You have probably heard about the weight loss medication craze by now. Everyone in Hollywood is doing it, and probably your neighbors too. When this first hit, I wanted to hold back from prescribing it to make sure that there wasn’t some terrible negative effect that was going to come out about it a few years later, like has happened in previous weight loss crazes. To my surprise, instead of negative articles being published, the news has been mostly very positive. There are benefits being reported that go way beyond weight loss – including less desire to engage in addictive behaviors – including smoking, drinking, gambling, or compulsive shopping, among other things.
The GLP-1 related medications (generic Semaglutide and Tirzepatide) are based on naturally occurring peptides that our own body produces. The drug companies were able to make these short-acting compounds into long-acting compounds, so they only have to be injected once a week instead of daily which is a big advantage. They also perfected the autoinjector device for people who are squeamish about sticking themselves with a needle. However, the cost (over $1000 per month) is a big factor for many people, and insurance companies often refuse to pay for them even for people who meet the FDA-approved criteria.
Fortunately, due to the shortages of these medications, compounding pharmacies have been allowed to make the same medication available at a much cheaper price for those who can inject themselves once a week with a tiny needle. My current favorite is Tirzepatide (generic Zepbound) because this compound has 2 peptides (GIP and GLP-1) to help with weight loss instead of just one, so it is more effective for most, and also seems to have fewer side-effects to boot. With the compounded version, the doses can be carefully adjusted and customized to each patient. Many people are doing well on very low doses and do not even need to go to higher doses.
In addition to other mechanisms of action, the medication slows gastric emptying and makes people feel full longer – so there is a natural desire to eat less. People feel full much faster which is the main way that people lose weight – they are eating a lot less food. The beauty of it is that they don’t want to eat more food – they are not hungry. So it isn’t a battle of will. Some studies show that overweight people do not naturally produce as much of these peptides after a meal as normal weight people do – so they literally are not getting the “I’m full” signal.
While there can be a number of mostly gastro-intestinal side-effects from Tirzepatide and others (acid reflux, burping, constipation, nausea) – by starting at a really low dose, increasing slowly and not going too high on the dose – most of these types of side-effects can be minimized.
The health benefits from not being overweight are huge – and the statistics show amazing decreases in many negative health consequences from obesity when these medications are taken properly. Overall, I have to say that the benefits do seem to outweigh the risks for these medications in overweight and obese patients at this time. If you are interested in giving weight loss peptides a try, give us a call.
To your optimal health,
Dr. Mielke