Weight loss medications are becoming increasingly popular to jumpstart your weight loss journey. While many weight loss medications are on the market, one of the most popular right now is Ozempic (ie #MyOzempicJourney trending TikTok). The nerd in me can't but point out that technically Ozempic is approved for type 2 diabetes, not weight loss, like its "twin" medication Wegovy. Both Wegovy and Ozempic are semaglutide, which I'll discuss later. But I digress. Either way, before taking Ozempic or any other weight loss medication, it's important to understand its potential risks and benefits. This blog post will discuss the four things you must know about weight loss medications.
What are weight loss medications?
The technical term for this class of medicines is "anti-obesity medication," or AOMs. Obesity is a complex medical disease where the body stores harmful levels of fat that cause inflammation and insulin resistance. Obesity is associated with over 200 diseases. So while other
people may only see your waistline shrinking, "weight loss" medications do much more than weight loss. They improve your metabolic health and decrease your risk of other diseases.
Although many products claim to be "weight loss medications" or "weight loss aids," there are currently only six anti-obesity medications approved by the US Food and Drug Administration (FDA). These medications work in different ways and treat various causes of obesity. See "how do they work" section for more details.
Who are weight loss medications for?
Weight loss medications or AOMs work best when selected for the "right" person. As I wrote in the Medscape article, "Are Weight Loss Medications For Health or Thinness?"
"Anti-obesity medications are intended to reduce excess fat levels to improve metabolic health, not make people underweight.... Using metabolic medications in the wrong population increases the risk for lowering body fat and muscle below healthy levels." Currently, FDA indications use BMI, body mass index. Cringe-I know the BMI has many flaws in measuring a person's "healthy weight ."However, it's currently the obesity screen tool we're working with. The requirements for AOMs are having: a) a BMI of 30kg/m2 or b) a BMI of 27kg/m2 plus an obesity-related condition such as insulin resistance, PCOS, diabetes, high cholesterol, etc. But there's no one-size-fits-all regarding picking the right AOMs for you. That's why it helps to work with someone who understands your unique history and how to choose the proper medication.
How do they work?
Let's be clear the body loves fat and tries to hold onto it unless it receives the right signals to lose weight. Lifestyle changes help send the right signs for weight loss. Yet, f
or some people, lifestyle changes like nutrition, exercise, stress management, etc. won't be enough to lose more than 5% of their body weight won't be enough. That's where metabolic tools such as medication can help.
There are six, and hopefully soon seven, FDA-approved AOMs.
Here I've grouped them based on how they work:
-Increase your metabolism & decrease appetite (Sympathomimetics): phentermine, phentermine/topiramate ER (Qsymia), [*older medications like diethylpropion, benzphetamine, phendimetrazine may still be used]
-Decrease fat absorption from food: orlistat,
-Decrease cravings & appetite: bupropion/naltrexone (Contrave),
-Decrease appetite & increase fullness: liraglutide (Saxenda), semaglutide (Wegovy, Ozempic ).
-Address the genetic cause of obesity: setmelanotide (Imcivree),
*Coming soon, tirzepatide. Currently, tirzepatide's (trade name Mounjaro) approval is for type 2 diabetes. However, it has the most impressive weight loss we've seen from a medication. The FDA is currently reviewing approval for obesity treatment.
Contrary to popular belief, weight loss medication isn't one size fits all.
A few things to consider are:
What are your current weight & goals? The goal is to get you to your individualized metabolically healthy weight. As I discussed in my bestseller, Embrace You: Your Guide to Transforming Weight Loss Misconceptions Into Lifelong Wellness.
What is your side effect risk?
What issue/ weight gain trigger are you addressing?
Choosing the best medication depends on many factors. It's helpful to see an obesity expert. However, an obesity expert is more than a "weight loss doctor." We also take your entire health and well-being into consideration. See the resource list to learn about Embrace You's holistic care approach or find an obesity specialist n your area.
Are they safe?
People have many questions about whether or not they are safe when it comes to weight loss medications. After all, these types of drugs can have serious side effects. That's why they are only available through a prescription. Here are three essential things you should know to help you make an informed decision about using these medications.
All medications have possible side effects. For example, nausea and upset stomach are typical in the first few weeks of taking some medications like semaglutide (Wegovy, Ozempic). But semaglutide also has a black box warning that patients with a history of medullary thyroid cancer shouldn't take it personally or in their families. Moreover, a recent study showed that GLP-1 medications like semaglutide or liraglutide might increase the risk of all types of thyroid cancer. Other drugs have the potential for serious side effects like increased blood pressure (phentermine) or worsened depression and suicidal thoughts. (topiramate) .
Thankfully, the FDA monitors FDA-approved medications for safety and quality. However, examples like this are why a careful evaluation is essential before and while taking a weight loss medication.
Lastly, knowing when to stop weight loss medication is crucial. The first three months are a trial to see if the drug works for you. If it works, you'll need to stay on a medication least 6-12 months to see the most benefits. Some people may require long-term use.
Isn't Taking Weight Loss Medication "Cheating"?
Many people I've worked with through the years have struggled with the guilt and shame of thinking that taking a medication is cheating regarding weight loss. After all, losing weight involves lifestyle changes and eating a healthy diet. However, some people need medications to help them reach their goals. Medications can be a valuable tool for
maintaining weight loss since the body works aggressively to regain any weight you lose.
Weight loss medications aren't a quick fix for obesity. However, combining medication with:
nutritious foods,
regular movement (aka "exercise"),
stress management,
sleep improvement,
habit modifications
holistic care plans involving counseling, spiritual wellness, and nutritional education
can help people make lasting lifestyle transformation, improve their metabolism, lose weight, and keep it off.
It's also important to understand that not everyone is a good candidate for weight loss medications. Your doctor will assess your health needs and risk factors before recommending medication. If you're considering taking a weight loss medication, discuss the potential risks and benefits with your doctor first.
Remember, there is no one-size-fits-all approach to weight loss. Embracing medications is just one tool that will help you reach your goals. AOMs aren't magic. They still carry risks. Let's also remember the food, exercise, sleep, and stress management are also "medicine" to the body. And ultimately, changing your habits and lifestyle is essential to achieve lasting success.
Also, community and support are vital to your spiritual wellness by reminding you that you are not alone on your journey. Embrace You has several tools to help. For more information about how Embrace You Weight & Wellness personalizes your body-mind-spirit weight loss & wellness plan, click here.
Whatever you choose on your weight & wellness journey, may you always Embrace You!
Resources & References
From Dr. Sylvia
Embrace You: Your Guide To Transforming Weight Loss Misconceptions Into Lifelong Wellness by Dr. Sylvia Gonsahn-Bollie, MD, DABOM, FOMA,
Obesity Pillars Roundtable: Body mass index and body composition in Black and Female individuals. Race-relevant or racist? Sex-relevant or sexist? by Drs. Harold Edward Bays SylviaGonsahn-Bollie CourtneyYounglove SeanWhartond
What Causes Obesity? Obesity Medicine Association
General Information & Studies
Chakhtoura, M., Haber, R., Ghezzawi, M., Rhayem, C., Tcheroyan, R., & Mantzoros, C. S. (2023). Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. EClinicalMedicine, 58, 101882. https://doi.org/10.1016/j.eclinm.2023.101882
Srivastava, G., & Apovian, C. M. (2018). Current pharmacotherapy for obesity. Nature reviews. Endocrinology, 14(1), 12–24. https://doi.org/10.1038/nrendo.2017.122
Bezin, J., Gouverneur, A., Pénichon, M., Mathieu, C., Garrel, R., Hillaire-Buys, D., Pariente, A., & Faillie, J. L. (2022). GLP-1 Receptor Agonists and the Risk of Thyroid Cancer. Diabetes care, dc221148. Advance online publication. https://doi.org/10.2337/dc22-1148
Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F., & STEP 1 Study Group (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England journal of medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa2032183
Garvey, W.T., Batterham, R.L., Bhatta, M. et al. (2022). Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med28, 2083–2091 https://doi.org/10.1038/s41591-022-02026-4
Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., Stefanski, A., & SURMOUNT-1 Investigators (2022). Tirzepatide Once Weekly for the Treatment of Obesity. The New England journal of medicine, 387(3), 205–216. https://doi.org/10.1056/NEJMoa2206038