Weight loss drugs are super popular and clearly redefining the weight loss space. I don’t think anyone will do gastric bypasses in the future as these drugs become better known and studied. And for those particularly with BMI over 30- the health risks of having so much weight are real. Reflux, high blood pressure, diabetes, strain on joints.
The players are:
- SEMAGLUTIDE: Ozempic, Wegovy. This is a mimic of a gut hormone GLP-1, which activates after people eat. It slows digestion, reduces appetite, and boosts the release of insulin/slows release of sugar from the liver. The overall effect is fewer cravings, less insulin resistance, and feeling full longer.
- TIRZEPATIDE: Mounjaro. It has two hormones: GLP-1 and GIP. This causes greater effect. It also targets the gut signaling to the brain, reducing cravings for food.
The newest kid on the block Tirzepatide (from Eli Lilly) was approved to treat Type 2 diabetes. As with many of these medications, this also contributed to weight loss. There is buzz though that Mounjaro (Tirzepatide) is even more effective than semaglutide.
Findings for Mounjaro:
- Loss of 16% of their body weight (or more than 34 pounds) over 17 months.
- In separate trials, it was shown to result in greater weight loss than semaglutide, though the results seem to be close. A head to head trial is in the works.
- It also works centrally to decrease the desire to eat.
RISKS.
There are risks. There are the usual things you hear about: diarrhea, nausea, vomiting, constipation, stomach pain. There are some studies which indicate it affects muscle mass more than fat.
- Then there are bigger more serious issues like PANCREATITIS and gallbladder issues.
- There is a potential association with THYROID TUMORS. And there is difficulty getting off the medications.
- There are many who think you need to TAKE THESE MEDICATIONS FOR LIFE. If that is the case, what is the long term effect? We don’t know yet. There is always an underbelly of medications. These medications entered the scene about 4 years ago. We do not know the negative effects, and after being in medicine for 3 decades, I will tell you there is always unintended consequences.
My thoughts?
If your BMI is high, we KNOW you have medical risks and issues. For those patients, I think this is a gamechanger and good. Where I pause is for those who are in the grey zone… Those who have 10 pounds they want to shed after pregnancy or menopause or covid. It doesn’t seem to be something you can do for a short time and get off and maintain the weight loss.
Is there a way to wean off it? Does it cause any issues long term?
Time and science will tell.