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New obesity drugs promise to conquer hunger and melt away fat, but do they work and are they right for you?
Obesity and Sleep Medicine Physician Diana M. Plata, MD, said patients should know that these medications are “strictly for the treatment of obesity.”
The injectables are covered by many commercial insurance plans but unfortunately not by Medicare, Dr. Plata said, adding that each injection can cost at least $1,000.
Here, Dr. Plata answers more questions about how these drugs treat obesity:
When someone asks you what "obesity" actually is, how do you explain it?
Obesity is a chronic, multi-factorial disease in which increased body fat mass (i.e. adipose tissue) can result in adverse downstream health consequences. It can be caused by genetic factors, adverse reactions to medications, nutritional imbalance, or an unfavorable environment.
What is "normal" weight, and who defines that?
More so than weight, Body Mass Index (BMI) is commonly used to measure obesity. A normal BMI, as defined by the World Health Organization, is 18.5-24.9 kg/m2, with slight variation for Asian populations. BMI is used as a screening tool because it generally correlates with metabolic diseases, it is easy to use and low cost. However, it does not account for muscle mass, does not distinguish health risks between men and women or different ethnicities/races. Alternative measures include percent body fat or waist circumference.
At the individual level, there is no “normal” weight. Instead, the focus should be on optimizing body composition, improving objective measures like blood sugars and cholesterol and improving quality of life through better sleep and increased energy levels.
How do weight-loss medications work?
There are multiple medications approved by the Food and Drug Administration (F.D.A) that are available for weight management, all with different mechanisms of action. These include appetite suppression, regulation of the reward system in the brain, enhancement of satiety or delayed emptying of the stomach.
What is the difference between prescription and over-the-counter weight-loss pills and supplements?
Prescription medications go through a much more rigorous review by the F.D.A. where they have to demonstrate effectiveness and safety data from clinical trials before the medication can become available to patients.
Are weight-loss pills safe to use?
Use of weight-loss medication should be done under the guidance of a physician who can explain side effect profiles, contraindications to use and drug interactions. The manufacturers of the medication also create reading materials such as medication guides that are published on the medication/manufacturer websites.
What should patients know about these weight-loss pills based on scientific data? (Belviq, Wegovy and Saxenda).
Belviq has been withdrawn from the market because a safety clinical trial showed an increased occurrence of cancer.
Wegovy and Saxenda are both injectable drugs that the F.D.A. has approved for weight loss. Wegovy is injected once a week and Saxenda daily.
Wegovy (semaglutide) works by mimicking a hormone that targets areas of the brain involved in regulating appetite and food intake. This can help you eat fewer calories, which can lead to weight loss.
Saxenda works the same was as Wegovy, by increasing feelings of being full and decreasing hunger in the brain.
In clinical trials, Wegovy showed up to 15% weight reduction in 68 weeks of use.
What categories of weight-loss medications do you prescribe most to patients, and is there a specific population each works best for?
More recently, we have seen an increase in prescriptions for glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These medications are best for patients who have diabetes. However, within this category, there are two medications that have been F.D.A. approved for the management of obesity - liraglutide and semaglutide. Clinical trials have demonstrated that these medications can safely be used to manage obesity even in patients without diabetes.
At what rate does the average patient tend to lose weight while on weight-loss medication?
Patients can experience up to 15% total body weight loss in just over a year. Generally speaking, we don’t encourage more than 0.5-1 pound of weight loss per week.
Are there benefits of continuing weight-loss medication?
Due to the chronic, relapsing nature of obesity, these medications can be used chronically for maintenance at the lowest effective doses as long as the side effects are tolerable.
How might someone know when to stop using a weight-loss medication, and what typically happens when they do stop using it?
There are situations in which patients have reached their personal health goals and may consider stopping these medications. This should always be done under the supervision of a physician. We work with our patients during weight loss to improve any imbalances in nutritional and physical activity and these changes can help to prevent weight regain after discontinuation of these medications.
If a loved one has not had success with diet and exercise to lose weight and asks, “Should I take a weight-loss pill?” what would you say?
A weight-loss medication is something that can be considered but should be discussed with and monitored by their physician. This requires review of the person’s overall history including medical history, family history, and medication history to determine if/or which medication would be appropriate and safe.
For more information about obesity and NorthShore’s weight loss programs, visit our Medical Weight Loss Clinic or our Bariatric services.