Weight Loss Medications
Have Changed the Game
There’s no doubt about it, the new wave of weight loss medications – particularly the GLP-1 receptor agonists – have changed the weight management game for good.
For many people, they offer the first non-surgical promise of sustained weight loss (the weight loss holy grail!). And they have been seen – by the public and members of the health professional community supporting them – as a magic pill that can solve all of your weight worries.
But while they can be a powerful tool, and one that is helping many people on what can be a long and difficult journey, there are important details that most people aren’t aware of when they buy the promise of a magic weight loss drug.
We Are All Learning Together
Over the past five years, my professional focus has been learning all about weight loss medications. During the last three, I have enjoyed sharing my knowledge with fellow health professionals – mainly doctors, dietitians, and psychologists – helping them to understand the interplay between the psychological, behavioural, and medical elements of the weight loss medications journey. I have also loved sharing this knowledge with my clients – helping them to decide whether weight loss medications may be worth incorporating into their journeys, and – if so – helping them get the best results possible with them.
I have also learned so much from other health professionals – as well as my clients – this is absolutely a space we are all learning about together.
But I have realised that – until now – I haven’t shared any of this knowledge with you. And I believe it’s knowledge you deserve to know. So – whether you are currently taking weight loss medications or considering whether they might be right for you – over the coming weeks I am going to share some ideas that I believe can profoundly improve your experience with them.
And I think this conversation should begin by discussing some of the things you may not be aware of …
Three Important Considerations Most People Miss
We hear all about the benefits weight loss medications can provide: the reduced appetite, freedom from ‘food noise’, and – of course – weight loss. That’s what makes them so attractive to us!
But it’s not until we consider all of the factors – positive and negative – that we can make a truly informed decision about whether they are right for us as unique individuals.
So I wanted to share three downsides of weight loss medications that I think people should know about.
1. Most people regain weight when they stop. The clinical trials show this clearly – when people discontinue weight loss medications, most regain a significant portion of the weight they lost, often returning to their pre-medication weight or higher. This isn’t a personal failure. It’s a predictable physiological response. But it’s one that most people simply aren’t warned about.
Example of continued weight loss on continuing semaglutide (Ozempic / Wegovy) VS weight regain when discontinuing semaglutide (switching to Placebo medication)¹
2. Muscle loss is a real risk. Research suggests that when people lose weight on weight loss medications, they can lose significant muscle mass alongside fat mass. But if they regain weight after stopping the medication, it is generally regained as fat, not muscle. This means their body composition is actually worse than before they started, even if the number on the scales is similar. I don’t think enough people are told that there is a possibility they could be worse off after taking weight loss medications.
Weight loss on semaglutide divided into fat mass (fat) and fat free mass (muscle and bone)²
3. The psychological side effects can be serious. This is the part that concerns me most as a clinician. While we tend to be aware of the physiological side effects (nausea, headaches, diarrhea, and vomiting etc.) we are less aware of the psychological side effects. While they are only experienced by a small number of people, they can be severe, and even life threatening. The most commonly reported psychological adverse effects are depression, anxiety, and suicidal ideation.³ Further, depression rates are higher for people who stop weight loss medications and regain weight, so the risk of adverse psychological effects increases if you don’t attain the long-term results you are hoping for.4 This is why I often advocate for psychological screening and support as an important part of any weight loss medication journey.
So What Can Be Done About It?
The good news is that – if you are taking weight loss medications or ever decide to in the future – there is a lot we can do to minimise the risks whilst maximising the benefits.
But it’s not until we understand the totality of the medications – their pros and their cons – that we can make the most informed decisions about if we are to use them, and – if we do – how to use them most effectively. It is this information that I’m looking forward to sharing with you over the coming weeks!
Yours in aware, supported, and empowered transformation,
Glenn
P.S. If you would like to explore working with one of our psychologists at Weight Management Psychology (including myself) for support with your weight loss medication journey, feel free to reach out to our team at any time.
1. Wilding, J. P. H., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., Kushner, R. F., & STEP 1 Study Group (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, obesity & metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725
2. Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F., & STEP 1 Study Group (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England journal of medicine, 384(11), 989–1002. https://doi.org/10.1056/NEJMoa2032183
3. Tobaiqy M, Elkout H. (2024). Psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide: a pharmacovigilance analysis of individual case safety reports submitted to the EudraVigilance database. Int J Clin Pharm. 2024 Apr;46(2):488-495. doi: 10.1007/s11096-023-01694-7.
4. Tucker, M. E. (2023) Tirzepatide weight loss continues on and off drug at 1 year. Medscape. Accessed February 3, 2024 https://www.medscape.com/viewarticle/997152?form=fpf
