It’s not uncommon for Fatima Cody Stanford to see patients who, for years, have tried dozens of different diets and workout routines only to find that the needle on the scale still won’t budge — or if it does, it won’t stick.
“Unfortunately, we have this idea that diet and exercise solve obesity,” says Stanford, M. D., an obesity medicine physician scientist at Massachusetts General Hospital in Boston and an associate professor of medicine and pediatrics at Harvard Medical School. But for many people, it’s more complex than that.
Everything from genetics to stress to competing health conditions — even age — can make it hard to shed excess pounds. And when diet and exercise don’t deliver, a prescription may be able to help.
A new generation of drugs is helping some people with obesity (which is defined as having a body mass index, or BMI, of 30 or greater) lose more weight and, in turn, reverse other related health conditions associated with obesity, like heart disease, diabetes and sleep apnea.
Experts say the potential of these medications could be dramatic and far reaching, given that obesity affects more than 40 percent of U.S. adults and puts a $173 billion strain on the health care system each year. Among adults ages 60 and older, obesity is even more common, affecting about 43 percent of the older population.
Here’s what you need to know about weight-loss medications and whether you should talk to your doctor to see if one might be right for you.
There’s a new generation of drugs
Several prescription medications have been approved for long-term use by the U.S. Food and Drug Administration (FDA) to help treat obesity. But it’s a class of injectable drugs that mimic a hormone called glucagon-like peptide-1 (GLP-1) that has “generated a lot of enthusiasm,” says Dina Griauzde, M.D., an assistant professor of internal medicine at the University of Michigan Medical School and an internist at the VA Ann Arbor Healthcare System. And that’s because they can be about twice as effective as some of the older medications on the market.
For example, people who use semaglutide (brand name Wegovy), which is one of these new GLP-1 drugs, shed, on average, about 15 percent of their body weight over the course of several months — that’s about 30 pounds for a 200-pound person. Losing just 5 to 10 percent of body weight can improve blood pressure, cholesterol and blood sugars, according to the Centers for Disease Control and Prevention.
The drug works by targeting the areas of the brain that regulate appetite and food intake. Semaglutide also helps to lower blood sugar levels, which is why it and liraglutide (brand name Saxenda), another GLP-1 medication that’s FDA-approved for weight loss, have been used for years as a treatment for type 2 diabetes.
Another GLP-1 medication, known as tirzepatide, hasn’t yet been cleared by the FDA for obesity treatment, but like liraglutide and semaglutide is an FDA-approved diabetes drug. A recent study published in The New England Journal of Medicine found that it led clinical trial participants to lose, on average, about 20 percent of their body weight.
It’s important to note, however, that these newer drugs don’t work wonders on everyone, and that some of the weight-loss drugs that have been around longer are still very effective in certain individuals. “With all of these medications, there’s wide variation in outcomes,” Griauzde says. “We’re never going to have a one-size-fits-all approach to obesity.”