Obesity has become a major health risk factor for the American public. Some facts published in 2018 by the National Health and Nutrition Examination Survey (NHANES) found that nearly 1 in 3 adults (30.7 percent) are overweight; 2 in 5 adults are obese; and 1 in 11 adults are morbidly obese.  

The National Heart, Lung and Blood Institute defines a body mass index (BMI) of 18.5  to 24.9 as a normal healthy weight. A BMI of 25 to 29.9 is overweight, and a BMI of over 30 is considered obese. A BMI of 40 and above is considered severely obese. 

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Being overweight and obese increases your risk for many health problems, including type 2 diabetes, high blood pressure, heart disease, stroke, joint problems, liver disease, gallstones, some types of cancers, sleep and breathing problems, and other chronic health problems, according to the Centers for Disease Control.  Because these conditions are so prevalent and many lead to premature death, the introduction of newer weight control medications has the public and the medical field very interested.

New drugs for weight loss

There are two types of weight loss medication in common use.  Ozempic, Wegovy and Rybelsus (an oral medication)  have the generic name of semaglutide.  Zepbound and Mountajaro are the trade names for tirzepatid.  Tirzepatid has been used for 10 years to control type 2 diabetes.  Both drugs help control diabetes by triggering  the release of insulin and slow the emptying of the stomach, so you feel full longer.

The U.S. Food and Drug Administration (FDA) has developed guidelines for those who are eligible for injected drugs like Wegovy. The guidelines include a BMI of over 30, or a BMI of over 27 and at least one serious medical condition, such as high blood pressure.

People who use these medications find they can lose up to 10 percent to 20 percent—or more—of their body weight in a year, depending on the drug that is being used. This weight loss stops and the weight could return, however, if this medication is stopped and the person was not following a diet and exercise regimen.   

Contraindications include a history of pancreatis, medullary thyroid cancer, multiple endocrine neoplasia syndrome (MEN2). Also contraindicated are women who are pregnant or attempting to conceive or breastfeed. 

There are some side effects commonly seen when starting these medications; those include nausea, vomiting, constipation or diarrhea, acid reflux, fatigue and stomach pain.  Benefits reported by patients include better mobility, less joint pain, lower blood pressure and the potential of resolution of sleep apnea.  

Some insulin-dependent people will find that their insulin usage decreases.

Other issues

Even though there is a huge demand for these medications, there are some issues that need to be considered.

Monthly costs for weekly injection range from $700 to $1400.   The drug plan you have can reduce this cost, but it all depends on your drug plan and your ability to absorb these expenses.  Your pharmacist can assist you in finding other locations to purchase these medications if the pharmacy is out. 

Because there is at times a shortage of injectables from FDA-approved companies, people sometimes seek out compounding pharmacies to prepare their weekly doses. Compounding pharmacies are not licensed or regulated like a usual pharmacy. 

The patients risk using an inaccurate amount of medication or receiving a complete substitution of another medication.

Other potentially serious side effects include vision problems, retina damage, swelling of arms and legs, rash, rapid heart rate, fever, yellow eyes and skin and trouble swallowing and breathing.  If there is a history of thyroid tumors, the use of semaglutides  can increase the chances of developing cancer.  Any of the above should prompt an urgent call to your physician.   In addition, there are a number of weight control medications on the market, and they should not be mixed with these newer medications.

Because these injectable medications are fairly new and the full extent of problems  with long-term use are not known,  you need to consult with your doctor  before starting. 

Because there is a demand for this type of medication, you might have difficulty finding  a source.  Even if you find a source, you still need to find out what is covered by your drug plan.  Many people may find that they cannot afford them long-term.  Many Medicaid and Medicare drug plans might require prior authorization before dispensing.

At this time, this type of drug is usually not approved for children under 12 years of age, but this is controversial.