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Know what to consider before starting weight loss medication

As prescriptions for popular weight-loss medications have increased, the class of medications known as GLP-1 agonists is changing the way people think about losing weight.

Initially developed to treat type 2 diabetes, medications such as semaglutide and tirzepatide have also been shown to be effective in promoting weight loss. The US Food and Drug Administration (FDA) has now approved both drugs for treating patients with obesity, even if they do not have diabetes.

What should people consider if they want to start taking these medications? How effective are they? What are some possible side effects? Where should people get their medicines – and what places should they avoid?

To help us with these questions, we spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously served as Baltimore's health commissioner.

CNN: What should people consider when deciding whether to start these medications?

Dr. Leana Wen: Let's start with the eligibility criteria for these medications. Both semaglutide and tirzepatide are approved for two indications: type 2 diabetes and obesity. Medications approved by the FDA for use in diabetes are called Ozempic It is Mounjaro, which are the brand names of semaglutide and tirzepatide, respectively. The same medications are also approved for the treatment of obesity under the brand names Wegovy It is Zepbound.

The FDA approved Wegovy It is Zepbound for weight loss in two specific circumstances. Individuals are eligible if they are adults with a body mass index of at least 30, which is classified as obesity . Adults may also qualify if they have a BMI of 27 or greater which places them in the overweight category, if they also have at least one weight-related condition, such as diabetes, high blood pressure or high cholesterol. For Wegovy, Patients aged 12 years or older and with a BMI in the 95th percentile for age and sex are also eligible.

I want to clarify two things here. In the first place, Just because someone is eligible doesn't mean these medications are always the right options for that person . These are weekly injections that, depending on insurance coverage, can be quite expensive and therefore unaffordable for many. Additionally, some people would do well without medication and could lose enough weight with dietary changes and exercise.

Furthermore, These medications must be taken for years, possibly for life. Some studies have shown that individuals who stop medications regain most of their weight loss. It is important to note that medications should be taken in conjunction with lifestyle changes, therefore, they are not intended to be a “quick fix” for people who are not willing to improve their diet and physical fitness. These are all considerations that patients need to discuss with their doctors when deciding whether to start medications.

Secondly, it is important to emphasize that These medicines are intended to treat health problems . Obesity is a chronic medical condition that predisposes an individual to many negative health effects, including increased rates of cardiovascular disease that culminate in strokes and heart attacks. People with obesity also have higher rates of back and joint pain, sleep apnea, and depression. Medications can be of great help to patients who are obese or overweight and already diagnosed with weight-related chronic diseases. These injections are not intended for people who want to lose weight in the short term, only for cosmetic, non-medical purposes.

CNN: You mentioned Ozempic and Mounjaro. Can these medications also be used for weight loss?

Wen: The FDA-approved versions of semaglutide and tirzepatide for weight loss are called Wegovy and Zepbound. There have been shortages of these medications and doctors sometimes prescribe Ozempic in place of Wegovy and Mounjaro in place of Zepbound.

This is a practice called off-label prescribing and is permitted. If the medications are prescribed by a doctor and stocked at a legitimate pharmacy, there should be no concern as the active ingredient is the same – they are just called by different names.

Medicine with the trade name Zepbound was approved by the United States regulatory agency in November 2023

CNN: How effective are these drugs at reducing weight?

Wen: There is robust evidence in favor of the effectiveness of these medications. A seminal study on semaglutide published in The New England Journal of Medicine found that those who took the drug lost an average of 14.9% of their body weight in about a year. This decrease was significantly greater than that of the placebo group, which lost an average of 2.4% over the same period.

Weight loss may be even greater for tirzepatide. A randomized clinical trial, also published in The New England Journal of Medicinefound that those who took the highest dose of tirzepatide had a 21.4% reduction in body weight in just over a year – a much greater reduction compared to placebo at 2.5%.

One thing I want to emphasize is that All of these studies also included lifestyle changes as part of the treatment regimen. Individuals who received the medication and placebo adhered to a strict diet that had a deficit of 500 calories per day. They were also asked to exercise for at least 150 minutes per week and had access to a nutritionist or other trainer. This shows that These medications should be used alongside lifestyle changes, not in place of them.

CNN: What are some of the possible side effects?

Wen: Common side effects are gastrointestinal effects. This includes nausea, vomiting, diarrhea and constipation . Some more serious stomach problems have also been reported. The FDA said it is reviewing reports of people experiencing hair loss and suicidal thoughts while taking the drugs, although a preliminary review of clinical trial results did not reveal an association between drug use and suicidality.

Long-term side effects are not known because it is a relatively new therapy. It is also unknown whether the effectiveness may end up decreasing over time.

CNN: Are there certain medications that prevent you from taking weight loss medications at the same time?

Wen: There are some medications that may interact with semaglutide and tirzepatide, including insulins and oral diabetes medications. Dosages of these medications may need to be adjusted. There is also the question of whether medications may make oral contraceptives less effective and additional forms of contraception may be needed. And these medications are not recommended for use during pregnancy due to lack of data. These are additional reasons why it is crucial to speak with your doctor to discuss the potential benefits and risks of starting these medications.

CNN: For those interested, where should people get these medications?

Wen: These medications are prescription medications. The decision to start them should be made in consultation with a doctor. People who are considering starting these medications should talk to their doctor. This is the person who knows them best and who manages the rest of their medical care. These medications can bring enormous benefits, but they are not for everyone. The expense, possible disadvantages, and side effects must also be carefully considered.

If you and your doctor believe you should start medications, you should obtain them from the pharmacy, just as you do with other medications. The safest version of the medicine is the one made by the manufacturers, which are Novo Nordisk for semaglutide and Eli Lilly for tirzepatide.

CNN: Some pharmacies advertise that they have “generic” versions of medications. Is it safe to buy these versions?

Wen: Both Wegovy and Zepbound are patented. There are no approved generic versions of these medications.

Pharmacies that advertise that they have so-called generics are referring to a process called manipulation. This is where some pharmacies can reformulate medications and sell them. The FDA allows this process when there is a drug shortage, as is the case now. However, the agency issued warnings about the safety of compounded medicines. Medicines manufactured by manufacturers are inspected for quality, safety and effectiveness, while compounded versions are not. People may have easier access to compounded versions and they may be cheaper, but they should know that taking them carries a greater risk and they should exercise caution.

I also want to warn people against counterfeit medicines. This is a very serious problem. The FDA said it has seized thousands of counterfeit semaglutide units, and both manufacturers have warned about the danger of illegal Internet pharmacies selling counterfeit drugs.

Let me emphasize: do not buy medicines from illegal pharmacies on the Internet. Doing this is very dangerous. You don't know what's in the medicines you're buying . The dosage may be wrong, the medicine may be contaminated, and you may not even be getting the medicine you think you bought. The FDA has a site which helps consumers distinguish legitimate pharmacies from dishonest companies illegally selling unsafe medications.

Source: CNN Brasil

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