WHAT YOU NEED TO KNOW ABOUT THE LATEST WEIGHT LOSS DRUGS
Sanaz Majd, MD
The latest weight loss drugs—and the buzz about them—have taken the world by storm. Perhaps you have a friend or family member who shed some pounds with them? Or maybe you simply cannot escape the incessant pharmaceutical ads swarming the television screen, encouraging viewers to sprint to the nearest doctor’s office for these absurdly high-priced drugs. If it is in a TV ad, you better believe it’s there to make the pharma companies millions (or dare I say billions) of dollars. Either way, everyone is wondering—what is the hoopla over these seemingly miraculous prescriptions that are shedding inches off the body?
HOW DO THEY WORK?
Initially developed to treat diabetes, these “glucagon-like peptide 1” (GLP-1) agonists bind to receptors and stimulate insulin release from the pancreas. One of the ways in which they improve glucose levels in diabetics is to induce weight loss itself, which in turn improves insulin resistance and allows cells to better respond to insulin. They also inhibit gastric emptying, which refers to the speed of delivery of the stomach contents into the next gastrointestinal (GI) segment, the small intestine. If this speed is delayed, the stomach stays full longer, increasing satiety and lessening hunger.
The drug companies then re-branded the same drugs and started to market them for obesity. But because there’s a national shortage of some and because they come with a hefty price tag and health plan coverage issues, there are now counterfeit, non-FDA versions of them floating around and marketed by certain “weight loss clinics.” Beware, as these fakes have been linked with hypoglycemia and seizures, and the sterility of the needles are not confirmed. If you are seeking weight loss, opt for the safe route and discuss with your doctor.
THE FDA-APPROVED OPTIONS
Most of these prescriptions are injectables, administered in the abdomen, thigh, or upper arm. So if you are not comfortable with self-administration, you may benefit from some formal teaching. This can sometimes be done at your doctor’s office as a nurse visit or with your pharmacist.
Note that, as always, I am in no way associated with any drug companies and will be listing the generic names of drugs only:
Liraglutide was the first GLP-1 agonist approved for the treatment of obesity in 2014. However, like insulin, it is a daily injection that has made it less desirable. And its efficacy is more modest than the rest. However, the good news is that it will be available as a generic in June 2024, making it much more accessible for patients and more likely for insurance companies to cover costs.
Semaglutide was approved by the FDA in 2021, attracting a lot more buzz as a once-a-week injectable with almost twice the efficacy. There are 3 different brands of this drug—an injectable for diabetics, an injectable for non-diabetics with obesity, and an oral pill for diabetics only. Access to the drug may be currently limited, however, as there is a national shortage.
Tirzepatide is the latest and, so far, the most potent of this type of drug. It works as a GLP-1 agonist, in addition to a “gastric inhibitory polypeptide” (GIP) agonist. There are two versions approved by the FDA—one for diabetics and, as of November 2023, another one approved for the treatment of obesity.
SIDE EFFECTS
As you can imagine, given that these drugs affect the GI system, side effects relating to the GI system are more prevalent. Nausea is the most commonly reported symptom, but vomiting and diarrhea are also potential side effects. For most people, however, they are typically mild or moderate in severity and occur upon initiation or with dose increases. These side effects can also be combatted by consuming smaller, more frequent meals, along with the simple tincture of time as they tend to self-resolve.
Interestingly, these drugs have also been shown to decrease the risk of heart attacks/strokes in those with diabetes. It is unknown if the same applies to non-diabetics, however, as there is not enough evidence.
In addition, in studies performed on rodents, this group of drugs was associated with the development of thyroid tumors, including cancer of the C-cells of the thyroid. Now, humans have far fewer C-cells than rats, so it is less likely that the risk is as great for us. However, we need further studies in humans to determine this risk.
CANDIDATES FOR A PRESCRIPTION
Not just anyone who wants to lose weight meets the criteria for treatment, unfortunately. For those without diabetes, most insurance plans have some strict criteria, including:
• Body Mass Index (BMI) of 30 or higher, or
• BMI of 27 – 29.9 who also have other related comorbidities (such as hypertension, prediabetes, cardiovascular disease, chronic kidney disease, PCOS, fatty liver, etc.)
And patients must demonstrate a failure to lose at least 5% body weight after 3 to 6 months on other weight loss plans in order for health plans to cover these drugs for non-diabetics.
These drugs are contraindicated in those with a personal history of pancreatitis, or with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia (MEN) 2A or 2B.
A few other important points:
• It’s vital to start at the lowest dose, assess efficacy over time, and then determine if dose adjustments are required.
• Lifestyle modification is still key while on GLP-1 agonists—that means dietary changes and exercise should be simultaneously achieved.
• Discontinuation of the drug has been shown to reverse weight loss in studies.
Note that I am in no way affiliated with any of these drug companies (or any drug company for that matter). My articles are only for general informational purposes. Please always consult your own doctor to determine the best plan for your personal health.
Sanaz Majd, MD, is a board-certified Family Medicine physician and host of the Majd MD YouTube channel, reviewing the most popular medical topics: www.youtube.com/MajdMD. You can also follow her on Facebook or Instagram: @SMajdMD.
