Listen to this articleWeight loss medication is having a moment, as the development of a new drug in recent years resulted in an explosion of interest in the treatment, especially on social media. It comes on the heels of a boom in bariatric surgery, which experienced a similar trajectory in the years prior.
“Bariatric surgery has been around since the 1960s, and it gained increased popularity in the 1990s and early 2000s,” says Dr. Iman Saleh, director of Obesity Medicine in the Department of Bariatric Surgery at South Shore University Hospital. “It has [recently] been used by many patients to lose weight due to increased safety and efficacy,” she says, indicating the rise of obesity among both adolescents and adults as a cause for growing demand for the surgery.
After receiving FDA approval, Semaglutide, developed by Danish multinational pharmaceutical company Novo Nordisk and sold under the names Ozempic and Wegovy, was first marketed in 2017 for treating type 2 diabetes. It belongs to a class of drugs known as GLP-1 agonists—medications that affect glucagon-like peptides (or GLPs) to control blood sugar levels.
However, after clinical trials revealed semaglutide reliably caused weight loss, Wegovy gained FDA approval for use as a weight loss medication, leading to its marketing on a much larger scale.
“[It is] the perfect storm of several factors working together to create an unprecedented demand,” explains Konstantinos Spaniolas, M.D., chief, division of Bariatric, Foregut and Advanced GI Surgery at Stony Brook Medicine and director of the Stony Brook Bariatric and Metabolic Weight Loss Center in Centereach. “More than 70% of the population has excess weight, and recent data from the CDC shows that more than 41% of adults are obese,” he says.
The robust marketing campaigns for GLP-1 medications has been a major factor in their popularity, Spaniolas adds. “There is a huge social media frenzy for these medications, fueled by record high ad spending by drug companies, [totaling] $1 billion in 2023 alone.”
Patients have embraced these medications in response. “They have become popular because it has given patients another non-surgical option for substantial weight loss without the risks and complications of surgery,” explains Saleh. “They have been also used by patients who have had bariatric surgery and need to lose more weight or maintain the weight they have lost.”
Additionally, the drug has been shown to reduce the risk of heart problems for some. “Recently, Wegovy has been approved to help prevent life-threatening cardiovascular events such as stroke, heart attacks or cardiovascular deaths on overweight or obese patients, or adults with cardiovascular disease, which has made it even more popular,” Saleh says.
Though the adoption of the new medications for weight loss has accelerated, the guidelines for prescribing these drugs aren’t necessarily as liberal.
The current indications for GLP-1 medications, or factors that justify the recommendation of their use, include type II diabetes, obesity with a body mass index (BMI) of 30 or above, patients who are overweight with a body mass index of at least 27 who are also diabetic and/or suffer from hypertension, and patients with an established cardiovascular disease.
Nevertheless, thanks to media interest and the endorsement of several celebrities, such drugs have gained widespread acceptance, with or without medical supervision, sometimes outside of the recommended criteria for use. And as with any pharmaceutical intervention, taking these drugs comes with potential side effects, whether they are used off-label, or under the direction of a doctor.
“One of the more common side effects patients will have is nausea and vomiting, because (the drug) slows down the rate at which food leaves the stomach and enters the small intestine,” says Dr. Charles Thompson, III, advanced robotic and bariatric surgeon at Mount Sinai South Nassau in Oceanside.
There are still more serious potential risks for patients. “Another common side effect is the potential for pancreatitis or cholecystitis,” notes Thompson, referring to inflammation or infection of the pancreas and gallbladder.
There are also some patients for whom weight loss medications are deemed too risky, because the use of medications that affect GLPs can potentially lead to medullary thyroid cancer. “If a patient has had thyroid cancer, or has a history of thyroid cancer in their family, these types of medication are contraindicated,” says Thompson. “When researching these medications, the risk of thyroid cancer was only seen in mice trials. Even so, the FDA would like all healthcare providers to let patients know of the possibility of [developing] thyroid cancer if these medications are used.”
Spaniolas notes the importance of a multidisciplinary program, including supervision and nutritional counseling, to ensure better outcomes when taking weight loss medication. “When the medications do work, if we don’t follow appropriate nutritional recommendations, with high protein foods and increased physical activity, there is a significant risk that a patient will lose valuable muscle mass during the weight loss,” he says.
This type of caution is imperative to administering such medications, Spaniolas asserts. “When [the public] uses GLP1 medications off-label, they often use non-traditional ways to obtain such medications,” he says. “There are well publicized risks with using online vendors and compounding pharmacies or clinics, with some serious risks for the individual.”
While many treatments have come and gone in the past, these weight loss medications are trusted in the medical community, and will probably be around for a while, according to many. “GLP-1 agonists are here to stay. This isn’t a ‘fad’ medication, it is a good medication for patients who need to lose weight,” says Thomson.
He warns, however, that the best outcomes are contingent on how they are administered. “Like all medications, the effectiveness of the medication relies on patient adherence. If [a patient] stops, or is not very consistent with their weight loss medication, their weight loss will stop as well, and they will gain back the weight they had previously lost,” he says. “As with any medication, patients will need to be very adherent to their medication schedule for their treatment to be effective.”