People — Americans, in particular — are always looking for easier ways to lose weight. Our diet and largely sedentary lifestyle make it particularly difficult to keep off the extra pounds, even without a medical complication. And every few years, a new diet fad becomes the latest weight-loss craze. 

The latest trend that seems to be reducing Hollywood stars to mere shadows of their former selves is injectable medication, like Ozempic, the brand name for semaglutide. Originally approved to treat Type II diabetes, Ozempic is so popular that Jimmy Kimmel cracked a joke about it in his opening monologue at this year’s Academy Awards. 

Not everyone is taking these medications just for vanity. As of February 2024, seven medications that can help with weight loss have been approved by the U.S. Food and Drug Administration. The most recent, Zepbound (tirzepatide), was approved in November for chronic weight management in adults with obesity. The FDA said, “Obesity and overweight are serious conditions that can be associated with some of the leading causes of death such as heart disease, stroke and diabetes.” About 70% of American adults have obesity or are overweight and losing 5% to 10% of body weight can lower risks of related conditions, the FDA says.

If your doctor has told you that you should try to lose weight, and diet and exercise haven’t been enough, you may be facing a decision about taking a supplemental weight loss drug. Here’s a rundown of what you should know.

The Basics of Prescription Weight Loss Medications

Prescription weight loss drugs are typically intended for long-term use, 12 weeks or longer. They are usually prescribed to be taken in conjunction with lifestyle changes, like a healthier diet and increased exercise, rather than as a magic bullet. Most prescription weight loss drugs work within the brain to make you feel less hungry or more full, and some do both. Orlistat (also known as Xenical or Alli) is one exception, as it affects the way that your body absorbs (or doesn’t absorb) fat.

Taking these drugs for a year can mean a loss of total body weight of 3% to 12% more than with lifestyle changes alone. This can have important health benefits, like lowering your blood pressure, blood sugar levels and levels of triglycerides (the so-called “bad” fats). It can make a big difference in overall health, particularly if you are disabled or have a condition that causes you to gain more weight than usual.

That said, there are almost always side effects. Mild side effects, such as nausea, constipation and diarrhea are common, but tend to lessen over time. Other side effects include headaches, fatigue, insomnia and yes, sometimes fecal incontinence. The drugs also tend to be expensive, and may not be covered by health insurance. Plus many people gain weight when they stop taking these medications, so you need to be prepared to stay on them for the long haul.

Should You Seek a Prescription?

In 2022, the American Gastroenterological Association released recommendations for weight loss medications among patients with obesity who do not respond adequately to lifestyle interventions alone. Their four first-line options were semaglutide (Wegovy or Ozempic), liraglutide (Saxenda), phentermine-topiramate extended release (Qsymia) and naltrexone-bupropion extended release (Contrave). Semaglutide seems to be more than just a Hollywood fad, in that two recent studies have found it to be the most effective prescription available (see this 2022 study, along with this larger 2021 trial reported in the New England Journal of Medicine). But keep in mind, the drawbacks include cost, side effects and the need to continue using the drug for the long term to get the weight to stay off. With its newfound popularity, semaglutide can also be very hard to get.

Only you and your doctor can make the decision to embark on this particular weight-loss journey.

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