The Risks of Weight Loss Medications (Wegovy & Zepbound): Real or Hype?

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There is a certain confidence that comes with FDA approval, and if you know anything about the process, you understand that the path to approval is lengthy, expensive, and arduous. So much so that many drugs and devices never get to market because of these costs alone.

As such, weight loss medications like Wegovy and Zepbound should inspire confidence, right? Well, we have heard of several, sometimes scary, side effects that may come with the use of these drugs. Some of these concerns are below:

• Gallbladder disease
• Pancreatitis, or pancreas inflammation
• Other G.I. concerns include constipation, diarrhea, nausea, and vomiting
• Gastroparesis – a condition in which the stomach is essentially paralyzed
• Suicidal ideation
• Hair loss
• Various aesthetic concerns
• And more

With Clinical Trials, What Gives? Why Weren’t These Discussed More During the Approval Process?

There are several reasons for this, including:

• A sample size is defined during clinical trials, which is necessarily smaller than the entire population that will qualify for the drug. As such, with such wide adoption, there are bound to be side effects that would not be caught during clinical trials.
• Patients vary in their habits and their existing conditions and diseases. During these trials, it’s virtually impossible to account for everybody’s lifestyle or health status.
• Some of these concerns still need to be fully understood and may or may not be attributed to these weight loss drugs, requiring more research.
• Finally, some of these concerns may not be considered significant or widespread enough to change the approval status despite being uncomfortable or even debilitating for some.

Just think about the last time you saw a commercial for a blockbuster drug. You may have been shocked at the possible side effects associated with its use. It is the simple fact of drug development – if the benefits significantly outweigh the risks, it’s likely to be approved. But they all come with risks.

Expectations and Considerations of Taking These Drugs

It’s important to understand several things about these drugs that are almost universally true. Knowing this information before taking the drugs could help better manage expectations and understand risk.

• First, we do not know the long-term effects of taking these medications. As such, it’s essential to use these drugs as a springboard for a renewed lifestyle such that if you eventually discontinue them, you have developed the habits needed to maintain that weight loss. Unfortunately, many patients do regain weight once they stop the drug if they have not acquired these new and improved happens.
• Because you will be adjusting to far less food – you won’t be hungry – there is a risk for muscle wasting, osteoporosis, especially in middle-aged post-menopausal women, and nutritional deficiencies. These must be mitigated through proper supplementation and close oversight from your weight loss or primary care physician. It may be tempting to use online purveyors that do not fully understand your medical history, but this may not be advisable.
• Many patients will experience side effects ranging from minor ones like nausea to more severe concerns like pancreatitis. Do not assume these can be ignored because they are listed as possible adverse effects; speak to your doctor and manage these side effects appropriately.
• For some, these drugs won’t work or will lose effectiveness over time. In this case, speaking to a qualified weight loss specialist like a bariatric surgeon could be an excellent way to understand how to proceed.
• We all have different insurance requirements, coverages, and financial means. Remember that these drugs must be taken to offer the slated benefit. If you stop taking these drugs, you will likely regain some weight, though this can be mitigated through proper diet and exercise habits that you may have developed while taking the medication.
• Don’t forget that rapid weight loss has some potential aesthetic effects. You may develop hanging or excess skin. The shrinking of fat cells around the body may not be uniform, and you may find that anything from your face or even labia may lose volume before your tummy, thighs, or upper arms do. There’s no way to predict how this will affect you.
• These medications do not address underlying issues that may have caused your overeating in the first place. We’ve all had moments where we overeat due to emotional occurrences. Food is a staple for many significant events – good and bad. If you have underlying psychological concerns that may have contributed to overeating, these will not go away with weight loss medications alone. Seeking appropriate care is advisable.

Are Weight Loss Medications a Bad Thing?

With all the potential risks and considerations, you may be concerned about taking weight loss medications. To be sure, just like any other medical or surgical intervention, there are risks that you must reconcile in your mind and address with your physician. However, these drugs can dramatically improve a qualifying patient’s life through the upwards of 20% body weight loss they can provide. Sometimes, this could be the life-changing first step toward better health. Most importantly, the suitability of these drugs in your situation is a conversation that has to be had with your doctor, who can advise you on the way forward.

With that said diet and exercise are the best, albeit most challenging, choices for weight loss and come with the fewest potential side effects and concerns. No matter what option you pursue for weight loss, whether medications or bariatric surgery, an improved diet and exercise program is a must and cannot be overlooked.