Successfully losing weight can depend on many factors, such as maintaining a balance of calories in vs. calories out (CICO), staying active, reducing stress, and possibly incorporating medications if other methods are not effective.
All medications have both benefits and potential side effects. For weight loss, medications may include the following:
- Metformin (Glucophage): An oral medication available in an extended-release form. It may cause mild side effects such as nausea and bloating.
- Xenical: An oral medication that blocks fat absorption in the intestines, thereby reducing caloric intake, primarily from fats. Side effects may include loose stools and fatty mucus leakage from the rectum, which are often worse after consuming fatty foods. It is available over-the-counter (OTC).
- Contrave: An oral medication that combines Wellbutrin and Naltrexone. Potential side effects include nausea, constipation, irritability, dry mouth, and dizziness.
- Qsymia: An oral medication that combines Topamax and Phentermine. Side effects may include nausea, dry mouth, insomnia, constipation, dizziness, anxiety, and, in rare cases, suicidal thoughts.
GLP-1
We will discuss GLP-1 RA medications in more detail.
Currently, most people use these medications for weight loss, as they often result in greater weight loss compared to other options. These medications work by slowing the emptying of the stomach (Peristalsis), which helps you stay full longer and feel less hungry. Interestingly, for reasons not yet fully understood, GLP-1 medications also cause alcohol aversion, leading to a significant decrease in alcohol consumption.
Common side effects include nausea, vomiting, abdominal bloating, mild discomfort, constipation or diarrhea, muscle loss and weakness, gastroparesis, dysmorphic body changes (such as skin loosening), and suicidal ideation.
Less common side effects include pancreatitis, acute kidney injury, worsening of diabetic retinopathy, thyroid medullary cancer, and hair loss. Diabetes should be carefully monitored, as these medications may cause hypoglycemia (low blood sugar), which can lead to fainting and other symptoms.
GLP-1 medications can offer many beneficial effects beyond weight loss. These include lowering blood pressure, improving fatty liver disease, and reducing the risk of heart disease and diabetic kidney disease.
Common GLP-1 medications include Ozempic, Victoza, Byetta, Saxenda, Semiglutide, Wegovy, Zepbound, Mounjaro.
Most GLP-1 medications are administered as weekly injections, with the exception of Rybelsus, which is a daily oral tablet. The syringes and needles used are similar to insulin syringes. Brand-name GLP-1 medications are often available as auto-injector syringes for ease of use.
How much do GLP-1 weight loss medications cost? Insurance coverage?
The cost of brand name GLP-1 medications (e.g., Ozempic, Wegovy, Mounjaro, Zepbound) is another significant concern, as they range from approximately $1,200 to $1,300 for a one-month supply. Few insurance plans cover these medications, and all require prior authorization.
Insurance companies typically require documentation proving the failure of prior weight loss treatments, including calorie-restricted diets, exercise, and lifestyle modifications, sustained over 3-6 months. Coverage is often limited to individuals with a BMI > 40 or BMI > 35 accompanied by additional obesity-related conditions, such as heart failure, type 2 diabetes, or fatty liver disease.
There are alternatives to brand name GLP-1 medications, often referred to as GLP-1 compounded medications. Compounding pharmacies, while FDA-registered, are not regulated or monitored by the FDA. The FDA permits the creation of personalized medications if they are not commercially available and would benefit the patient. Compounded medications are also allowed during shortages of specific medications.
These medications are made by combining two or more ingredients and are dispensed as 503A or 503B products. However, the FDA does not monitor or guarantee the potency, safety, or efficacy of these compounded medications.
Due to the acute shortage of GLP-1 medications, many new pharmacies have recently started operations.
These pharmacies may lack years of experience and documented reliability. It is important to exercise caution when choosing a compounding pharmacy. Consider factors such as which pharmacy is making the medication, their record, and how long they have been in business. Keep in mind that a higher or lower price does not guarantee quality.
The use of GLP-1 medications for weight loss is a relatively new phenomenon, and their long-term effects remain unknown. Patients must be carefully screened based on their medical history, current medications, comorbidities, and other relevant factors. GLP-1 medications should only be prescribed if they are deemed beneficial and should be titrated according to the patient’s symptoms. The goal should be to use the least amount of medication for the shortest possible duration.
When planned correctly, these medications can often be gradually tapered and possibly discontinued. The ultimate aim should be to avoid lifelong use. A lifelong treatment plan is not only very expensive but may also carry unknown long-term side effects.
Most illnesses can be improved or even reversed through intelligent management, lifestyle changes, and better nutrition, thereby reducing the need for daily medications. While genetics plays a small role in obesity, it is primarily a lifestyle-related condition. (Please also refer to last month’s article on obesity.)
Next month, we will focus on improving lifestyle habits and strategies for disease reversal.
