What is an anti-obesity medication?

Posted: Dec 04 in Weight Loss Medication by Dr. Lazarus

Did you know that obesity was recognized as a disease in 2013? Obesity is not thought to be the result of a lack of willpower (aka eating too much / exercising too little). It is a complex problem similar to diabetes.

While personal choices do affect the development of obesity, they also affect the development of many other chronic conditions including heart disease, diabetes and hypertension. Stress, lack of sleep, lack of exercise and unhealthy eating can cause high blood pressure, high cholesterol and heart disease, each of which we recognize as a disease. Similarly, these same things cause obesity – through similar mechanisms.

The recognition of obesity as a disease is important because while we understand that lifestyle changes are critical to success, so is good medical management. Much like we wouldn’t tell a patient with heart disease to try to have less chest pain, we don’t tell people with obesity simply to eat less when they are hungry. Both conditions respond well to lifestyle interventions and FDA-approved medications.

Anti-obesity medication

Since the recognition of obesity as a disease, 4 new medications are now approved by the FDA for chronic weight management in adults, 2 have been approved in kids down to age 12 (with a third not far behind), and we expect another new medication in 2023, and several by 2024.

Anti-obesity pharmacotherapy is recommended when lifestyle interventions do not provide adequate weight loss. They can double, triple, or even quadruple the amount of weight loss, and similarly, double to triple the odds of keeping the weight off.

Anti-obesity medications work through a variety of mechanisms ranging from decreasing the appetite to enhancing the sense of satiety so we don’t want to eat again shortly after dinner. They can also decrease hunger and cravings.

Chronic weight management

Weight loss medications are intended for long-term use, similar to medications for high blood pressure, high cholesterol or diabetes. The reason is that it is very clear that when anti-obesity pharmacotherapy is stopped, people regain roughly 2/3rds of the lost weight in the following year.

That’s why the FDA is holding anti-obesity pharmacotherapy trials to the same standards as medications for other diseases like diabetes. Pharmaceutical companies are required to study their drugs over the long haul and prove that they remain safe and effective, and that they don’t elevate risk for heart problems.

When willpower is not enough

While some people are able to achieve weight loss success with behavioral tools like intensive lifestyle intervention, oftentimes this does not provide adequate weight loss, or people struggle to sustain the weight loss that they achieved in the months to years afterwards. Powerful hormones exert their effects driving the weight back up to the previously established setpoint. It is estimated that 85-90% of people who achieve weight loss through lifestyle interventions regain the weight.

Anti-obesity pharmacotherapy opposes weight regain through a variety of mechanisms and is important to not only increase the amount of weight loss, but also to improve the odds of keeping the weight off.

FDA-approved anti-obesity medications can be in oral form (pills), or injectable form (daily or weekly injections). Unfortunately, most physicians are not trained in the use of these medications and don’t offer them to their patients, in spite of most national specialty society guidelines now calling for their use. While this is slowly changing, it is still estimated that less than 2% of people who would benefit from anti-obesity pharmacotherapy receive a prescription from their doctor.

Pills vs. Injections

Most of the oral medications (pills) double the odds of achieving and sustaining ~10% weight loss. So, for a 200 pound individual, they can help keep off 20 pounds. While more is possible by getting serious about the lifestyle component, this is the expected result of the oral medications for most people.

The newest weekly injections double to triple the odds of losing 15-20% of a person’s body weight. Wegovy averaged 35 pounds of weight loss in their STEP 1 clinical trial, while Mounjaro (approved for diabetes, applied for weight loss indication but this is pending as of the time of this article) averaged 52 pounds of weight loss in their first published study for chronic weight management. While these medications are expensive ($1,000 or more per month), many individuals have insurance coverage – check with your insurance company before you request a prescription of Wegovy from your doctor.

Obesity Medicine Specialist

Because it is a disease associated with 236 or more other medical problems, 13 cancers, and shortens lifespan 6-8 years, obesity should be treated by a doctor who understands all the complexities. Much like a hysterectomy should be performed by a gynecologist, you deserve to work with a doctor who is trained and experienced in obesity medicine.* The main organization certifying physicians in the U.S. is the American Board of Obesity Medicine. A properly trained weight loss doctor can help you get the most appropriate treatment option.

*Dr. Lazarus is certified by the American Board of Obesity Medicine and has 19 years of experience in clinical obesity medicine, and Heather Thomas PAC has practiced with him for 15 years.