Given their side effects, weight-loss drugs might not be good for all

When will we see through the haze of drugs like Ozempic and Wegovy?

Hopefully soon. These drugs might reach 30 million U.S. users by 2030. Surging, off-label demand has come with unintentional overdoses, rising prices and medication shortages. Further expansion seems likely with the Food and Drug Administration’s recent approval of another class of medications to reduce the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and either obesity or overweight.

These medications, called GLP-1 receptor agonists or semaglutides, have gotten the attention of the New York City Council. One member has proposed a law requiring the city health department to release information on the consequences of off-label use of these medications for weight loss.

About 20% of patients taking GLP-1s for weight loss experience nausea and vomiting; 30% get diarrhea. Add headaches, swelling of nasal passages, allergic reactions, pancreatitis, and fatigue to the list, along with rare cases of thyroid cancer in laboratory animals.

Admittedly, bariatric surgery, my area of expertise, also poses risks, like any surgical procedure. Still, it remains a safe, long-term option offering better long-term control of weight and glucose levels than medical therapies for patients with Type 2 diabetes. Patients need accurate information about the risks and benefits of all options.

There is no denying: Semaglutides are a powerful class of drugs helping push back on the obesity epidemic. They offer weight loss, reduced appetite, and slower emptying of the stomach that makes patients feel full faster.

I’ve also seen at my Great Neck-based practice what can happen when patients stop taking semaglutides. It can trigger weight (re)gain, a greater appetite, a surge of blood sugar, and lean muscle mass loss with body fat percentage gain. There can be withdrawal symptoms.

Data, physician awareness, and patient education can help us assess what’s best for each patient, medication or bariatric surgery. The lack of knowledge translates into only about 200,000 patients per year pursuing weight-loss surgery — about 1% of those who qualify for it.

Physicians need to share that bariatric surgery remains an effective, long-term tool that has become safer and less invasive. It can be highly effective for weight loss and management of obesity-induced complications, especially when surgeons use minimally invasive procedures. This approach, used in 90% of bariatric surgeries, results in shorter hospital stays, less blood loss during procedures, less postoperative pain, and fewer pulmonary complications and wound infections.

We need to review data comparing outcomes for patients who have undergone gastric bypass, sleeve gastrectomy, and intensive medical therapy alone. Of patients who underwent medical therapy, 12% achieved the desired diabetes targets after a year, but positive effects of metabolic surgery lasted longer and also improved cholesterol and triglyceride levels. Those advantages must be considered against potential post-surgical drawbacks like anemia or gastrointestinal problems.

It’s clear semaglutides have tremendous potential, though we don’t yet know their full impact. If we can find optimal ways to wean patients off those them, perhaps they might help patients maintain weight loss after bariatric surgery.

Semaglutides also have opened the door to reframing obesity as a medical condition — without shame. When we can consider weight-loss options without stigma, patients are better positioned to receive information from their doctors and make decisions. The less starry-eyed we are, the better we can focus on the positive, long-term health outcomes each patient deserves.

 THIS GUEST ESSAY reflects the views of Dr. Aurora Pryor, system director for bariatric surgery at Northwell Health and surgeon in chief at Long Island Jewish Medical Center.