Obesity is a complex disease that historically has been underrecognized and undertreated by the medical community. Only in the past 10 years have we begun to have discussions about treating it as a public health emergency because of its significant health and economic impact.
The problem began in the 1970s after the introduction of processed foods, but we’ve seen it become a crisis in the 21st century. The United States’ obesity rate rose from 30% in 2000 to about 42% in 2020, according to the Centers for Disease Control and Prevention (CDC). Obesity is a major risk factor for many other health conditions, and it has caused a rapid increase in the prevalence of heart disease, diabetes, kidney disease, cancer and infertility. According to the CDC statistics, obesity contributed to seven of the top 10 causes of deaths in 2021.
With obesity rates heading in the wrong direction, you can see why weight-loss drugs have captured the attention of the public, particularly in recent months as pharmaceutical companies market new medications that have shown impressive results.
If you’re a patient who’s considering these medications, I hope to give you a better understanding of how they work and where they fit into your pursuit of a healthier lifestyle.
How do these drugs work?
The new generation of weight-loss drugs is designed to mimic two hormones, secreted by the large (GLP-1) and small intestines (GIP), that lower blood glucose levels by releasing insulin when you eat carbohydrate-loaded foods and by suppressing glucagon in your liver. These medications also share the hormones’ ability to suppress hunger signals in the brain and to slow the movement of food through your digestive system, making you feel full sooner.
The new drugs, known as semaglutide and tirzepatide, are excellent options for those with Type 2 diabetes and obesity. They’ve proved to be far more effective than older-generation medications, which suppressed cravings and hunger but helped patients lose much smaller amounts of weight.
Semaglutide and tirzepatide are safe when used under a doctor’s supervision, but as with any drug, they’re not without side effects. The most common are gastrointestinal issues such as nausea, diarrhea, constipation, abdominal pain and vomiting. Hypoglycemia, also known as low blood sugar, can occur if patients use these drugs while they’re also on insulin.
Whom do they help?
The Food and Drug Administration approved the new medications to help patients diagnosed with obesity or Type 2 diabetes, both of which are chronic health conditions that require long-term treatment. Although medical spas in some parts of the country have offered the drugs to anyone who can pay, most doctors will not recommend these treatments for patients who lack a clinical diagnosis.
Unfortunately, even those who are eligible to use these medications might encounter obstacles that limit their ability to do so. The popularity of these drugs has caused demand to outpace production, which has limited their availability. The cost of treatment has also proved prohibitive for many people, as the medications cost $1,200 to $1,500 a month and aren’t covered by many private or federal insurers.
In the coming months and years, it will be very important that manufacturers and insurers work to improve the accessibility of these treatments for the patients who need them.
A healthy lifestyle
While these drugs can have a significant impact in the lives of patients, we also need to recognize that they’re not a solution by themselves. At the end of the day, any obesity management regimen should identify behavioral drivers of eating and reduce them, improve the quantity and quality of the calories you take in, and increase physical activity and burn off calories.
Those lifestyle changes are essential to losing weight and improving your health. Medications should be used when other measures are unable to help with or sustain the desired weight loss.
Dinesh Edem, M.D., is an assistant professor of endocrinology in the University of Arkansas for Medical Sciences (UAMS) College of Medicine and director of the UAMS Health Medical Weight Management Clinic in Little Rock.
