Doctor explains why weight loss drugs are not a quick fix
We are surrounded by influencers offering advice and formulae for quick weight loss. While Elon Musk, Oprah Winfrey and Amy Schumer have been proponents of miracle weight loss drugs, others like Karan Johar and Kim Kardashian have vehemently denied using these for their transformation. Whether it is Hollywood, Bollywood, X, Instagram or Tik-Tok, we hear only about the so-called success stories. What about the flip side? A Scottish nurse died of acute pancreatitis recently after taking two doses of a weight loss injection she purchased online. Numerous other stories of severe side effects are often lost in the buzz. So let's analyse the pros and cons of these wonder drugs.
What are these “viral” weight loss drugs?
Semaglutide injection is sold as ‘Ozempic' for diabetes management while the higher dose version of the same injection that has been approved by FDA for weight loss is called ‘Wygovy'. Another drug Tirzepatide is sold as injection ‘Mounjaro'. Technically, these are Glucagon Like Peptide (GLP)-1 receptor agonists which stimulate insulin release from pancreas and also delay emptying of food from stomach. This causes a feeling of fullness even on eating small quantities of food and suppresses appetite. This results in weight loss and better sugar control. These drugs have been primarily developed for management of obese diabetic patients with co-morbid conditions like hypertension and high cholesterol. These are meant to be used in conjunction with diet control and exercise. It not only improves diabetes control but also protects against heart attacks and stroke. The medication is supposed to be prescribed by a doctor after appropriate screening especially for a history of a particular form of thyroid cancer in the patient or his family. These are excellent anti-diabetic drugs and work well when prescribed as per guidelines.
Handle With Care
Obesity has been declared a ‘disease' by WHO. It is associated not only with heart disease, diabetes, stroke, gallstones, osteoarthritis knees but also has mental ramifications. The obesity epidemic is associated with binge eating disorder (BED), Anorexia Nervosa (AN) and Bulimia. Almost 20% diabetics are fond of binging. Some obese individuals just can't stop themselves from opening a bag of chips or rummaging their fridge at midnight. For them, food is better at the waist than to let it go waste. Anorexic patients are already undernourished. Using these drugs may cause some amount of weight loss but does nothing in terms of addressing the psychological aspect of the disease. There have been stray reports of suicidal ideation while on these drugs. In fact, these drugs can precipitate weight cycling or a yo-yo situation wherein there is a weight loss but it all comes back when you stop the drug.
Side Effects
The side-effects associated with these medications including nausea, vomiting, burping, flatulence, acid reflux, pain abdomen, gallbladder disease, acute pancreatitis, electrolyte imbalances, chronic bowel malfunctioning, malnutrition, vitamin deficiencies, suppressed immunity and susceptibility to infections. Anxiety and depression are well-known side-effects. The users adapts and adjusts to the milder side-effects over time. However, the more severe adverse effects include allergy, vision problems, kidney damage and risk of developing medullary cancer of thyroid. A diabetic patient is closely monitored by his doctor for these side-effects. Who will supervise you if you purchase these medicines from the grey market? How do you ensure that these fancy injections are real and not fakes? How will you prevent yourself overdosing? These drugs have a long half life and will take more than a week for the side-effects to subside.
Celebrities may continue singing praises and the social media maybe full of dealers supplying these glorified drugs but how can you ensure the genuineness of what you bought? At the same time, you are adding to the surge in demand and the diabetic or morbidly obese who were prescribed these are struggling to procure the medicine.
What is the solution?
There are no short-cuts. Nothing can replace a balanced diet and a supervised exercise programme. If these fail due to various metabolic, endocrine or genetic reasons you require these medicines. Use them as prescription drugs. Your doctor is your team-mate in this fight for losing weight, not your adversary. Every drug comes with a price-tag. It may not only empty your pocket but also drain your energy. Choose wisely. If you deserve to be on these medicines, your doctor knows best.
(Dr Monica Mahajan, Director Internal Medicine. Max Super-speciality Hospital, Saket New Delhi)
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