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Understanding the Pros and Cons of New Weight-Loss Drugs

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The new crop of weight loss drugs couldn’t have hit the market at a better time. According to the Centers for Disease Control and Prevention (CDC) (Opens in a new window) (Opens in a new window) (Opens in a new window), American adult obesity rates soared to 41.9% as of 2020. And when combined with figures for Americans in the overweight (Opens in a new window) (Opens in a new window) (Opens in a new window) category, that share swells to an alarming 73%. According to a nationwide study (Opens in a new window) (Opens in a new window) (Opens in a new window), the COVID-19 pandemic may have pushed these rates even higher. However, diabetes medications are now being prescribed as weight loss medications. And this may be a good thing, as the drugs have shown not only to improve diabetes, but also heart disease.

Semaglutide in the Spotlight  

Originally, segmaglutide, the active ingredient in popular medications such as Ozempic® and Wegovy® was only approved by the FDA for diabetes treatment. However, its weight-loss properties made it appealing for Americans looking to lose weight and become healthier. Soon the internet was teeming with forums and guides (Opens in a new window) (Opens in a new window) (Opens in a new window) detailing how people without diabetes could get off-label versions.

Public awareness of other semaglutide-based drugs exploded. The demand that followed led to shortages (Opens in a new window) (Opens in a new window) (Opens in a new window) around the globe. 

All this attention brought skepticism. More articles began publicizing the potential side effects of semaglutide (Opens in a new window) (Opens in a new window) (Opens in a new window) treatment. But how can we weigh the side effects of semaglutide against the risk of heart disease and other complications of obesity?

The Benefits

The question of semaglutide’s costs and benefits is tricky. Fortunately, cardiologist Andrew Freeman, MD, can help navigate the issue. 

“It's interesting because a lot of people are afraid of using these drugs, especially in the non-diabetic world,” Dr. Freeman noted. “These people recognize the drugs came out as diabetes medications originally. It's also important to realize that the vast majority of diabetes drugs either have no or minimal effect on weight, or they actually increase weight, like insulin. Semaglutide helps people lose weight and therefore affects a lot of other cardiovascular risk factors.” 

After it was discovered that semaglutide reduced the risk of heart attack and stroke, the FDA expanded the medication’s approved usage in 2020. 

“We’re excited about these medications,” Dr. Freeman said. “This one drug type is hitting not just diabetes, not just heart disease, not just weight, but all of them – it targets overall cardiometabolic risk. And when people lose weight, their heart health improves and they have a significantly better life. So these are exciting times because in a lot of ways -- these drugs both treat and prevent disease.” 

And when it comes to exactly how much weight patients are losing on semaglutide drugs, the numbers are frankly astounding. 

“Some of my patients have lost about 30 to 40 pounds over the course of two or three months,” Dr. Freeman reported.   

The Costs

When it comes to the costs and benefits of semaglutide, much of the former is quite literal. “It’s a very expensive drug,” said Dr. Freeman. 

The price will vary depending on insurance coverage. However, Dr. Freeman explained that some patients are paying as much as $1,400 a month for some versions of the drug. And if they want to keep the weight off, these patients can expect to keep paying. That’s $1,400 month after month, year after year, potentially without end. 

Of course, this makes semaglutide unaffordable for a large portion of the population. Many people who can afford it initially can rarely sustain it for long. 

“To tell you the truth, the vast majority of people are either getting samples or their insurance covers it for one reason or another,” said Dr. Freeman. “And then their insurance stops covering it, or it gets too costly for them. Then they just stop it and gain the weight back, usually within a month or so.”

While rare, there are serious potential side effects when using semaglutide. These can include pancreatitis, gallbladder disease, kidney damage and thyroid cancer, among others. And the long-term effects of taking semaglutide medications remain unknown. 

The Compromise

“I’m not opposed to using semaglutide for weight loss,” said Dr. Freeman. “But in my opinion, these drugs really should be used as a ‘running start.’ If you need to use these drugs to get the momentum you need for your weight loss journey, they might work for you. But you need to change your overall lifestyle too. Otherwise, the change won’t last.” 

According to Dr. Freeman, people taking semaglutide to spur weight loss should also adopt better eating habits and exercise routines.

“A lot of people out there will say, ‘Well, Doc, I'm just not going to exercise and I'm not going to eat the way you want me to eat. I just want the drug,’” said Dr. Freeman. “To me, that’s not the right outlook. You can use this to give yourself a boost. But the natural way is going to be better for you in the long term.”