Losing It

Peter Galvin, MD

Weight loss is one of the most talked about topics lately. The reason is that the number of obese individuals in the U.S. is growing at an alarming rate. Obesity is defined as having a body mass index (BMI) higher than 30%. In 1980, the obesity prevalence in the U.S. was 15% of the population. That number was 31% in 2000 and 42% in 2020. This problem is usually blamed on less physical activity and a diet high in fats, sugars, and ultra-processed foods. America needs help, so it’s no wonder that when discussing weight loss today, the conversation is dominated by the “new” glucagon-like peptide-1 (GLP-1) drugs. But in reality, these drugs are not so new. In fact, after insulin was discovered in the early 1920s, medical research turned towards finding insulin stimulating factors. And that’s what GLP-1 drugs are: a type of peptide hormone that can stimulate the pancreas to produce more insulin after meals, as well as slow the movement of food through the stomach to help suppress the appetite.

It wasn’t until 1984 that GLP-1s were first discovered. During the years of studies needed for the FDA to approve a new drug it was found that those on a GLP-1 drug had better diabetic control. It was also found that study participants on a GLP-1 were losing weight. So pharmaceutical companies started investigating GLP-1s for weight-management purposes. The first GLP-1 weight-loss drug, Saxenda (liraglutide, previously approved for diabetes under the name Victoza), was approved by the FDA in 2014. Today, there are three GLP-1 weight-loss drugs available; Saxenda; Wegovy (semaglutide), approved in 2021 (previously used for diabetes as Ozempic and an oral form, Rybelsus); and Zepbound (tirzepatide), approved in 2023 (used for diabetes as Mounjaro). Zepbound is the first GLP-1/GIP (gastric inhibitory polypeptide) and is thought to be more potent than a GLP-1 alone. Since 2014, prescriptions for these medications have increased by 300%.

These drugs are only approved for use in those with a BMI higher than 30. Both Saxenda and Wegovy can be given to those 12 years of age and older, while Zepbound is for adults only. They are contraindicated in those with a history of medullary thyroid cancer, gallbladder disease, pancreatitis, and those with multiple endocrine neoplasia syndrome type 2. All three drugs need to be started at a low dosage and gradually have the dosage increased. Saxenda is injected once daily and Zepbound and Wegovy once a week. While compounded versions (non-brand) of these drugs are available, they are not FDA approved. These medications should be prescribed by a licensed healthcare professional, and the prescriptions should be filled at a reputable pharmacy. They should never be obtained from an internet source, even if properly prescribed. That is because counterfeit versions of these drugs are common, especially from the internet.

These medications are not magic bullets. Those using them should maintain a healthy diet and exercise regularly. Weight loss is common but not guaranteed. Side effects are uncommon and may include nausea, constipation, or diarrhea. A common myth is that they cause suicidal ideation, which has never been seen in any study. Finally, the needles are tiny, much smaller than a flu shot needle, and are usually painless.

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