over five years.
For the first time, we’re seeing weight loss numbers with medications that are similar to bariatric surgery. Bariatric surgery is a good choice for some patients, but it’s also great to have some of these other options available.
BMI is typically the standard marker to determine obesity – anyone with a BMI over 30 or a BMI above 27 with a comorbidity. Comorbidities include high blood pressure, high blood sugar, high cholesterol levels, coronary artery disease, obstructive sleep apnea, osteoarthritis at the knees, hips, or back, obesity-induced reflux, prediabetes, insulin resistance, PCOS, and gestational diabetes. These would signal that a patient was struggling with energy processing problems and that we must address some of those levels.
We’ve all heard thousands of different stories about weight loss medications, right? So, one thing you must remember is that no medication comes risk-free. Every single medication has side effects. You also have to consider the risk you take by not addressing your health problems, particularly if you are struggling with energy imbalances (high sugar, prediabetes, fatty liver disease, etc). Whether or not you choose one of these medications, we must create a plan to help get your health back on track.
Because GLP-1 Receptor Agonists mimic the GI tract, the most common side effects are nausea and other GI issues such as constipation or diarrhea. Maintaining a healthy diet is important. Symptoms are much worse if patients do not make lifestyle changes. At true., we set up each patient for success with diet and nutrition resources and take any GI tract side effects very seriously. Don’t be afraid to ask!
Another side effect is a lack of appetite. We often see patients that don’t eat enough, which makes sense. These drugs are designed to modify your brain’s hunger signal. We don’t want to turn it off entirely, though! Your body still needs a healthy amount of protein, fiber, and fats. If you are experiencing low appetite, our team will work with you on dosing and a nutrition plan.
Hair loss is another side effect of weight loss drugs and can actually happen during any type of weight loss plan (bariatric surgery, meal replacements, major dietary shifts, etc.). I have seen patients lose hair, but not to the point of balding. We work to minimize this effect through vitamins and a healthy diet of protein and fats.
On each box, there’s a warning that the rodents in the animal studies developed something called medullary thyroid cancer. So far, this has not been shown to be true in human studies. I personally do not worry about thyroid cancer. If you are someone with a personal history of medullary thyroid cancer, however, you would not be a candidate for weight loss medications. For those on thyroid replacement treatments, we want to monitor and adjust your levels as you are losing weight.
I promise you, friends, it is not. Again, obesity is a disease. Just like if you were struggling with cancer or an autoimmune disease, this is not your fault. It’s a mismatch of much of the signaling happening throughout your body. Drugs are not the easy way out. They are a tool that can be used to support you, get your body functioning better, and help you achieve your health goals.
The answer is no, and I encourage you to view weight loss differently. The number on the scale and your clothing size don’t really matter. What does matter is how your body functions. Our bodies are functional when our energy processing systems work correctly. Imbalances lead to chronic diseases such as cancer, dementia, and vascular disease. Medications are a great resource that can help you better manage your energy and cravings. You can still love all the imperfections of your body AND want to get your energy balanced correctly for better health now and in the future. Taking care of your body fully is loving yourself!
A: Cost is a big issue. We continue to work on the backend with some of the larger groups across the country to try to make these drugs more affordable for people. The Obesity Action Coalition is working on some legislation requiring insurance companies to provide coverage for weight loss medications. Right now, some insurance plans do not offer coverage, while others require patients to fail other medications first (including Priority Health). I believe the positive cardiac data from these drugs will help push for future coverage. Our office knows all the different ways to cover these drugs for patients. I would be happy to discuss further during an appointment if that is something you are interested in!
A: Some of this has to do with the injectables and how the mechanism delivers medications. The auto-pen mechanism limits the capacity to make these drugs mass-produced. Patents are another obstacle. Tirzepatide, for example, is still under patent review and has yet to be available in generic form. We likely have a couple more years before the more successful weight loss drugs are available as generic options.
Many non-medical facilities, such as medispas and some doctors’ offices, use compounding pharmacies. Compounding pharmacies try to make weight loss drugs similar to those major pharmaceutical companies produce. Compounding medications, however, are not regulated by the FDA. The Obesity Society, Obesity Medical Association, and Bariatric Society also warn against using compounding medications. We know this can be frustrating as compounding medications are often cheaper, but we want to ensure our patients stay safe!
A: For the most part, you can use weight loss drugs with those medications. As of now, antidepressants are not something that’s contraindicated but should still be discussed with your healthcare provider to ensure safe consumption of all prescriptions. Weight loss medications can also be used with statins. In some cases, I’ve seen people’s cholesterol levels decrease because of the weight loss medication, and these patients no longer need to utilize stains.
A: Weight-loss medications are not short-term medications. These medications aim to change messaging signals that come to the brain; this rewiring process takes months to years. That being said, can I say with 100% certainty if a patient will gain weight after coming off medication? I can’t. I can tell you what happens in the short term without any additional lifestyle changes. Say a patient who struggles with binge eating starts a weight loss medication but doesn’t do anything else to address their issue. They don’t take any mood medications, they don’t seek out therapy, make any lifestyle changes, or practice coping exercises. When the medication stops, the patient will likely go back to binge eating and regain all the original weight. Weight loss medications are not “one and done.” They are a tool to make the weight loss journey easier and should be used in tandem with lifestyle changes.
A: It is essential for any weight-loss patient (calorie-restrictive, bariatric surgery, or weight-loss medications) to prep the body. Your muscles have to stay! Exercise, particularly weightlifting, signals to your muscles that they need to remain engaged and strong. Lifting weights, yoga, Pilates, aerobic exercise, and resistance training are all great exercises to incorporate into your weekly routine.
A: This is a great question! The best next step would be to review and reflect on your eating habits. What nutritional changes have been made so far? What could you be more mindful of in the future? A diet analysis can help you reset, especially after all the treats that sneak in over the holidays.
If you still want to continue losing weight, adding additional medications can be helpful. I know that it feels frustrating to keep adding on medications, but some of those older drugs can be added along with Wegovy to help keep patients on track in the short term.
A: The short answer is yes, there are pill options! The long answer is that a lot of what is available depends on your health history, whether you struggle with energy imbalance or whether you struggle with cravings (or a combination of these three). This would be a great question to discuss during an appointment in our office!
A: Well, first of all, congratulations! Losing 65 pounds is no small feat. I’m sure you’ve also made many lifestyle changes to help you lose weight. To lose the additional 60 pounds, I recommend looking into other medication options, such as Trizepatide, adding on medications, and working on daily nutritional and mindfulness exercises. Again, congratulations on how far you have come already!
A: It’s hard to say whether or not it’s a guarantee that you’ll regain the weight back. One study showed that people who stopped using the medication with minimal lifestyle changes regained weight. However, they lost 50% more weight overall than those in the placebo group, even after stopping medication. That being said, for some people, weight loss medication might be a lifelong commitment. And I do have some patients who prefer to stay on these medications because it has helped to calm their internal cravings so much. It has made their relationship with food and weight journey much more sustainable.
A: Saxenda was the first round of weight loss medicines. The side effect profiles have improved over time, particularly with Tirzepatide. I can’t promise that Tirzepatide won’t cause nausea, but I’ve had patients who have had success moving from a drug like Saxenda to Tirzepatide without as many GI side effects. I would not wipe all these drugs entirely off the map for you!
Struggling with weight and related health issues can be frustrating, especially when exercise and diet are not doing enough. Weight loss medications can be an excellent option for qualifying patients and have helped them reclaim their health journey. At true., Dr. Egan can provide in-person consultations and telehealth visits for patients in Michigan, Ohio, Illinois, Wisconsin, Florida, Colorado, and Alabama. You aren’t alone; this isn’t your fault, and treatment is possible!
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