It’s the holidays so most people can expect to watch the scales move up. A WebMD article about holiday weight gain suggests that the problem is not that people gain a lot of weight during the holiday season but that they gain a little every holiday season — which they never lose and which adds up. Getting rid of that fat in middle or late age has seemed pretty impossible until recently. Over the past year, I’ve noticed that a number of my friends and family members have been winning the war on their weight. I’ve complimented them on the transformation and they made no secret of how they did it. They all took a “glucagon-like peptide 1” (GLP-1) receptor agonist, which in different forms, has been on the market for diabetes treatment for almost two decades.
In June of 2021, the US Food and Drug Administration (FDA) approved the drug semaglutide for chronic weight management under the brand name Wegovy. Since then, demand for Wegovy has outpaced production causing shortages of this injectable drug for diabetes management (for which it is marketed as Ozempic). Only last week the FDA approved tirzepatide injections for weight management under the brand name Zepbound. That one is also a treatment for diabetes sold under the brand name Mounjaro.
A recent issue of JAMA discusses some of the rare side effects that are being reported with these drugs. That’s par for the course when a new drug is used widely -– rare problems being to show up. Anesthesiologists are seeing aspiration problems because “NPO after midnight” may not be sufficient to ensure an empty stomach for surgery in patients with drug-delayed gastric emptying. There have also been cases of acute pancreatitis and gall bladder problems. However, the drugs cause an average weight loss of 15% of body weight. The results of Zepbound suggest an average loss of 20%. I mean, that’s incredible. For people who are simply “overweight,” that means they could get back to their ideal weight. For patients who are obese, that’s enough weight loss to reduce some of their medical complications.
Obesity is the primary problem for most patients in the waiting room of a wound center. It’s exciting to think there may be a treatment that does not require major surgery. However, so far these drugs are incredibly expensive and thus out of reach for most obese patients. It’s no surprise that compounding pharmacies are selling more affordable versions. The FDA has warned people not to take these knock off drugs since they may not be safe or effective – however, I know at least one person who used a compounded version for a fraction of the price with excellent results. Having been a clinical investigator in a drug trial, I understand why novel drugs are expensive. (Let’s face it, those patients with pancreatitis will probably sue the drug company – there are a lot of costs involved before and after a new drug comes to market.) But, as we approach another holiday season, what lots of people want for Christmas is a reasonably safe weight loss treatment that does not break the bank. Right now, at least there are reasonably safe weight loss treatments…