What To Know Before Beginning (Or Quitting) Weight Loss Medications

Oprah Winfrey is well known for her lifelong struggles with weight. Recently, she hosted a prime-time special called “Shame, Blame and the Weight Loss Revolution,” in which she discussed her recent use of one of the popular weight loss medications and how it helped her achieve a healthier weight. 

Oprah’s weight loss special comes at a time when prescription weight loss medications, like Ozempic, Mounjaro, Zepbound, and Wegovy, are all the rage. While these medications are effective for many people, unanswered questions and concerns remain. For example, is weight loss medication safe? What are weight loss drug side effects? And what can users expect in the long term from these medications?

Long-term effectiveness of weight loss medication

While weight loss medications may be effective in helping you initially lose weight, what about maintaining your weight? These medications are intended to be used long-term, as obesity is considered a disease that needs to be continuously managed. 

However, many people don’t use these medications that way. Many stop taking them after a certain period. A study in the Obesity Journal found that only 19% of people still took the medication after a year. Prime Therapeutics found 27% who remained on it a year later in their study—a larger percentage, but only slightly.  

There are many reasons people discontinue these medications. Weight loss medications can be expensive, averaging $1,000-$1,500 per month, and many insurance providers refuse to cover them. There have also been ongoing shortages due to the popularity of these drugs. It is also believed that about 10% or more of people taking these drugs eventually quit due to digestive side effects.

Many others, though, simply quit once they hit their weight loss goal. This might seem logical at first, but there’s a problem: typically people who do it gain the weight back. One study discovered that most people regained about two-thirds of the weight lost with prescription weight loss medications within a year of stopping them. A second study found that subjects regained 14% of their body weight once they switched to a placebo.  

As the medication slowly leaves the body over a few weeks, many people report a significant increase in hunger shortly after stopping the medication. Dr. Christopher McGowan, the founder of True You Weight Loss, spoke in detail about this effect in a March 2024 article in Everyday Health. 

Essentially, increased hunger and weight regain are normal physiological responses to weight loss. When you lose weight, a hormone called ghrelin that triggers hunger increases while your metabolism slows. This is why many people have trouble maintaining long-term weight loss, no matter what method is used.

Weight gain may happen even faster if you do not maintain other diet and lifestyle changes that help manage body weight. If you are considering prescription weight loss medications, it is essential to understand that they are not a long-term magic bullet for weight loss, and if you stop the medication, you will likely regain the weight.

Is weight loss medication safe?

While weight loss medication is effective and safe for most people, there are a few side effects to consider. Common weight loss drug side effects include: 

• Nausea
• Diarrhea
• Constipation
• Abdominal pain
• Vomiting
• Indigestion
• Fatigue
• Headaches
• Bloating
• Gas

There are some rarer but potentially serious side effects to consider as well. These medications have been linked to: 

• An increased risk of certain thyroid tumors, specifically if you have a personal or family history
• Inflammation of the pancreas, known as pancreatitis
• Low blood sugar, particularly when paired with other diabetes medication
• Kidney problems or kidney failure
• Allergic reactions to the ingredients in the medication
• Gallbladder problems 
• Gastroparesis, a permanent slowing of digestion, may have long-term side effects
• Elevated heart rate, called tachycardia

Weight loss medications are not recommended for people who are pregnant or breastfeeding. Discuss the medication with your provider if you have a history of pancreas or kidney problems.

How do weight loss medications work? 

The medications help people lose weight by mimicking the action of one of two hormones, called GIP or GLP-1. These hormones are released after eating, increasing the feeling of fullness and helping you eat less. 

They also trigger insulin release while stopping the release of another hormone called glucagon. This action results in lower blood sugar after meals, which is why they are used to treat diabetes.  

Many people taking the medications report they also reduce cravings and “food noise” or obsessive thoughts about food. It is currently unclear how the medications do this, but it may be due to its influence on certain regions of the brain.

Prescription weight loss medications are typically injections that you give yourself once a week, although some are available as pills. The dose of the GLP-1 medication is increased slowly every four weeks to allow your body to get used to the medication and lower the risk of side effects. You will start on the lowest dose and gradually increase to a therapeutic dose over a few months. You may not lose significant weight until you reach the higher doses of the medication after four to five months. 

Once you reach your therapeutic dose, the expected rate of weight loss is 0.5-1% of your body weight per week. This means if you weigh 200 pounds, you will lose one to two pounds per week. Most people lose 10-15% of their body weight over a year. 

Types of weight loss medications 

This new class of prescription weight loss medications was first developed to help people with type 2 diabetes control blood sugar. These medications contain one of two active ingredients: semaglutide or tirzepatide. Wegovy and Zepbound are the names of the medications specifically approved for weight loss. Ozempic and Mounjaro are approved specifically for the treatment of diabetes.

Weight loss medications are generally only available with a prescription from your healthcare provider. They are recommended for those who:

• Have already tried and failed with traditional weight loss methods, such as diet and exercise.
• Have a body mass index (BMI) over 30. 
• Have a BMI over 27 but also have medical conditions linked to excess body weight, such as diabetes or high blood pressure.

Even if you meet the above criteria, the medication may not be right for you. Therefore, it is important to discuss your options with your doctor.

Alternatives to weight loss medications

If you struggle with obesity, have already tried weight loss medications, and are searching for a non-surgical long-term solution, you may want to consider endoscopic sleeve gastroplasty (ESG) instead. ESG is a non-surgical, minimally invasive procedure that reduces the overall size of the stomach to help reduce portions and promote weight loss. Gastric balloons are another non-surgical option, involving the insertion of a balloon into the stomach to help with portion control and weight loss.

ESG is considered the most effective non-surgical weight loss procedure available. After a year, an average of approximately 23% of body weight is lost. It has also been found to improve blood pressure and blood sugar and reduce sleep apnea. Importantly, ESG is a single intervention that provides continuous support for years, without the need for ongoing medication injections or side effects.

If you are interested in learning more about ESG or gastric balloons, request a consultation with one of our providers at True You Weight Loss.