How they work and how we couple them with lifestyle change at Northeast Medical Practice
Obesity is becoming an epidemic in the United States and many Western societies. More than 42% of Americans are obese. This increases to more than 66% if overweight is also considered. The treatment of elevated weight involves several “pillars.” These include proper diet, physical activity, sleep, and management of stress. In our practice, we focus on lifestyle as the foundation, with medication as a valuable additional tool.
As an internal medicine physician who is also board certified in obesity medicine, my patients often ask me about the newest weight loss medications. There is a great deal of buzz in the media regarding these drugs. I would like to take a moment to discuss two of the most powerful anti-obesity therapies currently available: Wegovy® and Zepbound®.
How do they work?
Wegovy® is the version of semaglutide that is FDA approved to treat obesity. For patients with diabetes, the medication is branded as Ozempic®. It works by stimulating a receptor called GLP-1, which is located in the gastrointestinal tract as well as the brain. In the gut, it slows down the digestive process. Therefore, you stay full longer. In the hypothalamus, the medication causes satiety. Through these effects, appetite is suppressed. Zepbound® is the FDA approved version of tirzepatide for weight loss (branded as Mounjaro® for patients with diabetes). It works in a similar fashion but stimulates two receptors (GLP-1 and GIP).
What are common side effects?
Due to the slowing of gastric emptying, the most common side effects are constipation and nausea. Rarely, as these medications are active in the pancreas to help increase insulin secretion, pancreatitis (inflammation of the pancreas) can occur. In general, these medications are well tolerated. The dose is also slowly increased over time to help decrease the likelihood of side effects. Please bear in mind that my comments in this article are for educational purposes only. Do not hesitate to speak with your medical provider regarding whether these medications are appropriate for you.
How much weight can you lose?
These medications have been real game changers in the treatment of obesity. Prior oral medications have generally been able to achieve about 10% body weight loss. Wegovy® typically causes around 15% decrease in body weight. In trials with Zepbound®, patients often lost more than 20% of their weight. Bear in mind that the range of weight loss on any medication is broad, and a small percentage of patients do not lose weight on these drugs.
How long do you need to take these medications?
My patients frequently ask how long they will need to take a weight loss medication. Obesity has been considered a chronic disease since 2013. I often use hypertension as a comparison. Let’s say that a patient comes to me with elevated blood pressure, and we cannot control it with lifestyle changes. I will then recommend that we start an antihypertensive. When the blood pressure is controlled, we do not celebrate and stop the medication. We continue the medicine unless the blood pressure begins to decrease due to improvement in lifestyle. Unfortunately, many patients are not able to make the necessary changes and are thus treated with an antihypertensive long term. In order to stop a weight loss medication, or perhaps decrease the dose, significant improvements in diet, exercise, sleep, and control of stress are required. Due to a variety of endocrine issues that result from obesity, weight regain after stopping medication is very likely. These medications are very powerful tools in the toolbox of obesity treatment. However, I cannot stress enough the importance of lifestyle change for patients on this journey.
Where to seek treatment?
It is also important to work with a clinician who is trained in the treatment of obesity. Our goal, whether with improved lifestyle alone or coupled with medication, is to reduce body fat. However, especially with rapid weight loss, it is likely that a patient will also lose muscle mass. Tracking body composition, and adjusting protein intake and strength training, are very important to prevent loss of lean mass.
Final thoughts
Obesity is not just an aesthetic issue, although stigma and bias can certainly impact a person’s self-confidence. It is strongly associated with many chronic illnesses, including hypertension, elevated cholesterol, diabetes, cardiovascular disease, and cancer. Acknowledgement of elevated weight as a chronic disease is opening our eyes to the true value of treatment. If you have an issue with your weight, please do not hesitate to reach out to us at Northeast Medical Practice. We are here to guide you on your weight loss journey. Appointments can be booked at www.northeastmedicalpractice.com or 516-604-3418.
