What to Consider With the Explosion of Weight Loss Medications

We cannot escape the buzz around the new generation of weight-loss medications. With these drugs — called glucagon-like peptide 1 receptor agonists, or GLP-1s — the appeal is obvious.

The physical challenges of excess weight are well known, such as being at higher risk for type 2 diabetes, heart issues, or some cancers. In addition, extra weight can have an impact on our emotional and mental health.

So, when there’s an opportunity to take a medication that changes our experience with weight loss, it feels life-changing. And many times, it is.

But how do we know if these medications are a good fit for our individual needs? Here are four things to keep in mind.

How do these medications work?

GLP-1 drugs can decrease hunger or change how we experience food, including cravings and feeling full. Some of these medications also work by slowing down our gastrointestinal system so that food lingers in our stomach, and we feel satisfied for longer periods of time.

What are the side effects, and are there any red flags?

Because GLP-1 drugs change gut motility, common side effects are bloating, fullness, diarrhea or constipation, and nausea. The good news is that side effects improve with time as the body adjusts, and most people can eventually find a dose that leads to weight loss with no or minimal side effects.

All medications have contraindications, and it’s really important that these drugs are prescribed by a physician who understands both their use and contraindications. This is especially true if you are pregnant or are trying to conceive, as the risks of taking GLP-1 medications during pregnancy aren’t well understood, with evidence suggesting that they could harm the fetus.

What is the long-term commitment needed for success with these medications?

Women are especially prone to weight management concerns due to hormonal influences, including PCOS, some contraception options and infertility treatments, and menopause later in life. So, for those of us who struggle with our weight, it’s important not to feel ashamed to seek help. We should understand that metabolism and our appetite are biological facts, not moral choices.

In terms of long-term commitment, once these medications are discontinued, the chances of weight regain are very high. As a result, we recommend starting these medications with the understanding that an individual may need to be on them for the rest of their lives.

In what instances could bariatric surgery be a better option in place of medication?

GLP-1 medications are becoming more effective and continuously improving. That said, current evidence suggests that bariatric surgery is the most effective treatment option overall. Bariatric surgery also leads to the most weight loss. Further, we have 10–20 years of data showing that bariatric surgery works long-term, and we don’t have that data available for the new class of weight loss drugs. We know that bariatric surgery is beneficial in reducing other health risks, such as getting type 2 diabetes or high blood pressure into remission.

There’s also a financial consideration because some of the weight loss drugs are costly and you may need to be on them for the rest of your life, whereas bariatric surgery is a one-time cost.

Ultimately, there is no one-size-fits-all solution, and it’s so important that we consider each person and their specific situation on a case-by-case basis.

In our multidisciplinary clinic, our role is to guide each individual to navigate the path that will give them the best outcome based on their goals, preferences, and values. Sometimes it will be one path but at other times it could be a combination approach.

About the Author

Maria Daniela Hurtado Andrade, M.D., Ph.D., is an endocrinologist with the Bariatric Center at Mayo Clinic, which offers a weight management program that helps individuals through a non-judgmental, compassionate, and customized approach. We tailor counseling as well as treatment plans to meet each person’s goals and everyday realities. If you would like to schedule a consultation with a specialist in our program, please contact us at (904) 929-9256.