Weight loss medications
Certainly a hot topic, but highly controversial in their uptake, are the injectable weight loss medications. They are the GLP-1 agonists, or the GLP-1/GIP agonists such as semaglutide and tirzepatide. Many more are in development because of how successful and popular they have become.
The medications work by suppressing appetite. They do not directly cause weight loss, but they cause people to eat less, which leads to weight loss. This is important. It happens via disruption of hormones in the gut that influence satiety (your feeling of “fullness”). They were originally developed for treatment of type 2 diabetes.
Quick facts about these medications:
They are effective for weight loss by helping you eat less.
They are injections, but pill forms of the medications are in development.
They are expensive. Many with commercial insurance will pay $200-$300/month out of pocket.
They are safe for the vast majority of adults to take, with a few well-defined exceptions.
They work best when paired with a healthy diet and an exercise program that includes strength training and aerobic training.
Medicare does not currently offer any coverage for these drugs for the purpose of weight loss (diabetes is different).
Some of the injectable weight loss medications have been FDA approved for other medical conditions besides diabetes and obesity, such as sleep apnea or heart disease. This means they have been researched to show improvements in these specific conditions. This also means insurance companies might be more likely to cover part/all of them if you have these conditions.
I do prescribe these medications, but the conversation always involves a discussion about the risks and benefits of using a medication for weight loss. We talk about possible side effects as well as a long term plan for potentially coming off the medication at some point.
Common questions about these medications:
Will I have to be on this medication forever?
What are the side effects?
What do we know about long term safety?
Will I regain weight if I stop the medication?
How much will the medication cost?
Are the online compounded meds safe?
Every situation is different, depending on age, other medical conditions, readiness for change, insurance coverage (unfortunately), among other various factors. I have seen the medications help with substantial weight loss, and I have seen weight regain when the medication is decreased or stopped. People stop these medications for a variety of reasons: couldn’t afford it anymore, experienced side effects, reached their goal weight. Regardless of the reason, it is common to see weight regain. However, being on the medication has allowed people to pay close attention to how much food they need to eat to lose or maintain their weight. It offers a learning opportunity while the “food noise” is quiet for a while. In other rarer cases, I have seen the medications have little to no effect on weight.
The most common side effects with these medications involve the gastrointestinal tract. Nausea and constipation are very common, especially if you overeat while on the medication. The side effects usually resolve if you stop the medication.
A brief word on compounded medications: weight loss medications are sold online and these usually come in a compounded form, meaning the vial contains the weight loss medication combined with another substance, such as vitamin B12 for example. Compounding pharmacies are regulated by the FDA and state pharmacy boards, but many online weight loss medications are counterfeit, improperly dosed, and/or contaminated. However, drug manufacturers also offer direct to consumer weight loss medications that are very safe. If you’re not sure on the safety, err on the side of caution and ask your doctor.
It is highly important to maintain adequate dietary protein and a strength training program while taking these medications. This will help prevent significant muscle loss. When someone loses weight, they will lose fat tissue and muscle tissue. Resistance training and dietary protein can help mitigate muscle loss. This is especially critical in the elderly population, and I use extreme caution when prescribing to this group.
Take home points:
Injectable weight loss medications are effective by causing you to eat less.
Weight loss medication does not replace a balanced diet that prioritizes protein.
Resistance training is critical to maintain and build muscle mass.
If you are unsure if it’s the right thing for you, have a conversation with your doctor that involves a discussion of the short and long term plan.
