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Weight loss drugs
My patient Karen was ecstatic to report that she dropped 12 pounds in the last few months and to her surprise, her energy and mood were much improved. She was enjoying exercise and finding she preferred healthy food choices. Karen had tried for years to lose weight without success until we initiated Semaglutide therapy, a medication in the class of glucagon-like peptide-1 receptor agonists (GLP-1RA) better known by brand names Ozempic and Wegovy.
Originally intended to treat Type 2 diabetes, this newcomer to the medical weight loss scene has raised as much interest as controversy, with plenty of champions and nay sayers. I maintain a “somewhere in the middle” perspective. Doubtlessly, weight is a major risk factor for illness and premature death. GLP-1RAs show unprecedented weight loss efficacy, thus impacting metabolic health along with reduction in obesity related disease. Moreover, there is building evidence that benefits may extend to multiple organs implicated in aging-related illness with some studies showing that they may have brain-protective and antidepressant properties. Regardless, it isn’t a panacea and, in my opinion, caveats to how they are used are warranted.
The downsides.:
There are side effects, usually not serious, mostly involving the GI system (nausea, constipation and reflux most common).
- Weight loss tends to plateau, but when the medication is stopped, most gain the weight back raising the question—Are these “forever drugs?”
- Lean tissue loss is a huge problem—at about 1 pound of muscle to 2 pounds of fat. Muscle is very difficult to get back and when people regain weight it is almost all fat.
- Ozempic/Wegovy cost about $1000 per month and are often not covered by insurance. Formulations can be obtained from compounding pharmacies for a fraction of the cost, but quality of the pharmacy is important.
- Since patients often eat less, they may incur nutrient deficits.
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As a Functional Medicine physician, my very strong bias is to mitigate the above issues by utilizing principles of comprehensive health. First, I only consider GLP-1RAs in patients with significant weight placing them at risk, then:
- Patients undergo a comprehensive evaluation so we can address issues that contribute to weight loss resistance: gut health, systemic inflammation, hormone balance, toxic load, stress management, lifestyle etc. These foundational pieces are first!
- Patients are coached on optimal nutrition (food and supplements) and exercise to help support a robust metabolism while losing weight.
- Weight training is an absolute non-negotiable necessity to stave off muscle loss.
- Detox support is provided to diminish the effect of fat-sequestered toxins that are released with weight loss.
- We try to stay at the lowest dose possible that provides slow steady weight loss while mitigating potential side effects and keeping down costs.
- We proactively use non-pharmaceutical approaches to managing above stated side effects.
At least one study has shown that when individuals incorporate programs as described above, patients can eventually be weaned off the medication with weight stabilization lasting at least six months. Yet this is an unfolding story, and caution is advised as we come to fully understand the risks and benefits of this recently popularized medical intervention. Moreover, when viewed from a societal perspective wide application of a medicine to “fix” metabolic dysfunction does nothing to get at the root issue of a broken food industry that feeds us, especially our kids, ultra processed foods. And yes, sadly, GLP-1RAs are also being used in kids as young as preteens.
But back to tending to the struggling individual in front of me, Karen will continue on her weight loss journey paying attention to her whole health and hopefully one day no longer require GPL-1RA support. I urge anyone embarking on this path to work with a qualified physician that embraces a holistic approach.
