In a world where weight loss advertisements dominate television screens, many may view new injectable medications as the solution they’ve been waiting for. However, experts warn that these drugs, while effective, come with a host of considerations that should be carefully evaluated before embarking on a treatment journey.
Dr. Susan Wolver, a prominent medical weight loss specialist at VCU Health, emphasizes the long-term nature of these medications. They require patients to commit to ongoing use for optimal results. Recent statistics from the National Health and Nutrition Examination Survey reveal a concerning trend: approximately 42.5% of U.S. adults aged 20 and older are classified as obese, with 9% experiencing severe obesity, and an additional 31.1% falling into the overweight category.
“Obesity is a chronic and progressive disease that necessitates appropriate treatment,” Dr. Wolver noted. Alarmingly, as of 2018, only 0.5% of individuals who were eligible for weight loss medications were actually receiving them.
While weight loss drugs are not a recent development—having been available since the 1950s—the emergence of newer injectable options has sparked significant public interest. Notable among these are Ozempic® (currently approved for diabetes, not obesity), Wegovy®, and the latest entrant, Zepbound®.
Dr. Wolver explained that these injectables belong to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for diabetes management. “Research revealed that individuals using these medications were losing weight,” she added, noting that Saxenda®, the first approved obesity drug, entered the market a decade ago.
These medications work by mimicking the GLP-1 hormone, which signals to the brain that the body is satiated. In clinical studies, participants taking Wegovy achieved an impressive weight loss of over 15% at the maximum dose, while Zepbound users experienced an even greater reduction of 21%—a substantial improvement over weight loss achieved through lifestyle changes alone.
Beyond facilitating weight loss, these medications offer additional health benefits, including improved heart, kidney, and liver functions. Current research is also exploring their potential applications in treating conditions such as polycystic ovarian syndrome, depression, Alzheimer’s, Parkinson’s disease, and substance use disorders.
However, the use of these medications is not without risks. Common side effects can include gastrointestinal issues, such as nausea, vomiting, constipation, and diarrhea, as well as more severe complications like gallbladder disease, an increased fracture risk, and potential pancreatitis. Women are advised to use reliable contraception while taking these medications.
Dr. Wolver cautions that discontinuing these drugs after a period of weight loss can lead to rapid weight regain. “These medications are intended for long-term use,” she stressed, highlighting that many insurance plans, including Medicare, do not cover them. Patients can expect to pay around $1,300 per month out of pocket, although cash payment options for Wegovy and Zepbound can lower costs by approximately 50%.
Given their relatively recent introduction, Dr. Wolver acknowledges the uncertainty surrounding the long-term effects of these medications, stating, “We don’t know what we don’t know.” As a precaution, many insurance companies require ongoing monitoring to ensure that patients are adopting proper nutritional and exercise habits.
Eligibility Criteria for Weight Loss Medications
Not everyone qualifies for these treatments. To be considered for weight loss drugs, individuals must have a body mass index (BMI) of 30 or higher, or a BMI of 27 or more with associated health conditions like hypertension. However, due to the high cost of these medications, some insurance providers have established their own criteria for eligibility and may require patients to try oral alternatives first.
When assessing patients, Dr. Wolver conducts a thorough evaluation to identify underlying factors contributing to weight issues. “My focus is on treating the disease of obesity,” she explained. “Our primary objective is to enhance overall health, rather than solely pursuing weight loss.” The program encompasses lifestyle modifications, including guidance on nutrition, exercise, sleep habits, and mental health management. For eligible patients, discussions may include medication or surgical options.
Dr. Wolver notes that human physiology is not geared toward weight loss, particularly extreme weight loss. This response can be traced back to our ancestors’ survival mechanisms. “Our bodies resist weight loss, leading to increased hunger and a slower metabolism,” she explained. “Regardless of the approach—be it weight loss drugs, surgery, or dietary changes—patients often face diminishing effectiveness over time due to metabolic adaptation.”
To counteract this, she advises individuals on weight loss medications to maintain muscle mass and metabolic function by consuming adequate protein, exercising regularly, and incorporating strength training into their routines.
Raising Awareness of Societal Challenges through Education
The widespread discourse around new weight loss medications has empowered individuals who have faced stigma regarding their weight to advocate for their health. “Obesity impacts every aspect of a patient’s life, and facilitating their journey to better health can be life-changing,” Dr. Wolver remarked. “Witnessing my patients transform and reclaim their lives is profoundly rewarding.”
However, the popularity of these drugs has also rekindled discussions about body image and societal pressures regarding thinness, especially amid a growing emphasis on body positivity. Dr. Wolver expressed her support for the body positivity movement, highlighting the importance of diverse representation in media. “I wholeheartedly embrace body positivity and appreciate the visibility of varied skin tones and body types,” she said.
Yet, the pursuit of thinness may lead some individuals without obesity to seek weight loss medications through questionable channels. Currently on the FDA’s shortage list, these drugs can be compounded, which may compromise safety and oversight, resulting in some individuals facing severe health consequences.
Most patients who turn to VCU Medical Weight Loss Program have exhausted various weight loss methods. Dr. Wolver emphasized the limitations of traditional advice to “eat less and move more.” While exercise is crucial for overall health, particularly in older adults, it has a minimal impact on weight loss. “We delve into root causes and barriers to achieving a healthy lifestyle, addressing issues like dietary understanding, exercise challenges, mental health, and disordered eating,” she said, noting that nearly 25% of her patients exhibit undiagnosed disordered eating patterns.
Dr. Wolver’s dedication to assisting her patients is evident. “Helping people regain control of their health is my passion,” she affirmed.
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