5 min
As Popularity of Weight Loss Medicine Soars, Professionals Caution Against “Magic Pill” Mindset
A growing weight-loss fad has been dominating headlines this summer. No, it isn’t a new type of trendy diet, exercise regimen or social media influencer-touted superfood. It’s two medications – Ozempic and Wegovy – that have skyrocketed in popularity as more Americans turn to these once-weekly injections to aid in their weight loss efforts. But, while acknowledging the drugs’ effectiveness, their intended patient populations and appropriate usage has become far more nuanced and situational, and the intended outcome of long-term weight loss and health is dependent on more than just taking either of these medications once a week. “While these medications can be helpful for some people who struggle with weight loss, it's important to remember that they are not a magic solution,” said Rebecca Shenkman, MPH, RDN, LDN, director of the MacDonald Center for Nutrition Education and Research at Villanova University’s M. Louise Fitzpatrick College of Nursing. First, it’s important to understand the components and histories of both Ozempic and Wegovy. They are prescription medications of the same drug, semaglutide, which belong “to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists, originally developed to treat type 2 diabetes,” per Shenkman. It was discovered by researchers that significant weight loss was a side effect of semaglutide. Ozempic is the 2017 FDA-approved drug used to help treat diabetes. Currently, it is not FDA approved for weight loss and typically not covered by health insurance when used for that purpose, per Shenkman, but is often prescribed off label for “weight management in certain individuals who do not have diabetes, but struggle with obesity or [are] overweight.” Wegovy was approved by the FDA in 2021 as an anti-obesity drug used for individuals living with obesity or individuals with excess weight, but not classified as living with obesity, who also have other associated health problems. “When used correctly, the drugs can have many benefits,” Shenkman said. “[Semaglutide] is shown to improve diabetes and body weight in addition to seeing improvements in cardiovascular health and risk factors.” However, “correct use” is what concerns Shenkman and other health and nutrition professionals. “Anti-obesity drugs are a valuable tool for people who have not experienced adequate benefit from self-directed or professionally directed lifestyle treatment,” she said. “However, what we are seeing more and more of now is that people are requesting anti-obesity medications without meeting eligibility criteria for drug use, [such as] body mass index and weight criteria, [or] having the foundational knowledge and application of healthy lifestyle behaviors prior to medication use.” To Shenkman’s first point, there are several factors, especially in American society, driving those who may not meet the criteria for these medicines or even truly need them to request and ultimately receive the drugs. The media’s portrayal of ideal body image is an enormous influence, which can lead to “body dissatisfaction and a desire for quick weight loss solutions,” said Shenkman. Advertisements for these drugs often promote those ideas, and even downplay side effects, making them more appealing. Intrinsically tied to body image is the struggle many individuals have with psychological issues related to food, such as emotional or binge eating. “They feel that their self-worth is tied to their weight, and they will do almost anything to lose weight, whether it be five or 50 pounds.” Shenkman said. “These individuals might believe that medication will help them control their eating habits more effectively.” Identification of such issues prior to prescription approval is something that providers need to be aware of and screen for, Shenkman said. “It is so important for providers to complete a comprehensive pre-treatment assessment of their patients who start on weight loss medications. Unsupervised or improper use can lead to malnutrition, unhealthy weight loss, or even a worsening of an undiagnosed and/or undertreated eating disorder or mental health condition.” But even users who meet all pre-treatment criteria may be turning to the drugs in haste, or believe that they alone will solve their problems, and do so quickly. “Americans are known for having that ‘quick-fix mentality’ where people often seek quick solutions to their problems, including weight loss,” Shenkman said. “Weight loss medications might promise faster results compared to lifestyle changes, which can take time and dedication.” Compounding this “quick-fix mentality” is the frustration many feel when they fail to see results after multiple unsuccessful attempts at weight management. “The abundance of information on diets, exercise routines, and weight loss programs can be overwhelming… Some may turn to medications as they seem more straightforward and require less effort to understand,” explained Shenkman. But, as health care providers know, they are far from straightforward. All drugs, including Ozempic and Wegovy, come with the potential for side effects, which can vary with the individual. Headlines this summer focused on reports of users experiencing gastroparesis, described by Shenkman as the “the slowing down or ‘paralysis’ of the digestive system and gastric (or stomach) emptying.” Though most often reported to cause nausea and vomiting, complications of gastroparesis can be quite serious. “If someone continues the medication and experiences chronic gastroparesis, complications to be aware of include malnutrition, dehydration, acid reflux, blood sugar control and even bowel obstruction,” Shenkman said. The American Society of Anesthesiology also recently issued guidance on the use of such drugs prior to surgery, given potential life-threatening complications. “When prescribing anti-obesity medication, it is the responsibility of healthcare providers to inform patients about potential side effects and risks associated with the medication,” Shenkman said. “It is also the right of the patient/consumer to ask questions and understand what they are putting in their body. A thorough discussion about benefits and possible adverse effects can help patients make informed decisions about their treatment.” Many users may also not fully understand that these drugs are usually taken long-term, even after reaching a desired weight. Stopping without the knowledge of how to keep the weight off may lead to its return. Considering the pros and cons of the drugs, Shenkman’s advice is simple. “Weight loss medications should always be used as part of a comprehensive weight management plan, which includes a balanced diet, regular physical activity, and lifestyle changes. Relying solely on medications without addressing other aspects of weight management is not likely to lead to long-term success no matter how long you stay on a medication.”
