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Even before New Year's resolutions are made, some in the medical community are predicting that more Americans might reach their health and weight loss goals in 2024. Their confidence in the ability of people with obesity to shed pounds has been boosted by a class of injectable drugs called GLP-1 medications. Interest in these drugs is soaring as word spreads about their effectiveness.
"Unfortunately, 85% of those who work hard to diet and exercise over a long period of time, tend to fail," Juliana Simonetti, MD, co-director of the Comprehensive Weight Management Program at University of Utah Health says. "So, these medications are amazing since they address the underlying physiological cause of weight regain. I've been working in this field over the last decade, and really these results are very impressive."
Ozempic, known generically as semaglutide, was first approved in 2017 by the Food and Drug Administration (FDA) for use by adults with type 2 diabetes. But the drug's ability to trigger weight loss was already becoming apparent, Simonetti says. "As they were doing the clinical trials for the diabetes drug, they saw those patients being treated with Ozempic lost significant amounts of weight."
By 2021, the FDA had approved the drug Wegovy for long-term treatment of obesity. "It is the exact same drug as Ozempic," Simonetti says. "The treatment for weight loss just tends to call for higher doses of the medication." Both drugs have the active ingredient semaglutide. This November, the drug Zepbound, generically known as tirzepatide, won FDA approval for weight loss. It has a slightly different molecular makeup.
Zepbound went on the market this month, prompting Kyla Lara-Breitinger, MD, a cardiologist at the Mayo Clinic, to suggest that obesity drugs "are here to stay." As she told The Atlantic, "There's only going to be more and more of these drugs coming to the market."
In fact, the recent approval of Zepbound is most likely just the beginning. In comparison to semaglutides like Wegovy, which target just one hormone, GLP-1, to reduce appetite and increase fullness, Zepbound targets two. Some of the drugs in the pipeline target two and even three hormones and may be made available in pill form rather than injectables.
Simonetti hopes more competition drives drug prices down, since cost (around $1,000 per month) and lack of insurance coverage are currently preventing many who could benefit from these treatments from obtaining the medications.
"I think we really need to move toward insurance approval of more of these medications for the treatment of obesity," Simonetti says. "We have drugs now that are proven to be effective, proven to be safe, and also improve mortality and reduce cardiovascular risk. I don't see how insurance companies can continue to reject coverage of these medications for patients who really need them to improve their health."
This November, the results of an extensive study of more than 17,000 patients with obesity and heart disease were published by Novo Nordisk, the company that manufactures semaglutide drugs like Wegovy. It concluded that Wegovy reduced the risk of major cardiac events like heart attack, stroke, and even death by up to 20%, which could open up insurance coverage for more patients.
In the Comprehensive Weight Management Program at U of U Health, Simonetti and her colleagues are seeing firsthand the life-changing and possibly life-saving properties of these weight loss medications. She shared the story of a patient who went on one of the medications following years of battling obesity with no results.
"Now his glucose levels are normal, his cholesterol is under control, his blood pressure has improved, and you are like, 'This is amazing,'" Simonetti says. "For the first time in years, he has been riding his bike and doing other exercises and feels that he has control over his food choices. He told me, 'This is the healthiest I have ever been.'"
Of course, Simonetti stressed that the drugs are not the only tool her team has to work with when treating patients with obesity. That is why supervision by a medical provider when a patient is taking these weight loss medications is imperative.
"We now have a better understanding of the physiology, some of the genetics, the environment, and overall mood, depression, and anxiety," Simonetti says. "There are really a lot of factors, and the amazing thing is that we are understanding a lot more of those factors and trying to address as many of those as possible."
Simonetti does worry about people who are overweight or living with obesity who decide to take access to weight loss drugs into their own hands. Many are using so-called "med spas" to get the medications for a lower price through a compound pharmacy. "I understand how limited access to these medications, due to cost and lack of insurance coverage, can lead someone to pursue the compound pharmacy path," Simonetti says. "However, I do worry about the risk associated with use of compounded salts that have not been studied, particularly when given in combination with vitamins such as B12. We don't know if this combination can collect under the skin or if the doses given are higher, potentially causing severe side effects."
There are additional reasons why these medications should be prescribed by physicians and medical providers. People taking them should be regularly checked because there are recommendations on how to increase the doses to reduce side effects. Also, there's a need for additional dietary advice, including increasing protein intake, and guidance on exercise with resistance training to prevent muscle loss.
"With increasing weight loss, there's a potential for loss of muscle mass, which may lower someone's metabolic rate, cause leg weakness, and lead to an increase in risk of falls," Simonetti says. "This is especially concerning for older patients who may already be at an increased risk of bone fractures." The Comprehensive Weight Management Program at U of U Health is staffed with obesity medicine specialists who are experienced in prescribing these medications, addressing many of these issues and helping patients in their weight loss journey.
In the near future, Simonetti envisions much greater access to weight loss medications, along with discoveries that will lead to more effective treatment of people with obesity. "It is just such a rewarding field to be in because we are seeing just how well patients are doing, how much better they feel, and how much their quality of life is improving."
