Weight Loss Medications – Are They Safe?

“Mindy Kaling’s weight loss secret revealed!” 

“Ozempic -The worst-kept secret in Hollywood”

Headlines across the nation have peer pressured many individuals into the world of weight loss, diets, and exercise. New trends throughout Hollywood and social media have brought countless conversations about the pros and cons of weight loss drugs to the hospital and clinic.

Many weight loss medications currently being whispered around actually began as therapies for uncontrolled Diabetes Mellitus management. Unlike Metformin which acts on the liver and mitochondria, GLP-1 agonist like Semaglutide (Ozempic) and Dulglutide (Trulicity) work through endocrine cells to secrete the hormone incretin. ^5,6In glucose homeostasis, incretin is responsible for augmenting the release of insulin after meals and stimulating a decrease in blood glucose levels.⁶ Furthermore, they have been shown to reduce appetite and food intake leading to weight loss.⁶ Other medications approved for weight loss in the United States include Bupropion-naltrexone (Contrave), Liraglutide (Saxenda), Orlistat (Xenical, Alli), and Phentermine-topiramate (Qsymia).

Who receives weight loss medications?

In order to qualify for prescription of a weight loss medication, patients must have a BMI > 30kg/m² or have a BMI of 27 – 29.9 kg/m² with weight-related comorbidities. Furthermore, patients need to try comprehensive lifestyle interventions like healthy eating and exercise to move into medication management. From there, the choice of agent is based on history, current medical diagnosis, and access. For example, Phentermine-topiramate (Qsymia) may increase the risk of fetal malformations and should be avoided in women of childbearing age.

How do you know it works?

After patients have picked which medication works best for their lifestyle and weight loss goals, their blood pressure, heart rate, and percent body weight lost are ideally monitored for 6-8 weeks. If a patient has not lost approximately 4-5% of body weight after 12 weeks of therapy on the maximum dose, then their medication must be tapered and discontinued. From there they may choose a different medication or start to discuss surgical intervention such as gastric bypass as an option.

Side Effects:

Similar to Metformin, GLP-1 agonists may cause nausea and vomiting as well as diarrhea, hypoglycemia, and anorexia.⁶ In rare cases, GLP-1 agonists may even cause pancreatitis, gall bladder disease, and renal impairment.⁶ One thing to note about medications like GLP-1 agonists is that these medications do not keep the weight off when stopped. There have been many cases of patients who have been unable to resume GLP-1 agonists due to accessibility, insurance, and availability leading to weight gain.

Business & Culture:

With the rise of pharmacy companies breaking into the health and beauty commercial arena, one telehealth subscription service has started to collaborate with other diet orientated businesses. Sequence is an online provider that prescribes users GLP-1 agonists similar to Ozempic and Trulicity to treat obesity and diabetes mellitus.⁹ On March 7, 2023 Weight Watchers (WW) acquired Sequence and launched itself into the prescription weight loss drug field.⁹ As a result, WW will broaden its resources for subscribers and will tap into the growing field of commercial healthcare. With the new collaboration between Weight Watchers and Sequence, it is interesting to see how healthcare becomes marketed with social media.

As more medications become available, more patients with co-morbidities tied to weight become easier to treat. However, as these drugs become more accessible to individuals with a higher socioeconomic status those without those advantages are stuck watching their peers fluctuate in body size. As a result, the mental toll on adolescents and young adults will impact their well-being and lead to another cultural battle.

As prescription weight loss medications become more accessible, they are also more prone to being abused. Commonly seen diet pills are classified into 3 categories: stimulants, fat inhibitors, and appetite suppressants¹⁰. Out of the 3 classes of medications, the most mistreated medications are stimulants such as phentermine, methamphetamine, and benzphetamine¹⁰. Long term dependence on stimulant based diet pills can result in pulmonary hypertension, heart disease, and insomnia¹⁰. If you, a loved one, and/or patient are abusing weight loss medications, please seek help from a substance abuse treatment near you.

References

1. The importance of language in a healthy body image | MHT. Accessed June 29, 2023. https://www.mentalhealthtoday.co.uk/blog/awareness/the-words-we-choose-to-talk-about-our-bodies-can-make-all-the-difference
2. Body image: Men suffer too | British GQ. Accessed June 29, 2023. https://www.gq-magazine.co.uk/lifestyle/article/body-image-men-suffer-too
3. Mindy Kaling’s weight loss secret revealed: See her unrecognizable transformation | HELLO! Accessed June 29, 2023. https://www.hellomagazine.com/healthandbeauty/health-and-fitness/20221221160156/mindy-kaling-weight-loss-transformation/
4. Ozempic has become a blockbuster weight loss drug : NPR. Accessed June 29, 2023. https://www.npr.org/2023/04/01/1166781510/ozempic-weight-loss-drug-big-business
5. Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia. 2017;60(9):1577. doi:10.1007/S00125-017-4342-Z
6. Collins L, Costello RA. Glucagon-like Peptide-1 Receptor Agonists. StatPearls. Published online January 13, 2023. Accessed June 29, 2023. https://www.ncbi.nlm.nih.gov/books/NBK551568/
7. Weight Loss Pills, Past and Present. Accessed June 29, 2023. https://www.everydayhealth.com/weight/weight-loss-pills-past-and-present-how-they-work-safety-and-more/
8. New Weight Loss Drugs Disrupt Long-Held Beliefs About Obesity | KQED. Accessed June 29, 2023. https://www.kqed.org/forum/2010101892196/new-weight-loss-drugs-disrupt-long-held-beliefs-about-obesity
9. Weight Watchers gets into prescription weight loss business by acquiring telehealth company Sequence – CBS News. Accessed June 29, 2023. https://www.cbsnews.com/news/weightwatchers-prescription-weight-loss-ozempic-wegovy-trulicity-sequence/
10. Diet Pill Abuse and Addiction – Carolina Center for Recovery. Accessed July 4, 2023. https://carolinacenterforrecovery.com/addiction-blog/diet-pill-abuse/