A doctor’s take on safety, cost, and whether the weight will come back.
Weight loss drugs like Ozempic, Mounjaro, and Wegovy are skyrocketing in popularity, but consumers still have plenty of questions about them, and there’s a whole lot of misinformation to wade through. Because the interest in these medications shows no signs of slowing down, we turned to Melanie Jay, MD, the director of NYU Langone’s Comprehensive Program on Obesity, to sort fact from fiction.
Dr. Jay’s research focuses on improving treatment for weight management, and she’s closely followed the development of the class of drugs known as the GLP-1s (glucagon-like peptide 1 receptor agonists). That means she knows quite a bit about how they work, their side effects, and who should and shouldn’t consider giving them a try. Below, she answers a few questions from readers of our health and wellness newsletter, Body and Soul. (You can subscribe right here.)
What’s know about how long-term use affects the body? – Denise
Dr. Melanie Jay: The class of GLP-1 medications have been around for close to 10 years, but the newer, weekly injectable medications have only been FDA approved for a couple of years. The longest trial I’ve seen is the SELECT study, where people with cardiovascular disease were randomized to take either the medication or a placebo, and they were followed for four years. The people who took the medication had a decreased risk of a cardiovascular event, like heart attack or stroke, or death. Other studies have shown a decreased risk of kidney disease progression and improvement of fatty liver disease, obstructive sleep apnea, and other diseases.
We know from the bariatric surgery studies that long-term weight loss generally improves health outcomes, including lowering the risk of death and cancer in the long term. We may find this to be true of the GLP-1 medications as well. As for serious long-term consequences, these are potent medications and we could find problems in the future.
They should only be used in people where the potential benefits outweigh the potential risks. For instance, I wouldn’t recommend them for people with only 10 pounds to lose who aren’t at risk for diabetes, cardiovascular disease, or other serious health conditions.
What about the safety of this medication as it relates to age? I took an online survey to see if I “qualified” and I got a black box stating I’m too old, although I’m younger than celebrities like Oprah, who are using the drugs. – Meg
Older adults can certainly benefit from GLP-1s, but they’re more likely to have other health conditions or take medications that need to be monitored closely to prevent adverse effects. I’d suggest everyone be followed by a physician and healthcare team with experience in comprehensive weight management and familiarity with your medical history.
Another thing to consider is muscle loss. All patients who lose weight, especially with the GLP-1s, may also lose muscle. But it’s especially important for older adults to maintain muscle through resistance training and eat an adequate amount of protein.
I’ve seen a probiotic product that purports to stimulate natural GLP-1. First, is this true? And second, are they harmful in any way? – Carolyn
GLP-1 is a peptide that’s released by the intestines when we eat. Thus, food itself stimulates natural GLP-1! GLP-1 attaches to receptors in the pancreas to release insulin in the gut and brain that decreases appetite. The difference between our own natural GLP-1 and the medications is that the peptides we produce only last for a few minutes before they’re broken down by enzymes in our body, while the GLP-1 medications linger for several days and at much higher levels, so they’re much more potent.
Weight-loss medications are a big business, and there are many companies out there trying to make money with false advertising. Herbal supplements are not regulated in the same way and don’t need randomized controlled trials to make health claims, so people can waste hundreds of dollars on things that aren’t effective. Also, there is a big problem with counterfeit GLP-1s containing dangerous ingredients, so it’s not safe to buy medications from an unreputable source. GLP-1s are serious and potent medications with potential serious side effects, so I would stick to the FDA-approved versions at this time.
I’ve heard that Ozempic can cause blindness. I have a friend who’s been on it for eight months and woke up blind in one eye. What causes this? And how common is this side effect? – Cindy
Your friend may have had a condition called nonarteritic anterior ischemic optic neuropathy, also known as NAION. This is a rare, serious condition that leads to sudden blindness. A recent study suggested that this may happen more frequently in patients taking GLP-1 medications. However, the study was observational and not a clinical trial, so we don’t know for sure. In the clinical trials, we haven’t seen this show up as an adverse event yet. In the SELECT study, for example, which includes 17,000 patients, NAION wasn’t observed, but we need to do further studies.
Is there any expectation the price will drop on these drugs? – Lisa
I don’t have a crystal ball, but I’m hopeful that prices will drop. There are more than 30 GLP-1 medications currently being tested, and there are several new ones that already appear effective in clinical trials, but aren’t yet FDA approved. So future competition alone may drive prices down. There are also policies being discussed in Congress that may lead to lower prices.
Will you regain the weight if you go off the medication? – Kathy
Clinical trials show that when people are taken off the medications, they gain back about two-thirds of the weight they lost in a year, on average. When we give patients with hypertension medications to lower their blood pressure, we expect that their blood pressure will go back up when we take them off the medication. Obesity is the same way — it’s a chronic disease.
At this point, we should expect these medications to be used long-term, and I counsel patients to expect weight regain if they go off of them. That said, some patients have been able to maintain weight loss once they go off the GLP-1 medications, but I don’t have a tried-and-true way of determining who will be able to keep weight off and who won’t.
