Pharmacologic treatments for obesity

A healthy, wellbalanced diet coupled with physical activity has long been touted as the treatment for losing weight. However, in recent years, new drugs have been making headlines as being the key to treating America’s obesity epidemic.

“Some obesity specialists welcome these new medications as tools to treat obesity as an alternative to bariatric surgery,” said Lauren Amaya, Oklahoma State University Extension prediabetes/diabetes specialist. “Medications such as Mounjaro, Wegovy, Ozempic, Zepbound and others are making headlines as effective treatments for obesity.”

Obesity management aims for weight loss to improve a patient’s overall health. Being overweight or obese can increase the risk of heart disease Type 2 diabetes, high blood pressure, high cholesterol, sleep apnea, non-alcoholic fatty liver disease, osteoarthritis and more.

Obesity clinical practice guidelines indicate there are three pillars of lifestyle interventions when it comes to weight loss, including behavioral and psychological therapy, pharmacotherapy and bariatric surgery.

Amaya said the extent of the required weight loss on improved health depends on the patient’s initial body weight and obesity-related comorbidities.

“Lifestyle interventions such as increased physical activity and eating a reduced-calorie diet resulted in a modest weight loss of approximately 3-5%, which is often inadequate to achieve weight-related health goals,” Amaya said. “Clinical trials with the new obesity medications indicate patients experience a 15-25% weight loss within the first year, while some participants achieve less than 10% weight loss, especially those with diabetes. It’s important to remember everyone’s response to these medications will vary.”

Amaya said there are risks to consider when it comes to rapid weight loss.

“Some of the stage 3 clinical trials associated with semaglutide and tirzepatide have shown these drugs cause up to 40% loss of lean body mass,” she said. “This puts individuals, especially older adults, at significant risk for sarcopenic obesity, which is a person with both muscle loss and obesity.”

To help mitigate the loss of lean body mass, people need to consume enough calories and protein and participate in resistance physical activity.

While most insurance covers medications for diabetes and other health risks that are the result of obesity, most do not cover the cost of weight-loss/ weight-management medication. The medications are expensive. The cost, if not covered by insurance, can be a significant barrier for many people. And, if people do acquire them, they may not have the ability to stay on them long-term.

“Long-term and equal access to new obesity medications is challenging due to the cost,” she said. “However, competition from new medications entering the market may drive down prices over time as older drugs lose patent protection. This would open up the market to those who may be priced out of the market at this time.”

Amaya said current research shows some people gain the weight back when they go off the medication, even when trying to maintain a healthy lifestyle. While the weight loss itself may decrease risks of certain chronic diseases, if lifestyle changes aren’t made, this benefit may be short-lived.

“Unfortunately, when people gain back the weight they lost they are gaining fat, not necessarily the lean body mass they lost initially,” she said. “From a health standpoint, this actually puts them in a worse place than they were before.”

This is a new era of obesity management, and it is yet to be seen how future funding from national health systems and/ or private health insurance will play out because at this time there’s a lack of cost-effectiveness data.

For more info, contact Risley, at the OSU Cooperative Extension Service in Sequoyah County at 918-775-4838 or janis. risley@okstate.edu.