HEALTHY SLIMMING
Weight loss medications aren’t exactly new, but they have recently gained significant attention. There is a surge of interest in semaglutides and tirzepatides for weight loss among people. With multiple applications and widespread positive feedback, these drugs offer various benefits. However, it is crucial to educate yourself before seeking a prescription. When it comes to slimming down, it’s essential to do so in a healthy manner.
Medications for weight loss have been around since the 1940s, when amphetamines were first used to boost energy and suppress appetite. However, their potential for addiction eventually became apparent. In 1959, the FDA approved phentermine, a new central nervous system stimulant, for weight loss, and over the decades, a slew of other drugs trickled into the market.
By the early 2000s, medications intended for diabetes management were also found to be effective in treating obesity. This begs the question, “What are the newer weight loss medications?” poses Dr. Juan Bautista of Bautista Health & Anti-Aging in Fresno. Included in the list of brand-name semaglutides and tirzepatides are Ozempic, Mounjaro, Wegovy, and Zepbound, to name a few.
Numerous factors determine whether someone is an ideal candidate for weight loss medications. At the forefront are patients who struggle with cravings and portion control, as these drugs target those issues. “The contrary would be a patient that actually has a very slow metabolism. Someone who says, ‘Doctor, I really don’t eat that much, and I still feel like I’m gaining weight.’ Those patients probably aren’t candidates. These [meds] are more so for patients that maybe have a family history of diabetes or, again, have difficulty with cravings and portion control,” Dr. Bautista explains.
It’s important to note that these medications work in multiple ways. “It works on decreasing inflammation,” Dr. Bautista begins. “There’s a big article recently published at Oxford that showed a decrease in Alzheimer’s by almost 86%. These studies have been shown to decrease the risk of heart disease and strokes. … And then, the one that is obviously how it got started, with regulating insulin. … These aren’t really new medications. These are medications that are just kind of getting better.”
Weight loss medications used to be administered once a day, and that was the norm for about fifteen years. However, the general consensus was that patients were hesitant to take daily injections due to the misconception that they were similar to taking insulin. “By making it a once-a-week injection, the compliance just got much better,” Dr. Bautista shares. “I would say probably within the last three to four years, it’s really become popular.”
Most weight loss medications are administered via injection, but the semaglutide Rybelsuscan be taken orally. “It did have a really good trial for diabetes, but it didn’t get the same effects as for weight loss. And one of the reasons we think that is because semaglutide and tirzepatide are what are called peptides,” Dr. Bautista explains. “Peptides are a chain of amino acids which give a message, a signal. Insulin is a peptide. It was actually the first peptide synthesized. So they tend to work better when they’re given through injection, subcutaneous injection, because it’s cleaved really quick in the body.”
Maintenance regimens vary for each individual. For many, once they reached their desired weight and discontinued medication, cravings and poor portion control often returned. “So many doctors started giving a maintenance dose, which could be once a month, twice a month, or every other week,” Dr. Bautista remarks.
Many people experience additional benefits from peptides beyond weight loss, such as reduced inflammation and joint pain. “Everywhere from rheumatology to primary care, internal and family medicine have really seen a benefit of keeping patients on a low dose maintenance, not only for weight, but also for comfort of the patient,” Dr. Bautista notes. “They’ll discuss less cravings for cigarettes and alcohol, which is big. So a lot of people will end up doing very well because, again, using what are called peptides—it’s working on your body’s own signals.”
“Because it’s such a popular medication for people who want to lose weight, there are side effects. The main one being—and it was a study that was done with Wegovy initially—the loss of muscle mass,” Dr. Bautista points out. “As we get older, we start eating less meat, a lot of us. And in reality, our protein requirements increase. So if you’re eating less protein, you’re eating less altogether with something like Wegovy (semaglutide) or Zepbound (tirzepatide). You have to be careful that you’re not losing muscle mass. We call that sarcopenia.”
A good doctor will monitor the broader implications of weight loss medications. “It’s more than just weight,” asserts Dr. Bautista. “You can lose a lot of muscle mass, which can, in reality, be also detrimental to your health. We know there are studies with lots of muscle mass and not only osteoporosis, but things such as Alzheimer’s.” It’s crucial that people who are taking weight loss medications maintain their muscle mass and engage in regular exercise, combining portion control with cardiovascular fitness. “You want someone that definitely is involved with their patients,” he says. “We want to make sure that people aren’t just starving themselves with their exercises.”
Risk stratification is a great starting point when considering weight loss medication options. Doctors should ideally assess your BMI, nutritional habits, exercise routines, metabolism, and family history of diabetes and obesity. “Where is this patient at now health wise? Are they just struggling with cravings? Are they struggling because they don’t know how to eat properly? Does diabetes run in their family? Those are all important questions to ask,” says Dr. Bautista. “My goal is really emphasizing that you have to do this along with exercise and nutrition.”
While all patients can benefit from a healthy gut from the outset, those with gastric issues must be particularly mindful that weight loss medications can cause severe constipation. If you plan to travel or undergo surgery, you may need to stop taking said medications for a doctor-recommended period. “The root we see in practice is that it’s really not dose-dependent. Some people do very, very well in low doses and some people require high doses. Everybody’s unique,” reiterates Dr. Bautista.
“Learning what your resting metabolic rate is, how your body processes food, your digestion—those are all important factors not only for your success with things such as semaglutides, but also your comfort with it. Because if you and I took Ozempic, Wegovy, semaglutide, and we’re losing weight, but we’re miserable, it’s not going to be very fun. You can make it a much better experience by knowing and expecting some of these things and working on it,” says Dr. Bautista.
Life happens, and it’s important to be present with the best mind and body possible. If you plan to visit family over the holidays and want to indulge in tamales and stuffing, consider skipping your dose that week, Dr. Bautista suggests. “Those are all things that if you know in advance, in my opinion, makes it a much more pleasurable experience with a lot less side effects.”
Interestingly enough, “a lot of these medications actually started for neurodegenerative disorders,” Dr. Bautista adds. “You’ll see is a lot of us doctors put some of our elderly patients on very low dose Ozempic, low dose Mounjaro. We’re not trying to get the weight loss because we need those older patients eating, but we’re seeing such a benefit in some of their neurocognitive diseases such as Alzheimer’s, Parkinson’s in the hospital. Many people call Alzheimer’s type three diabetes. Isn’t that amazing? So there’s a lot more coming down the pipeline with these patients.”
With increased demand comes a responsibility to use these medications appropriately. “Of course, it’s about using it properly. It’s about informing the patient, but also for that patient to be invested as well and say, ‘We’re doing this for neurocognitive protection, for cardiac protection.’ We’re going to stick with low, low doses.” Dr. Bautista continues, “We’re using it for weight loss. But we’re also going to work on nutrition, protein intake, and exercise. So those are all things that I think are very, very important for patients to know—that it’s not just giving medication and losing weight.”
Being your own advocate and understanding how weight loss medications work is imperative. Dr. Bautista explains, “If there’s a demand for it, there are going to be people that give it. But you have to look in the mirror and say, ‘We’re doing a good job.’ And I think there are plenty of doctors in the Central Valley and across the US that are doing a great job. There are always going to be outliers. But as a patient, though, you should always be an advocate for yourself, too. If there’s a medication that you’re going to take, you should read up on it and understand how it works so that you can expect some of the side effects.”
Editorial Director Lauren Barisic
Photographer Cait Fry
