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April 11, 2024

The Pros and Cons of Weight Loss Drugs

Obesity medications have quite a history in the US. Throughout the post-war era, amphetamines were widely used because of their appetite-suppressing effects until their addictive potential prompted the FDA to ban their use as a weight loss aid in 1979.

The mid-90s saw a surge in the use of fen-phen—a combination of two anorectics, fenfluramine and phentermine—before regulators pulled that pill from the market due to concerns over serious heart valve problems. Other pharmaceutical attempts to solve the obesity problem also failed: Meridia, Acomplia, and Ephedra have all been pulled from pharmacy shelves due to safety issues.

Suddenly there’s a new kind of weight loss drug on the market that has attracted a lot of media attention.

Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) are being used to help everyone from the morbidly obese who need to lose 100 pounds to those Hollywood celebrities who need to lose 10 pounds for their next movie.

These new drugs offer hope for people who have struggled with obesity most of their lives. They could be the answer for people who need to lose 100 pounds or more to be at a healthy weight.

But there are upsides and downsides to every drug. Let’s look at the possibilities these new weight loss drugs offer.

Semaglutide (Ozempic, Wegovy)

Semaglutide, a GLP-1 receptor agonist, was approved by the FDA in 2017 under the brand name Ozempic as a treatment for diabetes. The drug mimics a hormone produced in the stomach that reduces blood sugar levels. It also happens to reduce food intake by lowering appetite and slowing down digestion in the stomach.

When Novo Nordisk, the Danish pharmaceutical company who created Ozempic, realized the drug helps with weight loss, they quickly pushed the FDA to approve higher doses of the drug as a treatment for obesity. In June 2021 the FDA approved Wegovy, the trade name for a higher dose of Ozempic, as treatment for obesity, marking the first time since 2014 that federal health authorities had given the green light to a new weight loss drug.

Ozempic and Wegovy are the same drug administered in different doses for different purposes.

Tirzeptide (Mounjarno, Zepbound)

Tirzeptide, sold under the brand name Mounjarno by Eli Lilly, also functions as a GLP-1 receptor agonist. GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) are both hormones secreted by cells of the intestines in response to eating. Tirzeptide activates receptors for both hormones, leading to improved blood-sugar control. Like semaglutide, tirzeptide also reduces appetite and slows digestion in the stomach. Mounjarno was approved by the FDA to treat diabetes in 2022.

In November 2023 Eli Lilly received FDA approval for tirzeptide as a treatment for obesity under the brand name Zepound. Again, both Mounjarno and Zepbound are the same drug that have been approved for two different types of treatment using different doses, just like Ozempic and Wegovy.

Who Can Take the Drugs as a treatment for obesity?

Both Wegovy and Zepbound are approved for adults and children ages 12 years or more with obesity. For adults that’s a BMI greater than or equal to 30, and for children it’s a BMI greater than or equal to the 95th percentile for age and sex. They are also approved for adults with a BMI of 27 or greater who also have medical related issues.

How Much Do the Drugs Cost?

Ozempic and Mounjarno are covered by insurance plans when they are prescribed for Type 2 diabetes. However, most insurance plans will not pay for Wegovy or Zepbound if taken for weight loss.

Currently, the price of Wegovy is $1,349 per month, and the price of Zepbound is $1,059 per month.

How Well Do They Work?

In clinical trials, Zepbound, in combination with diet and exercise, resulted in an average weight loss of 48 pounds with the highest dose. The lowest dose led to an average weight loss of 34 pounds.

Wegovy, in combination with diet and exercise, resulted in an average weight loss of 15% (about 35 pounds) over the course of a year. Also, one study last fall showed that Wegovy reduced the risk of cardiovascular events by 20% in people who have a history of heart disease.

These new drugs offer a lot of promise for people who are morbidly obese and have struggled to lose weight their entire lives.

How Are the Drugs Administered?

Semaglutide and Tirzeptide are both administered as an injection in the stomach once a week. Ouch!

What Happens if You Stop Taking the Drugs?

In the clinical trials for semaglutide, participants regained their weight when they stopped taking the drugs. If you decide to take these drugs, you will have to take them for the rest of your life if you want to maintain your weight loss.

So far, there is no indication that weight loss can be maintained on a lower dose.

What Are the Side Effects?

The websites for Wegovy and Zepbound indicate side effects may include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, upset stomach, dizziness, feeling bloated, belching, gas, stomach flu, heartburn, runny nose, or sore throat.

Serious side effects for Wegovy may include thyroid tumors, including cancer. In studies with rodents, Wegovy caused thyroid tumors and thyroid cancer.

Other serious side effects listed are pancreatitis, gallbladder problems, hypoglycemia, kidney failure, change in vision, increased heart rate, thoughts of suicide and depression.

Hair loss is not listed as a side effect for either drug, but in clinical trials for Wegovy, 3% of people reported hair loss and 6% of participants in clinical trials for Zepbound reported hair loss.

What Does the Research Say?

Recent research has started to reveal the risks of the side effects. A study published in 2022 found that 87% of people taking GLP-1 receptor agonists experience gastrointestinal adverse reactions including nausea, diarrhea, vomiting, constipation, and pancreatitis.

A study published in the Journal of American Medicine in 2023 found that the use of GLP-1 agonists for weight loss was associated with an increased risk of pancreatitis, stomach paralysis, and bowel obstruction.

A study published in Diabetes Care found an increased risk of thyroid cancer for anyone using GLP-1 agonists for 1 to 3 years.

What do I Think About These Drugs?

I’m a firm believer that you need to try to avoid taking drugs unless you absolutely need them. I don’t think drugs are bad. Modern medicine has produced an overwhelming number of lifesaving drugs from penicillin to these very drugs used as treatment for diabetes. But too many people in our world are too quick to take a pill or a shot to solve a problem they could fix with exercise and good eating habits. Research demonstrates that developing good eating habits and getting enough physical activity can lead to significant, lasting reductions in body weight, a reduced risk of obesity-related comorbidities, and lifespan extension of 12-14 years.

If you decide to take GLP-1 receptor agonists to lose weight, you will need to take them for the rest of your life to keep the weight off. Even if you change your eating habits, once you stop taking these drugs, your insulin response, hunger levels, and digestion of food will change in a way that will make it impossible for you to keep the weight off. You just don’t have enough willpower to fight what will happen when you stop taking these drugs.

Also, consider the original intent of these drugs. They were created to treat diabetes. One of two things happens in someone who is diabetic—the cells of their body are resistant to insulin, or their pancreas isn’t producing enough insulin for their body to regulate blood sugar. GLP-1 receptor agonists mimic a hormone that tells the pancreas to produce more insulin. That’s lifesaving for a diabetic.

But what if you’re not diabatic and you take these drugs for weight loss? If you’re not diabetic, you have a healthy insulin response, and your pancreas is working properly. If you start taking a drug that requires your pancreas to work overtime, for no extra pay, it will protest. And that’s exactly what’s happening to many of these people who take these drugs and end up with pancreatitis.

If you’re considering taking one of these new weight loss drugs, you have to look at both the upside and the downside. If you’re more than a hundred pounds overweight, then pancreatitis and the long term effects on your endocrine system may be less dangerous for you than hypertension and a heart attack. But if you have 40 or 50 pounds to lose, the risk probably isn’t worth it.

Living a healthy lifestyle and achieving a healthy weight requires work. It means learning what is and isn’t good for you. It means saying yes to good choices and no to bad ones. It takes a support team of friends and family.

We’ve been helping people change their health and lose weight—and keep it off long term—for 20 years. We’ve helped our clients lose over 37,000 pounds since 2013. We have many clients who’ve lost as much as 50, 80, and even 100 pounds and kept it off for more than 10 years.

Before you decide to try one of these new weight loss drugs, please try every sensible approach you can to losing weight through healthy eating and proper exercise. Allow one of our coaches to walk with you in your weight loss journey. We are here to help.

If you ultimately decide that one of these new drugs is the answer for you, we are here to help as well. You will need to strength train to build muscle and you will need to develop healthy eating habits. Our Simple 9© nutritional program can help with that. We can help you win in whatever way you choose to achieve a healthy weight.

Stay Strong,

Bo Railey