Rethinking the Weight of the World

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Diabetes drugs like Ozempic are the next big thing in weight loss, but is there more than meets the eye?


AFTER DECADES OF FAD DIETS, sensationalist infomercials and failed New Year’s resolutions, it seems like we are witnessing the impossible: something is changing in the world of weight loss. Jenny Craig, the legacy weight-management titan, is closing its doors after 40 years in the industry. Diet culture, long touted as the key to shedding those stubborn pounds, is giving way to a focus on nutrition and individual wellness.

Meanwhile, everyone from Weight Watchers to Elon Musk seems to be throwing their, well, weight behind a newer generation of diabetes drugs — including Ozempic, Wegovy and Mounjaro — as the newest revolution in weight loss. But after so many supposed miracle drugs have fallen flat over the years, we have to ask: are these the real deal?

GLP-1 agonists slow the rate at which food leaves your stomach, making you feel fuller sooner and helping your body to better metabolize food. In large part, therein lies the secret to drugs like Ozempic: eat less, lose weight.

So far, the results appear promising. One 2021 study published in The New England Journal of Medicine saw patients taking Wegovy — a higher dose version of Ozempic approved for weight loss — lose about 15% of their body weight on average over 68 weeks. A similar study saw patients taking Mounjaro — a newer medication featuring a two-pronged approach — losing even more: up to nearly 21% on average. Reliable, rapid weight loss like this without the major health concerns of more traditional weight loss drugs was unheard of up until recently. So, what’s the catch?

“In general, they’re safe for pretty much any adult,” says Dr. Lauren Wood, internal medicine specialist with Memorial Health. There are exceptions, of course — those with a family or personal history of medullary thyroid cancer or those at risk for pancreatitis — but overall, there aren’t many serious concerns. In fact, studies show these medications actually have some significant cardiovascular benefits, such as decreasing blood pressure and reducing the likelihood of heart attack and stroke.

Double-duty Drugs

Originally designed to treat Type 2 diabetes, these drugs — known as GLP-1 agonists — mimic a hormone in the body that binds to a certain pancreatic receptor, increasing insulin production and lowering blood sugar after you eat. It also slows the rate at which food leaves your stomach, making you feel fuller sooner and helping your body to better metabolize the food you do eat. In large part, therein lies the secret to Ozempic and kin: eat less, lose weight.

Despite their recent surge in popularity, these are not new drugs. “This class of medication has been around for a long, long time,” says Dr. Ismary De Castro, president of Savannah Endocrinology. “It’s just that the agents have gotten better, the tolerability has improved and the accessibility of these medicines has expanded.”

“With many patients, it’s clearly an instant improvement, like turning on a light switch, and they do so much better.”
— Dr. Ismary De Castro, Savannah Endocrinology

When the first GLP-1 agonist, Byetta, was approved back in 2005 for diabetes and being used off-label for weight loss, it was a twice-daily self-injection, something many patients associated with being prescribed insulin. “People were afraid of it,” says De Castro. “They didn’t understand how it worked.”

In comparison, most of the mainstream GLP-1 agonists today are injected only once a week, are more effective and generally have fewer side effects, though nausea and other gastrointestinal ills may still occur. De Castro also credits the obesity awareness brought on by the COVID-19 pandemic and social media for their recent surge in popularity. #Ozempic alone has nearly a billion views on TikTok. But let’s face it, a lot of the buzz brought on by social media chatter and celebrity finger-pointing has fed into the misconception that these are simply miracle drugs, capable of melting away bushels of fat in a matter of weeks at the stick of a needle. As miraculous as these drugs may be, they are no silver bullet.

Weighty Disclaimers

“I do think that these medications are a great adjunct to lifestyle modifications, including diet and exercise,” says Wood. “However, the big keyword there is ‘adjunct.’” In other words, you shouldn’t take these drugs and just carry on with your life as normal. Just about every professional medical voice on the matter will tell you that diet and exercise are a must if you’re trying to lose weight healthily and keep it off. And it’s not just the doctorly thing to say; there are serious consequences to ignoring this advice.

“Oftentimes, not only is there fat reduction, but we’re also seeing some skeletal and muscle tissue being absorbed as well,” says Wood. This can happen to anyone on a calorie-restricted diet. She explains that if you’re not getting enough physical activity and protein and nutrients from your diet, your body will not pull from your fat deposits alone, but from your muscles and bones as well. And while these drugs are meant to be used indefinitely, should you ever need to stop taking the medication and you haven’t made those lifestyle changes, you’re at a high risk of gaining weight back.

Weight loss drugs like Ozempic aren’t a cure-all. Diet and exercise are still a must if you’re trying to lose weight healthily and keep it off.

“Education is really important for patients, just as much as building a game plan and being an advocate for them,” says Sandy Odom, founder and clinical director of Odomí Medical Spa. “But they have to meet you halfway.” Accountability is a big factor for Odom. Since she began offering GLP-1 agonists in January, Odom has tweaked the program to require patients to come to the clinic for their weekly injections. The act of driving there and being physically engaged with the program, she says, has led to greater patient compliance and success. “If someone is coming back to me next week, they’re going to think twice about putting that donut in their mouth,” says Odom.

And then there is the so-called “Ozempic face” — the gaunt, sagging appearance some patients get after quickly losing a significant amount of weight on these drugs. “What some people don’t understand is that in a rapid weight loss situation like these drugs produce, it is going to be an evenly distributed loss,” says Dr. Tim Minton of Savannah Facial Plastic Surgery. “You’re not going to just lose it from your belly; you’re going to lose it from every part of your body.”

Losing fat in the face, he explains, can make you appear more aged, and patients who are not overweight but taking GLP-1 agonists for aesthetic weight loss are far more likely to experience this effect. Fillers, fat transfers and facelifts can go a long way to help, of course. For a cost.

Pocketbook Punch

Speaking of cost, these drugs are expensive. With no generics on the market at this time, it often comes down to insurance to foot the bill, and while this isn’t a problem for diabetics taking the drugs, many insurance providers won’t cover weight loss prescriptions.

“I’ve had some patients be able to get Ozempic or Wegovy for no cost out of pocket depending on their insurance, and I’ve had patients have to pay up to $200 or $300,” says Wood. “Without any insurance coverage, it’s over $1,000 for each month’s dose.”

While those with clinical obesity may have an easier time getting insurance to pick up the tab, unless you have money to burn, you might be better off weighing other options with your doctor.

And even with insurance or a healthy cash flow, patients still might struggle to access these medications. With their explosive rise in popularity and the ease of access provided by telehealth prescribers, drugs like Ozempic and Mounjaro have experienced severe shortages over the last year that are still being resolved. According to analysis by J.P. Morgan, Ozempic prescriptions alone have more than doubled over the last year, and with demand growing by the day, it’s hard to say when the supply will fully catch up.

Reshaping America

Amidst all the hype, it’s important to consider just how revolutionary these drugs might be in tackling America’s growing obesity epidemic. According to the Centers for Disease Control and Prevention, the obesity rate was nearly 42% in 2017, and that number has likely only grown since the pandemic. This problem has been pinned on everything from nuanced socioeconomics to abject laziness, but our solutions have almost always been tainted by judgment.

A number of studies over the years have established a serious and detrimental weight bias by many healthcare providers, often based on the belief that obese patients simply lack self-control, leading to subpar care and more negative treatment outcomes. This stigma has been well-documented in the general population as well. But placing the blame solely on behavior is not only unsympathetic, it’s unscientific.

Diet and exercise are key to maintaining a healthy weight, but researchers have come to understand that our bodies have built-in mechanisms that actively fight against weight loss, making it harder to lose weight and keep it off in the long run. With that in mind, GLP-1 agonists just might offer a new path forward, giving obese patients a safe, reliable chance at a healthier life. “It’s amazing,” says De Castro. “With many patients, it’s clearly an instant improvement, like turning on a light switch, and they do so much better.”

So perhaps the real revolution of these drugs is how they will help us to understand that obesity is not just about personal responsibility alone, that there are complex metabolic factors at play. Perhaps that is the change we needed all along.

Find this feature and more in the July/August issue of Savannah magazine. Get your copy today.