What’s New for Weight Loss …
Plenty and this could be a game changer
Losing weight- just about everyone wants to do that, especially with the obesity epidemic in the US being what it is. According to the National Health and Nutrition Examination Survey (NHANES), about 32 % of the US is overweight, and about 40% of the US population is obese. By the way, overweight corresponds to a Body Mass Index ( BMI) of 25–30 and obese is a BMI over 30. Don’t know your BMI? Just get your height and weight and plug them into this calculator.
About 40% of the US adults are obese and 32 % are overweight.
So at some point in time, most of us have done our level best to lose some weight, for any of a number of reasons. It is a daunting process, fraught with frustration and the dreaded yo-yo syndrome- lose 10 pounds, gain back 20. Ouch!
Consequently, the weight loss industry is a multimillion-dollar empire, or perhaps even in the billions for all I know.
So let me put a stake in the ground and say flat out that the over-the-counter medications that are hawked for weight loss can be dangerous to your health and I never recommend them to my patients. Never ever.
Why? Many of them have high amounts of caffeine, which is a diuretic. And others contain a variety of stimulants which although “natural”, can still be dangerous to your health by causing palpitations, elevated blood pressure, and insomnia, just to name a few. As I tell patients, water is natural too but too much of it can kill you nonetheless.
So, what about FDA-approved meds? Well, until recently, that was a problem. The phen/fens of the world and others were never meant for long-term use. Most of those meds are also stimulants with the same noxious effects I mentioned above. Weight loss was modest and many times once patients stopped them because you can’t be on them forever, the weight came right back.
Most of the over the counter weight loss drugs, and the
FDA approved meds are not meant for long term use and
can have deleterious effects on your health.
For over 20 years now, bariatric surgery ( gastric bypass or gastric sleeve surgery) has played a role in only the most severe cases. Usually, you need to be at least 100 pounds overweight for approval; some insurances will cover it if you are 50 pounds overweight and have at least one other weight-related disease like diabetes or high blood pressure. So, not a solution for everyone and is certainly only used in the most serious of cases. And yes, I have seen patients get a gastric bypass and learn how to “graze” all day long and not lose weight. Hard to believe but true.
And then came ………
GLP 1 Receptor Agonist Drugs
What are GLP 1 Receptor Agonist Drugs?
The first thing to know is that these drugs were invented to help control diabetes, not to help patients control their weight. But, a beneficial side effect has indeed been weight loss with these meds.
How much weight are we talking about?
Depending on which one you take, anywhere from 10 to about 30 pounds. Remember, if you lose 5% of your body weight, you reduce your risk of diabetes by 58%. So if you are 200 pounds and lose 5% or 10 pounds, no more phone calls, we have a winner. You just did something outstanding for your health.
So why am I so excited about these meds? Because, unlike prior medications, they are approved for long-term maintenance use, just like they would be in diabetes. We know that when people stop meds, the weight comes back. So we could now treat obesity as a chronic illness, just like high blood pressure, etc.
Lose 5% of your body weight and drop your risk of diabetes by 58%
So how do GLP 1 Receptor Agonists work ( GLP1RA)?
GLP 1 stands for Glucagon Like Protein. This is a substance that we all make in our intestines, and it has many effects. Besides managing the release of insulin from the pancreas, GLP1 also regulates the emptying of the stomach and tends to make us feel full sooner and empty our stomachs slower.
Bingo- fuller faster, fuller longer, eat less, lose weight.
So these drugs are synthetic versions of GLP and stimulate the same receptors of the gut etc and cause the same effects as GLP that we make would do to us.
What are some of the current drugs on the market that are GLP1RA’s?
Here is a partial list: ( Generic/ Brand)
- Dulaglutide (Trulicity)
- Exenatide extended release (Bydureon
- Semaglutide (Ozempic)
- Exenatide (Byetta)
- Liraglutide (Victoza or Saxenda)
- Semaglutide (Rybelsus)
One drawback- most of those are injectable, but many just once a week. The last one is available in oral form.
Coming soon is the one I think will be a game changer, called Tirzepatide (Mounjaro). This is a cousin of the above and is called a Glucose Dependent Insulinotropic Polypeptide/Glucagon Like Protein Receptor Agonist ( say that three times fast!). I won’t go into the additional mechanism of action, but in a study published in the respected New England Journal of Medicine, it showed favorable results even at 72 weeks. Patients lost up to 20 percent of their body weight during the study- if you were 200 pounds you would now be a svelte 160. That is pretty remarkable.
This drug is not approved for weight loss yet, but I suspect it will be shortly. Currently, it is only indicated for diabetes.
So who should not take a GLP1RA?
Don’t take a GLP1RA if you have :
-A personal or family history of Pancreatic cancer or medullary thyroid cancer or Multiple Endocrine Neoplasia Syndrome or
A prior personal history of pancreatitis
Weight loss is a multistep process and ideally should be incorporated with an exercise program. Check with your doctor before beginning any exercise regime.
Some caveats about exercise-
- start slow and slowly increase your aerobic activity every week or two
- ideally, you should have 150 minutes of aerobic exercise a week to achieve cardiac benefits
- Walking is fine, but it should be a “Honey we’re late for the plane” walk and not a “let's see what’s on sale at Nordstrom’s walk”
- You can’t out exercise a bad diet. The foundation of weight loss is limiting what you put in your body. Exercise is a turbo booster to the process.
I hope you found this information useful. I wish you luck with your lifestyle change.
Remember- the information I present is for your information only, and should not be used to diagnose or treat any medical condition. You should seek medical care from a qualified medical doctor.
Disclaimer- the words and opinions expressed are the author’s and his alone, and not those of his employer.
This article first appeared on MedUpdate on Substack.
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Reference for NEJM article
Jastreboff AM et al; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205–216. doi: 10.1056/NEJMoa2206038. Epub 2022 Jun 4. PMID: 35658024.
