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  • Writer's pictureSophia Kamveris, MS, RDN

Weighing In on Weight Loss Medications


It’s hard not to turn on the TV or to land on social media platforms and not be inundated with all of the advertisements promoting a variety of medications. Today, I want to look at a class of drugs called semaglutides. You may know them by their brand names —Ozempic and Wegovy.


The FDA approved the use of Ozempic in 2017 exclusively for the treatment of Type 2 diabetes. Wegovy was FDA approved in 2021 exclusively for the treatment of weight loss. Criteria for its use is based on BMI (body mass index) scores with a BMI ≥ 30 (obese) or BMI ≥ 27 (overweight); plus at least one weight-related comorbidity such as hypertension, Type 2 diabetes, or high cholesterol. These two sister drugs are prescribed with different dose recommendations but the products are the same. Both are administered by the patient themself as an injection, once a week. You may have also seen ads for Rybelsus. This drug is a tablet form of a semaglutide and is for people with Type 2 diabetes. It is taken orally on a daily basis.

How do these drugs work?

Semaglutide-based drugs are a class of medications that mimic a hormone called glucagon-like peptide-1 (GLP-1). This incretin hormone is naturally secreted by the small intestine in response to food intake. The drugs are commonly referred to as “incretin mimetics” because they mimic the effects of the body’s natural hormone. GLP-1 suppresses appetite and inhibits glucagon secretion; both functions help to keep blood sugars low. GLP-1 also stimulates the release of insulin in response to a meal (and an elevated blood sugar) and delays gastric emptying. GLP-1 also affects gut motility (the speed of food moving through your system) and also Inhibits gastric acid production and secretions, which help in the digestion of food. The incretin mimetic drugs do all of these things, as well!


You still with me?? I know that was a lot of biology but hang in there—it gets easier from here!


Cost and Side Effects:

Both have a hefty price tag (over $1000/month) and may or may not be covered under all health insurance plans. Ozempic is not covered by insurance for weight loss alone. The drugs are sensitive to ambient temperature and need to be refrigerated. With the cost comes many gastrointestinal side effects that include nausea, diarrhea, vomiting, constipation, bloating, and gas. Other side effects include pancreatitis, hypoglycemia, headache, fatigue, dizziness, and gallbladder issues. Dosages can change; your physician will adjust as needed. As with any medication, don’t compare your dose to a friend’s dose!

How do I feel about these drugs?

I have not worked with many patients that are on these drugs. I was curious about them, so I am following a Facebook group of people who are on the medication. Everyone has a different experience with them. There are no long-term studies regarding the effectiveness of keeping the weight off for the long haul . My understanding is these drugs are chronically prescribed medications. In other words, you are on them for life. Statistics demonstrate that more than 50% of individuals will regain to their baseline weight by 5 years once they revert to previous lifestyle patterns.

Bear with me for a little bit more biology! Remember, the GLP-1 drugs work by suppressing appetite—or they make you feel so sick you don’t want to eat. They slow the rate of stomach emptying and extend a feeling of fullness. Hormones work in tandem with one another to maintain homeostasis in the body. Our bodies have a natural way to tell us when to eat and when to stop; ghrelin and leptin are the hormones that control when we start to eat and when we stop. Consider it a choreographed dance between the stomach and the brain. My biggest concern with GLP-1 drugs is that they interfere with this natural, primal instinct to eat. I get nervous when we start to fool around with Mother Nature.

Skipping meals or under eating (because of the feeling of fullness) can easily lead to fatigue, as you may not be eating enough calories to sustain normal body functions. The dramatic weight loss is from calorie deprivation. Some people are exercising along with the medication use, so that requires even more calories need to be eaten. Without adequate calories, your body will seek alternative sources of energy stored in your body and that includes muscle mass. You need adequate muscle mass to support a healthy metabolism!


Many clinicians (therapists and dietitians) do worry about patients developing disordered eating patterns with these drugs. One of the comments from the Facebook group was “I miss the feeling of enjoying food.” That saddens me.

There’s no question that obesity and diabetes affect health outcomes. But, anyone going on these drugs needs to understand how they work and to team up with a registered dietitian. I am not advising you what to do, but I encourage you to make an informed decision. Work with your physician to fully understand the course of treatment ahead of you. And please meet with a registered dietitian to assess your own individual energy needs!


In good health,

Sophie



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