A Weighty Subject

Those new movie star drugs

by Gary Klein MD, Concierge Physician - WellcomeMD Mooresville

So just tell me: do you really need to hear some more advice about weight loss? Well, I think I know your answer, but hear me out. Some of this may be just a bit surprising.

You may have heard about those new weight-loss drugs originally developed for diabetics – Ozempic, Wegovy, Mounjaro – and more are on the way. They’re so popular that there’s a shortage. One presenter joked about them during the Oscars. Only Wegovy is FDA-approved for weight loss so far, and then only for obese patients. The other drugs are prescribed for weight loss, too, but off-label.

These formulations all incorporate a drug called semiglutide. They’re effective for weight loss, and that’s gratifying. But your wallet will lose a lot of weight, too – as much as $15,000 a year. Most insurers do not cover this use. For these drugs to keep working, you’ll very likely have to continue taking them for life.

Semiglutide suppresses appetite by targeting parts of the brain that regulate hunger and cravings, and it prolongs the feeling of fullness after eating. The various brands of drugs that include it come with a long list of potential side effects; some merely unpleasant, some much worse. The most common are gastrointestinal issues such as nausea, vomiting, diarrhea and constipation. Some users have experienced sagging and old-looking faces, because a portion of the weight loss occurs there, rather than where it’s desired. The risks of pancreatitis, kidney failure and medullary thyroid carcinoma are also elevated, along with gallbladder disease that can occur with fast weight loss.

Federal data says more than 40 percent of American adults are obese; another 30 percent are overweight. Obesity is linked to a couple of hundred diseases, including cancers, heart ailments and kidney disease. You knew that. No wonder we’re preoccupied with it.

About one in four of us make New Year’s resolutions, and losing weight is a perennial front-runner in the annual national survey run by The Economist. What have we figured out about how to keep the January promises about weight loss, and improve the odds that favor a longer and healthier life, without a never-ending shotgun marriage to a new drug?

The medical journal Family Practice published a study that nails part of the problem: often, weight-loss advice from the family doctor is generic and ineffective. The findings were that we general practitioners frequently “lack knowledge and confidence when giving advice for weight loss,” or “mostly give generic advice, which patients report as unhelpful,” or “specific weight-loss recommendations...were rarely evidence-based.” More guidance is needed for the family doctors giving weight-loss advice, that study concluded.

Dr. Zhaoping Li, chief of the division of clinical nutrition at the University of California at Los Angeles, told a reporter that those new drugs can be useful for some but are by no means the answer.

“I don’t want people to lose their attention on the fundamental issue — we really need to help each individual have the best lifestyle for their bodies and themselves,” Li said.

That’s where you and I can have a really useful conversation about what we’re eating and how we’re moving – nutrition and exercise – and set reasonable goals for improvement. Maybe that’s already happening for you, and if so, bravo!