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Weighing In on Weight Loss Drugs

Amanda Velazquez, MD

Amanda Velazquez, MD

Weight loss may seem like it comes down to a simple equation: Eat less plus move more equals success.

While healthy food choices and exercise are tools that will always be in the weight loss toolbox—and none of the other tools will work effectively without them—they're not the only tools available to people who want or need to lose weight, says Dr. Amanda Velazquez, director of Obesity Medicine at Cedars-Sinai.

"I want every patient to feel empowered, knowing there are tools available," Dr. Velazquez says. "Every patient who is having trouble losing weight deserves to have access to those tools."

"More than 40% of the nation is affected by obesity," she says. "The reason weight loss is such a challenge is not because people aren't motivated enough or they lack willpower. It's because obesity is a real disease."

Bariatric surgery—which can reduce the size of the stomach and bypass part of the digestive system to promote weight loss—is an option for many, though only about 1% of eligible patients have surgery.

Weight loss drugs also are an increasingly safe and effective option for some patients, in combination with healthy behaviors, Dr. Velazquez says.

If you are considering weight loss medications, here are some important facts to help you decide if these treatments are right for you.

It's not your imagination: Your body does work against you

When it comes to weight loss, you and your body are at odds: You want to lose weight, and your body wants to keep it. The body tends to favor a certain weight (usually at the higher end of the scale) and will lower your metabolism or amp up your hunger signals to get back to it.

It's called the set point, Dr. Velazquez explains. Environment, genetics and many other factors influence your personal set point.

This is one of the reasons 90% of people who lose weight eventually return to their previous weight—or higher.

"It's not in your head," Dr. Velazquez says. "For people who have lost weight over and over again, the reason they're not able to maintain that weight loss is actually because their body is fighting against them. That's why so many people live with obesity."

Weight loss medications can help overcome the influence of the set point.

Medical technology is improving

Even though it was pulled from pharmacy shelves in 1997, fenfluramine-phentermine—more commonly known as fen-phen—is unfortunately still the first drug that pops to mind for many people when talking about weight loss medications. The combination of appetite suppressant and amphetamine caused heart valve problems in up to a third of people who took the medication.

Current weight loss medications still fight against the stigma from fen-phen, even though there are now five other medications approved by the Food and Drug Administration for weight loss that have a history of safe use over a couple of decades.

Researchers are developing new medications that aim to work with the hormones involved in appetite regulation and are investigating how these hormones interact with our brain and our gut. Another research hotspot is the gut-brain-microbiota axis—how the complex ecosystem of flora and fauna in the digestive tract interacts with our brains and influences our body weight and eating habits.

You can find a personalized solution

There isn't a pill that will magically melt away unwanted pounds. However, Dr. Velazquez says doctors can use medications to help treat obesity as what it is: a chronic metabolic disease.

Different weight loss medications have different mechanisms, and a doctor will have to evaluate if you're a good candidate for any of them.

Some of these medications work by suppressing appetite. The newest drug is semaglutide™? 2.4 mg, which is taken as a self-administered injection once a week. This drug mimics a hormone that targets the areas of the brain that control appetite and can make you feel fuller sooner. It can help someone lose about 15% of their body weight—so a person who weighs 300 pounds could expect to lose 45 pounds.

Weight loss tools are most effective when used in combination, Dr. Velazquez says. Working with a dietitian to develop a food plan that is sustainable and effective, finding physical activities you enjoy, and working with a doctor to explore if medication or even surgery can help you are strategies best used together.

"Not every medication will be right for every person or will work for every person," she says. "If one doesn't work, we can move on to another one. Obesity is a complicated disease, and it takes a multipronged approach to treat it. We can usually find what will work best for each person."

Focus on the health benefits, not the pounds

In today's society and media, there is a toxic hyperfocus on lowering the number on the scale, Dr. Velazquez says.

When it comes to meaningful medical weight loss, however, the goals and motivators are a bit different. Lowering blood pressure, reducing diabetes and cancer risk, easing joint issues, and reversing sleep apnea are a few of the critical health goals in reducing weight.

Those goals can be achieved and health can be dramatically improved even without working toward an "ideal" weight.

"Many patients often think they need to lose a lot of weight—sometimes 100 or more pounds—to be healthy or they have to reach a so-called 'normal' body mass index," Dr. Velazquez says.

"Most of the time, our goal is aiming for 5% to 10% of total body weight loss. That loss can make a big difference in improving health."

Don't hesitate to ask for help

It can be hard to ask for help, Dr. Velazquez acknowledges. Studies have shown serious biases and stigmas against helping people with their weight.

"I want every patient to feel empowered, knowing there are tools available," she says. "Every patient who is having trouble losing weight deserves to have access to those tools."

Start by being aware of the different approaches—including medication and surgery—that are available in addition to healthy behaviors, like a balanced diet, adequate sleep and staying active.

It's also useful to be aware of your eating patterns because that can help determine which weight loss medication could potentially be most helpful. For example, take note if you feel some foods are completely irresistible and you feel you don't have control over them.

Do you crave high-salt or high-fat foods? That might indicate those foods are stimulating a certain part of your brain. It also can be helpful to notice what times of day you're the most likely to snack or overeat.

Think about it as a preventive health measure

"If someone came to us with uncontrolled blood sugar, we wouldn't tell them to go home, eat fewer carbohydrates, start walking more and then come back," Dr. Velazquez says. "We would get them on medication."

Don't wait for high blood pressure, sleep apnea or other complications to reach out to your doctor for help.

"It can be easier to prevent a complication than to try to reverse one later on," she says. "If you frame it in terms of prevention, that can be very helpful."