October 13, 2023
A friend of mine recently began a weekly regimen of injectable weight loss medications. On multiple occasions, she confidently declared, “I don’t need to worry about what I eat or track my activities anymore! This injection will effortlessly shed those extra kilos for me.”
Never mind that it doesn’t work that way- these weight loss medications don’t work as a magic fix. While they may help you shed some pounds, they won’t address the root cause of the problem that made you gain weight – unhealthy lifestyle choices. This sets individuals on a cyclic journey of deprivation, celebration, and regression.
This cycle typically starts with deprivation, where people restrict their food intake while relying on medication to create a sense of fullness. Once they see initial results, they celebrate their progress and often discontinue the medication. Unfortunately, without adopting new eating habits during this process, they gradually fall back into their old routines, piling up the lost weight.
My friend’s tendency to overindulge raises a pertinent question: Is it responsible to start weight loss medication without emphasizing lifestyle changes? The answer lies in the fact that there’s no magic pill capable of effective weight loss while maintaining unhealthy lifestyle choices. It’s essential to understand that medication can be a tool, but lasting results hinge on a commitment to altering one’s lifestyle for the better.
We are in an exciting era of new and emerging weight management medications that can facilitate impressive weight loss. A weekly injection that leads to dramatic weight loss without serious side effects sounds too good to be true.
Over the past decade, injectable diabetes drugs such as dulaglutide (Trulicity), liraglutide (Victoza), semaglutide (Ozempic), and Tirzepatide (Mounjaro) originally developed to treat type 2 diabetes have helped people lose up to 20% of their body weight. More recently, liraglutide and semaglutide have gained approval specifically for weight loss, available in formulations marketed as Saxenda (liraglutide) and Wegovy (semaglutide) (a pill, yet to be released in several countries).
This groundbreaking information has spread like wildfire through social media, talk shows, and tabloids, with countless people considering off-label use for weight loss purposes. But are these medications the best choice for losing weight? Do they really work? And are there any side effects? Most importantly, how can one sustain the weight loss achieved through these medications? We’re here to dissect it all.
How do these medications work in your body?
These GLP-1 agonist medications function by mimicking a hormone naturally present in our bodies known as GLP-1 (glucagon-like peptide-1). They signal the pancreas to release insulin when blood sugar levels rise after a meal, promoting optimal blood sugar regulation. Moreover, they play a crucial role in curbing appetite by slowing down the emptying of the stomach and communicating with brain receptors to suppress appetite (the feeling of wanting to eat). Consequently, these medications help individuals reduce their food intake, creating a negative calorie balance. This leads to weight loss and improved blood sugar levels.
A notable newcomer in the field gaining substantial popularity is Mounjaro (tirzepatide). This medication operates similarly to GLP-1 agonists but possesses the added advantage. It not only mimics GLP-1 but also imitates another hormone called glucose-dependent insulinotropic polypeptide (GIP). This dual-action approach can result in more effective blood glucose control and potentially greater weight loss compared to GLP-1 agonists. In clinical studies, Mounjaro users shed 7 kg to 11 kg, depending on dosage.
Who can take these medications for weight loss?
People with type 2 diabetes who carry excess weight are good candidates for these medications, especially those at high risk of heart disease. For people without diabetes, the official criteria for prescribing the drugs is body mass index (BMI) of 30 or higher, or a BMI of 27 or higher and at least one weight-related health problem, such as high blood pressure or high cholesterol.
Do you have any risks on these medications?
These medications are titrated (measured and adjusted) over time to reach a maintenance dose and minimize side effects. The most common side effects are nausea, indigestion, diarrhea or constipation, and fatigue. These symptoms are more pronounced at higher doses. Most side effects do not require discontinuation of the drug.
Other less proven side effects, according to viral TikTok videos, include “Ozempic face,” which refers to losing volume in the face due to rapid and drastic weight loss, causing the skin to sag. However, dermatological changes are common in weight loss patients as the structural integrity of the skin is affected during weight loss, affecting its overall elasticity, and can be unavoidable in many cases.
There may also be an increased risk of thyroid cancer and medullary thyroid cancer, especially if you’ve used GLP-1 agonists for 1 to 3 years.
When medications are prescribed, what actually might happen to lifestyle changes?
The thinking might seem like this: if you’re struggling with losing weight through lifestyle choices or believe that altering your lifestyle habits is beyond your reach, your doctor may opt to prescribe these medications. Once the medicine is doing its job, it may seem like it’s not so important to continue with the diet and exercise routine. This is because it’s seen as a substitution for a healthy lifestyle, conveniently encapsulated in a shot.
What happens when you stop taking these medications?
When you stop taking these medications, you’ll likely regain the weight you lost. Unless you adapt to mindful eating, with the right portion sizes and proportions of nutrients, include some form of active movement and improve your sleep hygiene.
Without these adjustments, you’re at risk of reverting to the familiar cycle – initially depriving yourself, celebrating progress, only to eventually succumb to disappointment and despair, believing that even medications couldn’t work for you.
.Why it’s not okay to slack off on lifestyle changes like diet and exercise if you’re taking these medications for weight loss.
The results can be interpreted in various ways. Some people who start taking medications might assume they can relax about dietary and lifestyle choices. It’s also possible that people who ultimately needed medications were less careful about following a healthy lifestyle even before medications were prescribed — and that may explain, at least in part, why they needed medications in the first place. Another factor to consider is that those needing these medications may have inherited high-risk obesity genes.
Regardless of the underlying reasons, people struggling with weight issues should aim to shed at least 3-5 percent of their excess weight. This is whether or not medications are involved. In fact, it may be even more important for those who were prescribed medications, because if their conditions were severe enough to warrant a prescription, they may be at higher risk of complications (such as a heart attack or stroke) than those able to avoid medications.
The time you are taking these medications could be viewed as a window of opportunity to make the best to adapt to healthy choices. It could be used as a tool to help you adhere to portion control. Added physical activity, identifying and managing emotional eating and stress-induced overeating, and prioritizing good sleep hygiene will make the transformation more magical and sustainable.
The bottom line
For many lifestyle-induced diseases, medications can only provide a partial solution. Medication effectiveness is significantly enhanced when combined with healthy lifestyle habits.
For people with excess body weight, medications should complement, not replace, lifestyle modifications. These lifestyle choices not only increase the likelihood of better weight loss but also improve blood glucose levels, reduce blood pressure, and lower the risk of certain cancers. Furthermore, if you maintain these positive lifestyle changes, you may no longer need medication in the future.
If you find yourself prescribed a medication after attempting dietary adjustments, exercise, or other lifestyle modifications, it’s advisable to consult your doctor regarding the continued importance of these lifestyle factors. It shouldn’t come as a surprise if your doctor emphasizes their importance to your overall well-being.
Note: This blog is not a substitute for professional medical advice. Discuss any concerns you may have with your health care provider.
Note: This blog is not a substitute for personal medical advice. Discuss any concerns you may have with your health care provider.
Apovian, C. M., et al. (2019). Body weight considerations in the management of type 2 diabetes. Advances in Therapy.
Bezin J, et al (2023). GLP-1 Receptor Agonists and the Risk of Thyroid Cancer. Diabetes Care.