Weight-Loss Drugs: What to Know Now
Apr 05, 2023 Cassie Tomlin
Awareness of the latest weight-loss medications is steadily increasing, and more people are taking them. But semaglutide and tirzepatide—which also treat Type 2 diabetes and are sold under the brand names Ozempic, Wegovy and Mounjaro—aren’t meant to be taken by those who are simply hoping to slim down for summer. They are used to treat obesity, a chronic disease that puts people at risk for other conditions, such as heart disease and certain cancers.
Nearly 40% of U.S. adults are living with obesity, but only 1% of patients who qualify for weight-management drugs take them, says Dr. Amanda Velazquez, director of Obesity Medicine at Cedars-Sinai.
"Obesity is a disease that merits treatment like any other disease, and we know that treating it has many downstream effects that lead to improved health."
Here’s what you should know about the latest weight-management medications, including how they work and who can consider taking them.
What is the history of this new class of weight-management medications?
Dr. Amanda Velazquez: These drugs, GLP-1 receptor agonists, have been used to treat Type 2 diabetes—and have been used off-label to treat obesity—for more than a decade. These self-administered weekly injections improve insulin sensitivity and target the GLP-1 hormones in the gut and brain to reduce appetite.
GLP-1 receptor agonists have become more mainstream since summer 2021, when the U.S. Food and Drug Administration approved the use of Wegovy (semaglutide 2.4 mg) for weight management. Wegovy has been found to help people lose 16% of their total body weight in about a year. Depending on the dose that is prescribed, Ozempic (semaglutide, but at a lower dose than Wegovy) can achieve nearly the same result.
Mounjaro (tirzepatide) is a slightly different drug that targets two gut hormones, which facilitates greater weight loss at an average of 20% of a person’s body weight in about a year.
Amanda Velazquez, MD
Amanda Velazquez, MD
Who qualifies to take these drugs for weight management?
AV: Anyone with a body mass index (BMI) of 30, or a BMI of 27 to 29.9 with a weight-associated medical condition, can qualify. At the Cedars-Sinai Center for Weight Management and Metabolic Health, we fight for every single patient, no matter where they are on the scale of obesity.
But we do prioritize patients who are high risk and very medically complex, like those who are awaiting transplant and cannot get on a list for an organ before losing weight, or patients who experience weight gain after cancer treatment. And for patients with severe forms of diabetes, these drugs can help them regain kidney function and quality of life.
Are people who do not have obesity abusing these drugs?
AV: I suspect that a very small minority of individuals are using these drugs for cosmetic purposes, and it’s become sensationalized. The attention on the small instances of misuse is taking focus away from the importance of these medications as a tool for populations who are very much in need.
These are effective, safe drugs that help individuals with obesity improve their medical state and potentially live longer, healthier lives.
How long do people need to stay on weight-management drugs?
AV: Studies show that when people stop taking these drugs, they gain the weight back. For the most part, obesity is a chronic disease a person will have for life. These drugs are not designed to give you a boost in willpower so you can figure out the rest on your own.
When I prescribe these drugs, I explain that they act to calm the biological pressures trying to force your body to be at a higher weight. If you take away that tool, even though you’ve implemented a wonderful diet and exercise program, your body will go back to its previous weight. There are individuals who can get off these medications and stay healthy, but they’re the rare exception.
Will these drugs work for anyone with obesity?
AV: For patients with severe obesity—a BMI of 40 or greater—and for patients with a BMI of 35 or greater with weight-related medical conditions such as diabetes, high blood pressure or obstructive sleep apnea, we highly recommend bariatric surgery. It’s the mainstay treatment and the best tool we have to reduce morbidity and mortality. In some instances, we consider both pathways for patients. Like any medication, we don’t know how people will respond, and not all drugs work for everybody.
What should patients do if they are interested in taking weight-management drugs?
AV: When someone is concerned about their weight, I encourage them to get informed about available weight-management treatments and make an appointment with their primary care doctor specifically to ask which path is right for them.
A healthy lifestyle should always be the foundation for obesity treatment, but wider access to medications is greatly needed. I hope the increased awareness of weight-management medications will catapult our healthcare system in that direction. Obesity is a disease that merits treatment like any other disease, and we know that treating it has many downstream effects that lead to improved health.