New weight loss drugs like tirzepatide (Mounjaro) and semaglutide (Wegovy) show promise. However, they can have side effects and may not work for everyone.

How Do These Weight Loss Drugs Work?

Carlene Johnson, a 48-year-old from Boston, always felt hungry, even after eating. Despite trying many diets, the hunger persisted, and she faced societal pressure for her larger body.

In January 2021, her doctor suggested weekly liraglutide injections, which help people lose 5% to 10% of their body weight when combined with diet and exercise. Johnson experienced even better results, losing 28.6 pounds (13.6% of her peak weight) over four months, going from 210.4 pounds to 181.8 pounds.

This medication freed her from constant hunger, and she finally realized that her persistent hunger wasn’t something diets could fix. “It wasn’t until this medication that I understood my biochemistry was abnormal,” Johnson said. “Finally, I could eat and feel full.”

Liraglutide, prescribed as Saxenda, is a GLP-1 receptor agonist, initially used for Type 2 diabetes but now marketed for weight loss. Saxenda was approved in 2014, and a newer GLP-1 drug, semaglutide (Wegovy), approved in 2021, has shown an average weight reduction of 15% over 68 weeks.

A related drug, tirzepatide (Mounjaro), approved in May for Type 2 diabetes, activates both GLP-1 and GIP receptors. A recent trial (SURMOUNT-1) found tirzepatide could help people lose 20% or more of their weight, comparable to bariatric surgery.

However, before tirzepatide can be approved for weight loss, the manufacturer Lilly needs to complete three more trials. “We are discussing an expedited path with the FDA based on SURMOUNT-1 results and hope for an update before the year ends,” said Maggie Pfieffer, a spokesperson for Lilly’s diabetes program.

Dr. Sean Wharton, a contributing author to SURMOUNT-1, believes tirzepatide could become a blockbuster drug. “Semaglutide opened the door; tirzepatide will bust it open,” he said.

What Are the Risks and Limitations?

These medications can be expensive, have serious side effects, and may not be covered by insurance. They often need to be combined with diet and exercise for effectiveness. If stopped, weight can be regained, and long-term use might be necessary.

GLP-1 and GIP are hormones released by the intestine when you eat, stimulating insulin release, lowering blood sugar, and signaling fullness. These drugs mimic these hormones, enhancing insulin release, slowing digestion, and reducing appetite to promote weight loss. “These molecules stop hunger,” Wharton said.

However, they are not magic solutions. Many report gastrointestinal side effects like nausea, diarrhea, and constipation. There is also a potential risk of thyroid cancer, pancreatitis, and gallbladder disease.

They Don’t Work for Everyone

Some people see minimal results from GLP-1 agonists, and the reasons are unclear. In the tirzepatide trial, about 9% lost less than 5% of their body weight, compared to around 50% losing 20% or more. Future research needs to address why some people respond differently.

Costs and Supply Issues

Liraglutide (Saxenda) and semaglutide (Wegovy) cost about $1,700 per month for uninsured patients. Type 2 diabetes formulations are cheaper but still expensive. Johnson, with good insurance, pays $50 per month, half of which is covered by a savings card.

Some insurance companies don’t cover GLP-1 agonists. For example, Medicare and most insurers don’t cover Wegovy. Apps like Calibrate offer coaching and access to GLP-1 agonists for a fee, working with insurance to get coverage.

Due to a needle pen shortage, new Wegovy prescriptions have been temporarily halted. Novo Nordisk is focusing on producing the highest doses to serve current patients, hoping to meet demand by late 2022.

The Need for Continued Use

Johnson saw her weight plateau even on the highest Saxenda dose and regained weight after stopping it. She is now trying Wegovy but might experience nausea due to the low-dose shortage.

Wharton believes ongoing medication use is necessary for chronic conditions like obesity. Duke, on the other hand, believes some patients may eventually stop the medication with the right lifestyle changes.

Not for Short-Term Weight Loss Goals

These medications are not for short-term weight loss before events like weddings. They are for those with chronic obesity, which is a neurological issue, not just a behavioral one.

GLP-1 treatments are helping to destigmatize obesity by showing it as a treatable health issue. “The more we understand this as a biological condition, the more we can recognize it’s not the person’s fault,” Wharton said.

How to Get Help

For those looking to treat obesity, the first step is to talk to your family doctor. Even with medication, diet and exercise are crucial. If your doctor isn’t supportive, seek an obesity specialist. You can find specialists using the Obesity Medicine Association’s portal.

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This post originally appeared on BuzzFeedNews.

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