Long-term weight loss is a hot topic. About half of adults in the U.S. are trying to lose weight in any given year. More than 2 out of 5 U.S. adults are obese, and 43% of adults worldwide are overweight.
Contrary to the mainstream belief that reducing caloric intake and exercise are the staples to shedding pounds, recent studies have found that hormonal imbalances frequently lead to overeating and inefficient fat storage. While traditional weight loss strategies are less effective in this case, newly developed, promising GLP-1 Receptor Agonist medications, the most famous being Ozempic, give hope to addressing underlying metabolic issues.
Still life closeup of the big three injectable prescription weight loss medicines. Ozempic, Victoza … [+]
UCG/Universal Images Group via Getty Images
These drugs are huge in the market right now. Health care providers wrote more than 9 million prescriptions for Ozempic and similar drugs in the final three months of 2022. J.P. Morgan Research predicts that 30 million people will use GLP-1 Receptor Agonist medications by 2030.
Dr. Deepa Macha has found benefits, and risks, to using Ozempic and similar drugs in her clinical … [+]
Photo by Marvin Shaouni
While Dr. Deepa Macha has been helping patients in Ann Arbor, Michigan with medical weight loss for nearly a decade, she has been prescribing GLP-1 RA medications for the last two years. Her clinic, CosMedic LaserMD, treats hundreds of patients a year for hormonal imbalances and weight loss. “Being overweight may not be your fault,” Dr. Macha tells her patients. “There is a lot of genetic propensity to obesity.” She’s found that, in many cases, diet and exercise are just not enough. “Pathways in our brains genetically predispose some people to be obese.”
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Dr. Macha has found prescribing glucagon-like peptide-1 receptor agonists (GLP-1 RA/GIP RA’s) such as Wegovy and Ozempic (semaglutide) or Mounjaro and Zepbound (Tirzepatide) incredibly effective in controlling weight. While traditionally used to treat Type-2 Diabetes, these drugs have also been found to increase insulin secretion, lower blood glucose levels, modulate hormonal pathways and improve metabolic health, slowing down gastric emptying and suppressing appetite. They are now prescribed frequently for long term weight loss, both on label and off label.
The most effective strategy?
Dr. Layne Norton, says an exercise regimen will help maintain muscle and bone mass and other lasting … [+]
Courtesy of Layne Norton
“Resistance training…alongside GLP-1 RA’s will be very important. It is not a choice of drugs or lifestyle, it should be drugs AND lifestyle.” According to Dr. Layne Norton, physique coach, powerlifter and founder of Biolayne, based in Tampa, Florida, this regimen will help maintain muscle and bone mass and other lasting benefits.
These medications have changed the landscape of how we treat obesity, reducing the need for bariatric surgery by 25%. “This transformation extends beyond physical changes, affecting a person’s sense of self and how they show up in the world, bringing a profound sense of lightness to both body and soul,” states Dr. Macha. “GLP-1 RA mimetics are the most effective fat loss tools ever to be brought to market. In research studies, people consistently reduce their body weight by 10-20% on average & maintain that weight loss so long as they maintain their drug regimen,” adds Dr. Layne Norton. GLP-1 RA’s are FDA approved for weight loss in patients with elevated BMI of 30, or those with BMI 27 with comorbidity (Type 2 DM and CVD).
Off label uses for LP-1 Receptor Agonist medications include:
- Perimenopausal Women
- Individuals with/or prone to Heart Disease and Strokes
- Managing food addiction and cravings
- Emotional eating
Dr. Jason Fung, New York Times-bestselling author and nephrologist, explains that GLP-1’s like … [+]
Photo by Dean Macdonnell
Dr. Jason Fung, Toronto-based New York Times-bestselling author and nephrologist, explains that “GLP-1’s are particularly useful in their ability to curb cravings associated with food addiction, especially ultra processed foods.”
Why are LP-1 Receptor Agonist medications so effective?
“They affect human physiology at multiple levels – in the stomach, by slowing gastric emptying, and directly affecting the areas in the brain responsible for eating behavior,” according to Dr. Fung. According to NovoNordisk’s STEP 1 study published in the New England Journal of Medicine, participants using GLP-1 medications (i.e., semaglutide) experienced a 14.9% reduction in body weight over 68 weeks, compared to 2.4% in the placebo group (Wilding, et al. NEJM. 2021).
Dr. Macha shared that her patient, 72-year-old Phillip has been able to walk all the way to his mailbox without stopping since he started taking medication. He’s also lost over a hundred pounds. Allison, a 50-year-old menopausal divorcee, lost 76 lbs, and has started yoga, hiking, and dating with a new sense of self esteem. Quality of life changes beyond weight loss cannot be overstated.
Dr. Deepa Macha started researching Ozempic and similar drugs when she herself experienced weight … [+]
Photo by by Marvin Shaouni
Dr. Macha did research on weight loss and GLP-1 RA’s when she started going through perimenopause. She found that in her case, a lack of estrogen combined with stress on her body was causing an increase in inflammation and belly fat, and difficulty losing weight. “These hormonal issues increase weight in perimenopausal women and further increase our risk for heart disease and stroke,” she adds.
The FDA recently included a warning label that these drugs can cause intestinal blockages.
The FDA has also received hundreds of reports of suicidal ideation in patients taking these drugs. While many patients face side effects such as nausea, vomiting, diarrhea, constipation, bloating, and fatigue, plaintiffs in class-action lawsuits against these companies say that the manufacturers hid many more serious side effects, including kidney injury, gallbladder injury, pancreatitis, and depression. While Dr. Macha has rarely had to suspend use in patients with severe side effects, she thinks that stereotypes about obese people are leading to all this negative press. She claims that following patients closely in office with close monitoring has circumvented most adverse effects.
“It’s time we stop the judgment. It’s just not fair to fat shame people and make them feel like it’s their fault. It’s really time to start understanding that some of these things are beyond their control. It comes down to how genetically wired certain people are in their brain pathways,” said Dr. Macha.
Unfortunately, “there is a high potential for abuse in patients that just want to lose just a couple of pounds,” adds Dr. Macha. Widespread availability through mail-order and websites raise concerns about safety and legitimacy. She recommends consulting with a professional healthcare provider who knows how to assess labs and diagnose comorbidities and performs proper medical evaluations while patients undergo treatment. Monthly check-ins for accountability on lifestyle changes in diet (such as intermittent fasting) and increase in exercise (preferably incorporating resistance training), addressing emotional and psychological wellbeing and adequate protein intake despite reduced caloric intake.
These drugs are not for everyone.
Patients who are pregnant or planning to be, planning a major surgery, have a history of pancreatitis, thyroid medullary carcinoma, Multiple Endocrine Neoplasia Type 2, gallbladder disease or a history of gastroparesis should not be on these medications. They are also very expensive, and frequently not covered by insurance. Yet their use is on the rise.
Many patients find these drugs to be life changing. Dr. Macha reflects, “We have the most obese nation in the world. For the first time ever, we’re able to offer people something that can actually improve their quality of life. That is the magic that this class of drugs has been able to offer people.”