Life Changing Weight Loss Drugs: Are They Worth It?
Kelly Parcell
Posted On:
May 31, 2024
Most patients who come to see me are looking to prevent taking medications for their health concerns. Whether it be high cholesterol, heart disease, or osteoporosis, they want to do anything they can to avoid having to take medication. Medications that have been in the pharmaceutical industry and used on the world’s population for decades, such as Synthroid, Lisinopril, Rosuvastatin, and Metformin are simple medications with minimal side effects that have been demonstrated to prevent disease progression. Yet because they are pharmaceuticals, people are afraid of them.
The Lure of Weight Loss Drugs
When it comes to weight loss, it’s a different story. Women come in to see me wondering if the medications they are reading about on the internet are safe for them to use. They often have taken the ‘healthy diet’ route and it was too hard, and did not result in enough weight loss. They want more. They want a quick fix. Even if it means injecting themselves with medications that have very little time-tested data in human use.
Surgery for Obesity
Prior to 1985, obesity was thought to be a result of lifestyle choices. In 2013, the American Medical Society recognized it as a chronic disease. There is a big difference between obesity and being overweight. Obesity is defined as having too much body fat. Being overweight is simply weighing too much. In conventional medicine the most successful weight loss strategies for obesity have been bariatric surgery (reducing the size of the stomach), which causes people to feel full faster as well as causing an inability to eat large volumes of food. Surgery has proven to be successful and lucrative over time. So, since the American Medical Society has determined that obesity is a chronic disease which has been treated successfully with surgical interventions that result in lifestyle practices which then reverse it, is it still truly a ‘disease’?
Obesity Medicine
The practice of medicine that involves weight loss is called bariatrics or obesity medicine. The drug companies also have had a hand in this arena of medicine. Up to this point, drug therapy approaches have been geared largely towards increasing energy expenditure by increasing the metabolic rate. Medications such as Amphetamines, caffeine, and others that increase dopamine and norepinephrine have been used for decades. Weight loss drugs up to this point in time have largely focused on affecting energy expenditure such as stimulants.
In 2017, the drug industry released Ozempic for the use of Type 2 Diabetes. Four years later, in 2021 the FDA expanded the approval of Semaglutide to include the treatment of persons who are obese or who are overweight and have a weight-related condition, such as hypertension (high blood pressure), or hypercholesterolemia (high cholesterol). As an anti-obesity treatment, the drug was marketed as Wegovy.
Are Obesity Medicines Like Ozempic Safe?
Now that these medications have been approved and on the market for a certain amount of time, there are compounding pharmacies legally making them available as their active ingredients and typically with B6 added. These products are called Semaglutide (Ozempic/Wygovy) and Tirzeptide (Mounjaro) and are injectables. It is legal for pharmacies to make these products and it is legal to use these products for weight loss, however, patients must pay out of pocket for them in this form. Insurance only pays for the patented products with a medical necessity and diagnosis of uncontrolled Type 2 Diabetes. Wygovy is an exception, however it is unbelievably expensive and very difficult to get.
Comparing Ozempic vs Mounjaro
How Do Weight Loss Drugs Work?
Semaglutides are glucagon-like peptide-1 (GLP-1) receptor agonists which control blood sugar levels. It affects the appetite centers of the brain to reduce hunger and increases the feeling of fullness. This feeling of fullness occurs because the function of the stomach slows down (gastroparesis). Typical dosing includes weekly injections.
Tirzepitides have two mechanisms of action: they are a glucose dependent insulinotropic polypeptide (GIP) and a GLP-1 agonist.
GLP-1 receptors are in the pancreas and in the central nervous system. They are the receptors that when stimulated, release insulin. They also cause reduced appetite and slow gastric emptying.
Insulin is what regulates blood glucose. Insulin is also a pro-inflammatory hormone. When you eat, GIP is secreted, and this stimulates insulin secretion. GIP has been shown to cause people to be fat and make fat cells. Although it has long been considered the ‘obese hormone’, when this is used with GLP-1 it exerts a more comprehensive and beneficial effect on fat metabolism and insulin control eliciting weight loss. It does not affect food intake and eating behaviors like GLP1 does. GIP action on the brain regarding inflammation is still under investigation and I believe we will see its benefits in neurodegenerative diseases such as Parkinsons and Alzheimer’s disease.
There may be added benefits of these peptides, such as decreased inflammation in the brain and prevention of heart disease, but these medications are new and have only been used on the population since 2017.
Side Effects of Weight Loss Medications
More serious side effects of both Semaglutides and Tirzepitides have been reported and include acute kidney injury, GB problems, pancreatitis, and risk of thyroid cancer. Common side effects are nausea, vomiting, diarrhea, tummy pain, and constipation. Loss of muscle mass and gastroparesis are the two most concerning/common side effects that I have seen in my practice. It is important to avoid alcohol, grapefruit, caffeine, and high fat foods when using these products. These are injections, so pain and discomfort along with side effects that come with injections are also something to be considered.
Regaining weight is common after the use of these medications. In particular, I have seen women feeling happy about the weight loss, but unhappy about the loss of muscle mass while on these medications.
There are always unwanted side effects of short cuts like weight loss drugs. These medications are short cuts and they do work most of the time, but they will come with side effects and rebound health consequences. Although there are ways to minimize these unwanted side effects and to optimize outcomes for patients coming off of these injectable weight loss drugs, there is no doubt about it, the safest way to lose weight long term and keep it off is through diet and lifestyle.
A Naturopathic Approach to Weight Loss and Associated Medicines
Relying on pharmaceuticals without addressing underlying factors that cause weight gain or rebound weight gain is trouble. The key to successful weight management while taking these medications is to employ good dietary and lifestyle practices. Surgery and pharmaceuticals are financially rewarding to doctors and the drug companies; however, they are not patient centered therapies.
Patients who want alternatives to these medications hope they can reverse the imbalance in their health and live long without any medications. They are right to seek this out. There is an answer. Diet and lifestyle practices are the key to reversing and preventing many of the diseases of aging such as obesity, heart disease, Type 2 Diabetes, and high blood pressure. Lifestyle changes are the gold standard and the most difficult to execute. You are in control of your health. It all starts with what you put in your mouth and what you do each day. That is why my approach to weight loss education for women who are on these products is so successful long term. I provide a plan for women to use during their use of these medications and then when they come off of the medications.
As a Naturopathic doctor, I am an expert in diet and lifestyle management, exercise prescription, and knowledge of natural alternatives to prescription drugs of all types. All of my patients get advice in these areas during their visit. Of course, with a keen knowledge in the safety and efficacy of prescription drugs and their appropriate application, it is understandable that women come to see me for advice on this as most women do not want to be on medications. The weight loss medications that are peptides, such as Semaglutides, Tirzepatides, and others, have their place. When it is necessary, I offer women an understanding of how to use these medications along with their lifestyle practices that will set them up for long term success. Doctor as teacher (Docere) is one of my favorite Naturopathic principles and greatest tools for women to achieve optimal health.