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  • Writer's pictureAlan Frischer, MD, MPH

Weight Loss

In my practice, not a day goes by without a request for weight loss drugs. Obesity has become an enormous (no pun intended) problem in our country. If we define obesity as having a BMI (Body Mass Index) of over 30, then over 42% of Americans are obese! For many years, the only drugs available were potentially dangerous, and had little or no lasting benefit. The weight tends to come back…and then some. You may recall the notorious weight loss drug fen-phen, which was taken off the market in 1997 due to numerous and serious side effects. And how can we forget Xenical, which can indeed lead to some weight loss…along with diarrhea? This drug is still on the market, along with several others.

There may finally be a more effective and safer drug available, and I feel that it is worth sharing here. (I am aware that it may appear that I’m being paid by a pharmaceutical company. I am NOT.)

The FDA (Food and Drug Administration) has approved Semaglutide, a once a week, injectable drug. It was originally used as a diabetes medication to lower blood sugar levels…and also happened to cause weight loss. This GLP (glucagon-like peptide) drug is now available for weight-loss purposes, and it is no longer necessary to be diabetic in order to have prescribed. (Fortunately, this product does not lower blood sugar levels in a non-diabetic.) Note that, like all newly approved medications, it may not be covered under your insurance.

For weight loss, Semaglutide will be marketed as Wegovy. Wegovy is intended for the obese, or for those who are merely overweight, but also have at least one weight-related ailment. It is not intended to work magically on its own, but is to be used along with reducing calories and increasing physical activity.

The FDA approved it for weight loss in 2021, after analyzing its safety and efficacy. Study participants showed an average 15% to 18% weight loss over 68 weeks. No other drug has come close to producing this level of weight loss. It appears to reduce hunger and increase the feeling of fullness, by mimicking a hormone that targets areas of the brain that regulate appetite.

This drug does have some gastrointestinal side effects, but they appear to be brief, and range from “mild to moderate.” There is one dangerous potential side effect (carrying with it a “black box” warning): It’s possible that it may increase the risk of thyroid tumors, including thyroid cancer. The FDA and medical experts have concluded that the huge health benefits of weight loss outweigh the risk of this possible side effect. So, unless you are at risk for this rare cancer, your doctor is allowed to prescribe it.

Obesity carries with it a high risk for so many serious health conditions, including heart disease, diabetes, and high blood pressure. I urge you to discuss with your doctor whether this new treatment option might be a good choice for you.

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