SAN ANTONIO – New medications promising major weight loss are on the rise, but their growing use is sparking questions about effectiveness, safety and the true challenges behind America’s battle with obesity.
The use of GLP-1 medications such as Wegovy, Ozempic and Mounjaro has has exploded. Americans spent $132 billion on these drugs last year, which now make up about 14 percent of prescription drug spending in the U.S. Experts say the country is facing an obesity epidemic and in Texas alone, about 10 million adults and one in five children are considered obese. In Bexar County, at least 65 percent of residents are overweight or obese.
GLP-1 medications were originally created for diabetes care. Dr. Aruna Venkatesh from University Health says these medications have radically shifted options for care.
“In sort of a simplistic manner, they work on the natural signals of hunger and feeling of fullness. Just very simple. And what they do is they decrease the sense of hunger and increase the sense of fullness,” explained Dr. Venkatesh.
Dr. Carolina Solís Herrera from UT Health San Antonio wants people to understand obesity’s impact.
She explained, “Obesity is not an obsession or just trying to look good. It’s a chronic inflammatory disease that needs long-term therapy. And unfortunately, in the last 100 years, we haven’t been able to find drugs that are effective, efficient, that have additional benefits like cardiac benefits, renal benefits.”
Dr Solís Herrera added that untreated obesity is associated with roughly 200 complications.
Some patients shared personal stories about using GLP-1s.
One woman who started the medication in 2020 said, “I have lost more than 60 pounds, and the nausea was very minimal in the very beginning.”
Another explained that she relied on the medications for her weight loss but noticed her muscles were initially achy, emphasizing the need to stay active.
However, the medications are not without risks. Common side effects include nausea, vomiting, diarrhea, stomach pain, acid reflux and fatigue. Some rare but more serious side effects can be pancreatitis, gallbladder problems, kidney injury, thyroid tumors and changes in vision.
For some, the adjustments have been tough. “It’s been a catastrophic adjustment for me. I can’t drive. I lost my job,” explained one GLP-1 user.
There are also concerns about counterfeit medications.
Dr. Solís Herrera pointed out, “We do not recommend compounding. Neither of our societies do – the American Association of Clinical Endocrinologists, the Endocrine Society or the American Diabetes Association – because there have been multiple studies that have shown that these compounded drugs have caused hospitalization, they have caused seizures, they have caused death.”
Experts on the panel explained that weight loss achieved through GLP-1s or any means can lead to muscle loss, so resistance training and sustainable diet changes are important.
“Weight loss is a lot more complicated than it’s made out to be on social media, for sure. There are so many things at play for someone and whether or not they are able to achieve it. So we have our biology, our genetics, our environment, our mental health,” explained Chelsea Crawford, a registered dietitian with Fuel for Life Nutrition.
When it comes to stopping GLP-1 medications, weight regain is expected.
“If you stop the GLP-1, there is no legacy effect on GLP-1s. So it might linger for about two months, which is the half-life, but then after that you’re going to start regaining the weight, you’re going to start getting hungry and then that’s where the frustration comes,” said Dr. Solís Herrera.
Our experts also addressed mental health and the stigma around obesity.
Dr. Solís Herrera noted, “One of the [problems] of obesity is the stigma. And stigma is something that we don’t talk about a lot because even physicians and health providers, not only the society and patients, think that it’s a lack of willpower, a lack of discipline, a lack of exercising more and improving your diet. But that is not correct. Now, the stigma is real, but obesity is 60 to 80 percent genetic.”
Viewer questions flooded in about everything from fertility to insurance coverage.
On surprise pregnancies linked to weight loss drugs, Dr. Venkatesh said, “When you lose weight, you’re actually addressing that indirectly even though you didn’t mean to and therefore there’s a relief of that underlying reasons for not being able to conceive and you basically have treated that.”
Panelists cleared up confusion about drug names such as Wegovy, Ozempic and Mounjaro. Venkatesh explained, “They’re not – I want Wegovy, Ozempic is not working. It’s the same medication.”
The panel also addressed access.
Solís Herrera outlined: “A BMI or a body mass index, which is an equation associated with your weight and your height, that is more than 27 with one complication associated with obesity like hypertension or hyperlipidemia or having a body mass index of 30. There are other indications depending on the drug, like if you have sleep apnea, for example, if you have fatty liver, which is about 90 percent of the patients with obesity and diabetes.”
Stories of personal journeys offered hope and realism.
Rachel Dickens, who had a gastric sleeve in 2012, said, “It really is just making those changes and sticking with it, no matter what tool that you use.”
Meanwhile, Alex Longoria-Mendoza emphasized balance, “Just because you’re on a GLP-1 and just because you’re trying to lose weight, it doesn’t mean that you can’t have the things that you, you know, still love to have.”
Other experts encouraged people not to give up or be discouraged by setbacks.
“Slow and steady wins the race,” Crawford said.
As to the future, Dr. Solís Herrera said, “There are many ways that we can try to request the medication to the insurance companies. And now with the bridge program with Medicare, also patients with a BMI of 27 and prediabetes, which is 1 out of 3 Americans, are eligible for the medication if they have Medicare Part D. So there are many ways that we can explore this path.”