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Do diabetes drugs really work for weight loss?

Friday, November 10, 2023 11:47 AM

By NorthShore – Edward-Elmhurst Health

Everyone is looking for a quick fix for weight loss. And with about 70 percent of adults in the U.S. struggling with being overweight or obese, there has been a high demand for medical solutions.

A diabetes drug called Ozempic became a household name this year as a “miracle drug” for weight loss when a connection was made between Ozempic and its sister drug, Wegovy. Semaglutide, the active ingredient in both drugs, helps to both lower blood glucose levels and induce weight loss by telling your body it is full.

Measuring waist

However, while Ozempic has not been approved to treat obesity, Wegovy was approved by the U.S. Food and Drug Administration (FDA) in 2021. And, more recently, the FDA approved another drug for obesity called Zepbound.

Zepbound was previously approved for diabetes treatment as Mounjaro, which uses the active ingredient tirzepatide. Also injectable, the drug works much the same as Wegovy.

Both drugs highlight an understanding that obesity is a medical problem, not merely a lack of self-control. They could make a big difference for those who’ve struggled to lose weight without success.

But is injectable medication a quick fix for weight loss? Or is there more to it?

Neha Shah, MD, an obesity medicine medicine specialist with Edward-Elmhurst Medical Group and a Diplomat of American Board of Obesity Medicine, said the medication could be life-changing for a patient who has struggled with their weight.

“Most people have tried everything under the sun before considering weight loss medication,” Dr. Shah said, adding that it’s important to take the drugs while under the care and monitoring of a doctor, especially someone board certified in obesity medication who understands the medication.

Physician direction is especially important, given the stories about celebrities and others using Ozempic to lose weight who have suffered harmful side effects from misuse.

“Ozempic has little oversight and is commonly being prescribed for weight loss by people who aren’t familiar with appropriate use,” Dr. Shah said. Drug shortage is also a concern for those taking the medication to treat type 2 diabetes.

What are the side effects?

The side effects of semaglutide may include: constipation, diarrhea, nausea, vomiting and stomach pain, intestinal obstruction and hypoglycemia. Serious but rare side effects include a rare thyroid cancer (medullary thyroid carcinoma) and pancreatitis. Anyone with a personal history of pancreatitis or intestinal obstruction, or a personal or family history medullary thyroid cancer, should avoid taking semaglutide.

Side effects of tirzepatide may include: nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion and stomach pain. Serious but rare side effects include pancreatitis, stomach and gallbladder problems.

Recently the FDA added "Gastrointestinal Disorders: Ileus" to the list of adverse reactions for Ozempic. Ileus, meaning intestinal blockage, has been reported in about 16 people.

Additionally, more research about how semaglutide can alter mood and the potential increased risk of suicide that is being reported with this medication. People who struggle with binge eating often use food as a coping mechanism. When a patient takes medication or undergoes bariatric surgery, the ability to overeat is eliminated and people lose a coping mechanism. This can increase anxiety, depression and suicidal ideation as already seen in studies of patients post bariatric surgery.

A final warning from the FDA and doctors cautions against buying these medications online, where there is no FDA regulation for safety or quality.

What does a safe weight loss plan look like?

To safely move forward, the first step is to consult with your doctor.  Any medication should also be part of an overall plan that includes lifestyle changes to lose weight and keep it off.

“My job is partnering with patients in chronic disease management,” says Alina Elperin, MD, internal medicine physician and Diplomate of American Board of Obesity Medicine with NorthShore Medical Group, part of NorthShore – Edward-Elmhurst Health.

“During the first weight management consultation, we discuss patients’ unique patterns of nutrition, sleep, physical activity and address their various social/emotional needs. I give patients recommendations and tips to get them moving toward their weight and health goals. We might discuss medications during the first visit, but we may not start them right away.”

Just as blood pressure or cholesterol medications are titrated for a patient during long-term use, weight loss drugs have similar protocols to determine the right dose that allows weight loss goals to be maintained, added Dr. Elperin. Once a patient hits a target weight for a period of time, continuing the medication can help keep the weight off.

Screening for active depression and discussing patients’ moods, coping strategies and support structure is another cardinal feature of a weight management treatment plan.

“Overall Wegovy and Zepbound are an exciting advancement for those struggling with weight and can provide a life-changing avenue to prevent disease and improve quality of life,” Dr. Shah said. “As with all medication, it needs to be done under the guidance of an experienced physician.”

There are also several older medications, such as Qsymia and Contrave, that have been used successfully for weight loss for many years. The older medications can be a great option to meet patients’ goals such as decreased metabolic disease progression, lowering cardiovascular disease and reducing other complications.

As always, medication alone is not a golden ticket as TikTok videos report. Lifestyle changes combined with medication, and in partnership with healthcare professionals, is the safe and effective way to approach obesity as a disease.

At NorthShore University HealthSystem, our weight loss experts can help you successfully and effectively lose weight to prevent and treat disease and improve your overall health. Learn more.

Need a doctor? With hundreds of board-certified physicians to choose from, you’re likely to find the perfect doctor for you close by. Find a doctor at NorthShore University HealthSystem