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Editor’s Note: In “Hey, Health Coach,” Sarah Hays Coomer answers reader questions about the intersection of health and overall well-being. Have a question? Send her a message (and don’t forget to use a sleuthy pseudonym!).
Hey, Health Coach,
I have a couple of friends who are on new prescription weight loss drugs. One of them is taking pills and the other is giving herself shots. I have a solid 40 or 50 pounds to lose, but I’ve been burned by so many quick fixes for weight loss. What’s the research behind these new drugs? Are they safe, and do they work
– Wishing For A Magic Pill
I’m grateful for the way you’re approaching this question. Weight carries so much undue societal pressure. It’s an emotional topic for many people, and, as you mentioned, the question of how to lose weight can lead to all kinds of confusing and misleading information and methods.
As a health coach, my job is to help people implement lifestyle, behavioral or clinical support systems that they determine (in communication with their health care providers or other caregivers) will contribute to their health and well-being. Like you, I’m wary of false promises and the long-term safety of new treatments, so our best way forward is to rely on existing science and research and consult with experts along the way.
Since we’re talking specifically about prescription weight loss drugs here, your doctor would be the most viable resource for information about whether any new options are right for you. However, I’m hearing this question a lot, so I’ll do my best to shed light on what these new drugs are and how safe and effective they appear to be.
In 2021, the Food and Drug Administration approved Wegovy for weight loss. It’s an injectable medication called semaglutide—the same active ingredient in Ozempic, which was approved for treatment of type 2 diabetes in 2017. They are both administered through a weekly injection, usually at home.
According to the FDA, Wegovy mimics a hormone that targets areas of the brain that regulate appetite and food intake, causing users to feel fuller faster. It should not be used with any other weight loss prescriptions or over-the-counter weight loss supplements. Wegovy is approved for people with a body mass index (BMI) of 30 or greater, as well as people with a BMI of 27 or greater plus an additional health risk like heart disease, high cholesterol or high blood pressure.
Research shows that with a reduced calorie diet and exercise, semaglutide can be effective for weight loss. The New England Journal of Medicine published a 68-week study of nearly 2,000 participants where people taking semaglutide lost an average of 34 pounds compared to 5 pounds in the control group[1].
However, semaglutide has a long list of possible side effects, the most common of which include nausea, diarrhea, constipation, headache and fatigue, among others. The clinical trial reported these side effects frequently subsided over time. The medication also comes with warnings about an increased risk of thyroid cancer, pancreatitis, gallbladder problems, kidney disease and suicidal thoughts.
Harvard Health confirms that Wegovy is approved for long-term use, and researchers are still developing a study concerning the medication’s long-term effects on heart disease and stroke in overweight and obese patients.
Overall, Wegovy does help a lot of people lose weight, but it requires taking shots and carries a notable risk of side effects.
Mounjaro is a different drug called tirzepatide. As of October 2022, it’s only FDA-approved for treatment of type 2 diabetes. However, in a phase three trial of 1,879 people with type 2 diabetes, this drug showed even more significant results for weight loss than Wegovy, with patients losing an additional 5 to 12 pounds more than patients taking Wegovy, depending on dosage[2]. It works with two different receptors to reduce appetite and stabilize blood sugar rather than just one.
Mounjaro is also administered through a weekly injection. Side effects are similar to Wegovy, though the comparative study in the New England Journal of Medicine mentioned above noted that serious adverse events were reported in 5% to 7% of participants who received Mounjaro and in 3% of those who received Wegovy.
This medicine has been shown to be effective in the treatment of type 2 diabetes, and some doctors are prescribing it for weight loss, though it isn’t officially approved for that purpose.
A number of weight loss pills are available by prescription, but the newest one I’m aware of is Plenity, which is made by biotherapeutics company Gelesis. Approved in 2019 for people with a BMI of 25 or higher, Plenity is a superabsorbent hydrogel pill that expands in the stomach with food and water to create an increased sense of fullness and satiety.
In a double-blind study of 436 adults with overweight or obesity, participants were instructed to exercise 30 minutes a day and eat 300 calories below their calculated energy requirement. On average, the group taking Plenity lost 6.4% of their body weight while the placebo group lost 4.4% of their body weight. The most common side effects experienced by both groups included diarrhea, distended abdomen, constipation, nausea and flatulence.[3]
According to the National Institutes of Health, other oral weight loss prescriptions include Xenical, Qsymia and Contrave.
The Gelesis website reports that its hydrogels are “designed to mimic some of the effects of eating raw vegetables,” which begs the question: Why not just eat more raw vegetables to fill up? More vegetables are generally a great idea, but life isn’t always that simple. Some people don’t have access to fresh produce, and others simply don’t have the bandwidth or ability to change ingrained habits without additional support.
When people are facing significant concerns about their health, their health care providers may determine these treatments are the best way to reduce their risk of serious health complications. What patients do with that information is up to them.
Everyone has the right to decide—without judgment or recrimination from others—what medical treatments they receive and when to refuse that care.
Some people will stay on these medications for a few months while working on their diet and exercise routines. Others will stay on them indefinitely, and many will choose behavior and lifestyle changes without medical support.
Regardless of what you decide, exercise and nutrition are essential components of any healthy life, and small changes can make a big difference. In fact, research shows that walking at a moderate intensity for 15 minutes a day can increase your life expectancy by three years, and that’s just one example[4].
If you’d like to learn more about how to build healthy habits beyond these medicines, check out my previous Hey, Health Coach column, How Can I Stay on Track with My Goals?
“Hey, Health Coach” is for informational purposes only and should not substitute for professional psychological or medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your personal situation, health or medical condition.
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Sarah Hays Coomer is a Mayo Clinic and National Board Certified Health and Wellness Coach, certified personal trainer and author based in Nashville, Tennessee. She has spent nearly 20 years helping individuals and groups build personalized systems to ease chronic stress with self-selected, concrete behavioral changes. She has contributed to many publications, spoken at organizations and universities nationwide, and written three books: The Habit Trip, Physical Disobedience and Lightness of Body and Mind. You can find her on her website, LinkedIn or Instagram.
Alena is a professional writer, editor and manager with a lifelong passion for helping others live well. She is also a registered yoga teacher (RYT-200) and a functional medicine certified health coach. She brings more than a decade of media experience to Forbes Health, with a keen focus on building content strategy, ensuring top content quality and empowering readers to make the best health and wellness decisions for themselves.
