There is an almost 100% chance you have had a patient ask you about weight loss medications within the past year or two. Due to an increase in weight loss medication usage by Hollywood stars, celebrities, and social media influencers, these medications have become a hot topic. It is important to read the fine print when truly considering medication usage for weight loss versus using traditional lifestyle modifications.
What are weight loss medications?
Weight loss prescription medications promote fat tissue loss through several physiological mechanisms. The United States Food and Drug Administration (FDA) has approved 5 medications to be used for weight loss. Additionally, additional medications used to treat Type 2 Diabetes have been used to promote weight loss as well.
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist (brand names of Ozempic, Wegovy, and Liraglutide) that mimics the hormone GLP-1, which lowers blood sugars. This slows gastric emptying, regulates post-meal glucagon release, and reduces food intake. (Bocarsly 2018; Pratt 2018; Tak & Lee 2021; Bays et al 2021). Mounjaro is a Type 2 Diabetes medication similar to Ozempic, but adds an additional mechanism of the GIP receptor (glucose-dependent insulinotropic polypeptide), which assists the GLP-1 receptor agonism in body weight and glucose lowering efficacy (Garvey et al 2016; Fujioka et al 2015; Bays et al 2021; Tak & Lee 2021; Velazquez & Apovian 2018).
Other effective pharmaceuticals work in varying mechanisms to assist weight reduction. Orlistat is a pancreatic and gastric lipase inhibitor that reduces the gastric absorption of fats. Contrave improves mood with the reuptake inhibition of dopamine and norepinephrine and blocks opioid receptors that help to reduce cravings (Garvey et al 2016; Fujioka et al 2015; Tak & Lee 2021; Bays et al 2021). Qysemia acts on GABA receptors by increasing energy expenditure, reducing appetite and lipogenesis, and modifying cravings. Phentermine is still used on its own as an appetite suppressant and also increases energy expenditure (Bocarsly 2018; Pratt 2018; Tak & Lee 2021; Bays et al 2021).
What are the benefits of using weight loss medications?
Pros for weight loss medications include, you guessed it, weight loss! When other weight loss methods have not been successful, pharmaceutical treatment may be indicated. For example, Semaglutide treatment drugs have been shown to reduce body weight by an average of 10% in a 68 week trial and Phentermine/topiramate reduced weight on average by 8.6% in a 52 week trial (Tchang et al 2021). Weight loss of this magnitude may trigger improved health outcomes and quality of life. Studies show that weight loss of just 5-10% improves comorbidities including high blood pressure, high triglycerides, and high cholesterol (CDC 2023). Additionally, weight loss improves the health of patients by reducing the risk of developing other chronic conditions related to obesity like cardiovascular disease, diabetes, and mortality (Bays et al 2021). This shows the benefit of using pharmaceuticals for weight loss in those who have been unable to achieve weight loss using lifestyle modifications. Some weight loss medications may work to improve chronic conditions like diabetes by lowering blood sugar and hemoglobin A1c (Hussein et al 2020). Anecdotally, these medications may assist with improving mental health disorders like anxiety and depression but more studies need to be conducted for conclusive evidence. Weight loss medications can lead to a reduction in weight that is thought to be quicker than other lifestyle modifications including nutritional modification, physical activity, and emphasis on sleep and stress management, but it is very important to consider the drawbacks of medication usage as well.
What are the drawbacks of using weight loss medications?
Because some of these medications work to slow down the digestive tract, they may come with serious side effects like nausea, vomiting, diarrhea, constipation, new or worsening retinopathy, and pancreatitis. Other side effects of the medications include loss of appetite, insomnia, decreased absorption of fat-soluble vitamins, and dizziness (Bocslay 2018). For those with T2D and obesity, if these GLP-1 agonist medications are added to a regimen of insulin or sulfonylurea therapy there is an increased risk of hypoglycemia (Phillips and Clements 2022). We know weight loss medications can play an important role in weight reduction for some, however, the human body still requires the proper nutrients to function properly. Recent articles have indicated that stomach paralysis should be a heads-up for consumers to read and pay attention to the fine print. This is a condition affecting the nerves and muscles in your stomach that interferes with muscle activity, which moves food through your stomach and into your small intestine. Stomach paralysis can be caused by these pharmaceuticals due to slowed digestion and gastric emptying, as well as a reduction in food intake. Symptoms of stomach paralysis are acid reflux, nausea and vomiting, indigestion, bloating, loss of appetite, and upper abdominal pain (Cleveland Clinic 2023). Of course, the use of these medications should always be monitored by their physician.
It is noted that the long-term effects of these medications have not been studied, so their effects on the body and its systems are unknown. What is known is that stopping the medication has been shown to cause weight regain in patients, therefore, weekly injections may be needed to continue for sustained weight loss or blood sugar management. The process of data collection is ongoing and it is noted that medication usage should always be coupled with lifestyle modifications to improve weight and health (Bocarsly 2018; Pratt 2018; Tak & Lee 2021; Bays et al 2021).
Another con of using weight loss medications is that the cost can be a roadblock. These medications can cost anywhere from $12,000 to $15,000 a year without insurance coverage. Insurance coverage varies by provider, state, personal coverage, and specific criteria for medication usage. Additionally, these medications reduce appetite and food intake, which is beneficial for weight loss but may take away from the psychological benefits of dining with friends and family or enjoying satisfying meals. It is to be noted that weight loss medications may improve mental health, self-esteem, and self-confidence when weight is reduced. There are many factors to consider when comparing anti-obesity pharmaceuticals versus other weight loss methods including the use of meal replacements.
Can weight loss medications and meal replacement shakes be used together?
When comparing the use of weight loss medications to other lifestyle modifications, medications can seem shiny and flashy; however, due to the side effects, cost, and usage, anti-obesity pharmaceutics may not be for everyone. Patients often are in search of a quick fix, but overall it is important for patients to be well-informed of all the information surrounding weight loss medications. It is also important for patients to be prepared that medications are designed for long-term use.
It is important to note that for some insurance companies to provide coverage, one must participate in a behavior modification and nutrition program for a specific duration of time before either medication will be approved. If insurance coverage does not extend to these medications and the prescription must continue to be used long-term to achieve sustained weight loss, are they truly sustainable? Let’s compare the costs and quality of life aspects.
The average cost of a HealthWise protein supplement is $2.50. With a protocol using 4 meal replacements per day to cover breakfast, lunch, dinner, and a snack, the total cost per day would be around $10 per day. This total is very similar if not lower than the average cost of groceries in the US, which ranges from $68-$105 for males ages 19-50 according to USDA May 2023 data (USDA 2023). Lastly, the cost of weight loss medications has a wide range depending on if insurance coverage is involved. Using the cost of weight loss medications at $15,000 per year without insurance, the cost of these medications may be up to $41 per day. This cost would be in addition to the cost of food for individuals using these medications even though they often work to reduce appetite. It may be beneficial for meal replacements and protein supplements to be used in conjunction with weight loss medications to ensure nutritional needs and gaps are being filled due to appetite reduction.
Meal replacement shakes and soups can assist in weight loss by providing the body with a high amount of protein with a low amount of total calories. High levels of protein intake contribute to a sense of fullness after eating, a term deemed satiety. By allowing the body to use its hunger cues to sense that it is full, weight loss can be achieved due to an overall decrease in calories eaten (Veldhorst et al 2008). Furthermore, due to a reduction in nutritional intake, while taking anti-obesity pharmaceuticals, important nutrients including vitamins and minerals may be lost in the diet. HealthWise meal replacements like High Protein Chocolate Meal Replacement Shake are fortified to include essential vitamins and minerals including calcium, Vitamin D, potassium, iron, and vitamin D. These nutrients are critical for bone health, regulating heart rate, and carrying oxygen through the body. During weight loss, fewer calories are taken in overall, which may make it difficult to get adequate levels of micronutrients when consuming only solid foods without supplementation.
Overall a consistent healthy nutrition plan, coupled with physical activity, along with sleep and stress management may be a more sustainable option for weight loss over medication usage. A patient’s needs should be evaluated on a case-by-case basis, but due to the unknown long-term usage effects and sustainability, anti-obesity pharmaceuticals should not be the first line of treatment even for those who can afford it. The use of meal replacements, protein drinks, and whole foods through dietary modification still allows for flexibility in eating habits and joyful, sustainable weight loss.
–
Citations:
Bocarsly ME. Pharmacological interventions for obesity: current and future targets. Curr Addict Rep. 2018 Jun;5(2):202-211. doi: 10.1007/s40429-018-0204-0. Epub 2018 May 7. PMID: 30505644; PMCID: PMC6258181.
Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, Inge T, Linden BC, Mattar SG, Michalsky M, Podkameni D, Reichard KW, Stanford FC, Zeller MH, Zitsman J. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis. 2018 Jul;14(7):882-901. doi: 10.1016/j.soard.2018.03.019. Epub 2018 Mar 23. PMID: 30077361; PMCID: PMC6097871.
Tak YJ, Lee SY. Anti-Obesity Drugs: Long-Term Efficacy and Safety: An Updated Review. World J Mens Health. 2021 Apr;39(2):208-221. doi: 10.5534/wjmh.200010. Epub 2020 Mar 9. PMID: 32202085; PMCID: PMC7994651.
Bays HE, McCarthy W, Burridge K, Tondt J, Karjoo S, Christensen S, Ng J, Golden A, Davisson L, Richardson L. Obesity Algorithm eBook, presented by the Obesity Medicine Association. www.obesityalgorithm.org. 2021. https://obesitymedicine.org/obesity-algorithm/ (Accessed January 18th, 2023).
Garvey WT, Mechanick JI, Brett EM, et al.: American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract 2016 22 Suppl 3:1-203. https://www.ncbi.nlm.nih.gov/pubmed/27219496
Fujioka K. Current and emerging medications for overweight or obesity in people with comorbidities. Diabetes Obes Metab. 2015 Nov;17(11):1021-32. doi: 10.1111/dom.12502. Epub 2015 Jul 8. PMID: 26040215; PMCID: PMC4744746.
Velazquez A, Apovian CM. Updates on obesity pharmacotherapy. Ann N Y Acad Sci. 2018 Jan;1411(1):106-119. doi: 10.1111/nyas.13542. PMID: 29377198.
Tchang BG, Aras M, Kumar RB, et al. Pharmacologic Treatment of Overweight and Obesity in Adults. [Updated 2021 Aug 2]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279038/
Centers for Disease Control and Prevention. 2023. Losing Weight. Healthy Weight Nutrition and Physical Activity. Accessed July 7, 2023. https://www.cdc.gov/healthyweight/losing_weight/index.html
Hussein H, Zaccardi F, Khunti K, Davies MJ, Patsko E, Dhalwani NN, et al.. Efficacy and Tolerability of Sodium-Glucose Co-Transporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review and Network Meta-Analysis. Diabetes Obes Metab (2020) 22:1035–46. doi: 10.1111/dom.14008’
Phillips A, Clements JN. Clinical review of subcutaneous semaglutide for obesity. J Clin Pharm Ther. 2022 Feb;47(2):184-193. doi: 10.1111/jcpt.13574. Epub 2021 Dec 28. PMID: 34964141.
Cleveland Clinic. 2023. Gastroparesis. Accessed September 10, 2023. https://my.clevelandclinic.org/health/diseases/15522-gastroparesis#:~:text=What%20is%20gastroparesis%3F,and%20into%20your%20small%20intestine.
Veldhorst, M., Smeets, A., Soenen, S., Hochstenbach-Waelen, A., Hursel, R., Diepvens, K., Lejeune, M., Luscombe-Marsh, N., & Westerterp-Plantenga, M. (2008). Protein-induced satiety: effects and mechanisms of different proteins. Physiology & behavior, 94(2), 300–307. https://doi.org/10.1016/j.physbeh.2008.01.003
US Department of Agriculture. 2023. Official USDA Food Plans: Cost of Food at Home at Three Levels, U.S. Average, May 20231. Accessed August 3rd, 2023. https://www.fns.usda.gov/cnpp/usda-food-plans-cost-food-reports-monthly-reports.
–
By Katie Chapmon, MS, RD and Amanda Brainerd, MS, RD, LD, CSCS
About the Authors:
Katie Chapmon, MS, RD is a Registered Dietitian Nutritionist specializing in Bariatric Nutrition, GI Issues, and Hormonal Health and with 10+ years of hands-on clinical experience for leading medical providers. She is the proud recipient of the 2010 Recognized Young Dietitian of the Year Award and the 2018 Excellence in Weight Management Practice Award through the Academy of Nutrition and Dietetics.
She spent the first decade of her career as the bariatric nutrition lead dietitian for Kaiser Permanente Southern California. For the past several years, she has been working with industry partners and consumers to improve nutrition education within the field and maintains a virtual private practice. In April 2021, she launched Bariatric Nutrition Pro – to provide healthcare practitioners education to start (or continue!) their bariatric career with the confidence and knowledge to succeed.
She is a past Chair of the American Society of Metabolic and Bariatric Surgery Integrated Health Clinical Issues Committee and Chapter author of the 3rd Edition of the Academy of Nutrition and Dietetics Pocket Guide to Bariatric Surgery. She is a national speaker and enjoys time hiking and cooking in the kitchen.
Amanda Brainerd MS, RD, LD, CSCS is a Registered Dietitian Nutritionist specializing in weight loss, sports and exercise nutrition, and GI health. Her background includes a Masters of Nutrition and Dietetics, a Bachelor’s degree in Exercise Science, and certification as a Certified Strength and Conditioning Specialist.
By blending her expertise in nutrition and exercise, Amanda aims to support industry partners in all aspects of health and strives to help people establish dietary patterns that enable them to feel their best by applying an evidence-based, weight-inclusive approach. Amanda enjoys sharing a meal with friends and family, taking her goldendoodle on walks, and traveling around the country with her fiancé.