The Story Behind the Weight Loss Craze..

As a patient I’ve heard “the talk” about the importance of  “leading a healthier lifestyle”.. as a medical provider I’ve given “the talk” to several of my patients.  Believe it or not but It’s just as hard giving the talk as it is to hear it. No one wants to be reminded that they’re overweight. So let’s begin by talking about obesity and how these medications are revolutionizing the weight loss world.

So what is obesity and how do we fix it. By medical definition a BMI between 18.5 and 24.9 is considered “healthy”. Having a BMI between 25.0 and 29.9 makes you “overweight” and if you’re BMI is over 30 then the medical community has labeled you as obese. Even though you might think your medical provider is cruel and just fat shaming you by bring up your weight, your provider is actually trying to save you future medical problems that you might not be able to see at that time. Obesity increases the risk of serious health problems. Typically obesity results from a person taking in more calories than are burned through exercise or typical daily activities. Of course, there are exceptions to this rule. Other common causes that can contribute to obesity are medications, high amounts of stress leading to high cortisol levels, hormonal imbalances, certain disease processes and the obvious.. genetics.  The medical community has come to understand that obesity is influenced by a complex interaction of both biological and psychological factors.

Obesity has been linked to several health complications:

• Cardiovascular disease: including heart disease, stroke, high blood pressure and coronary artery disease

• Diabetes: more specifically, Type 2 Diabetes

• Musculoskeletal disorders: osteoarthritis in the knees, hips and ankles due to the extra weight and pressure put on these joints every day

• Breathing problems: including asthma and sleep apnea

• Memory and cognition: there is an increased risk of Alzheimer’s disease and dementia

• Fatty Liver Disease: from unhealthy dietary intake

• Cancers: such as endometrial, breast and colon cancer

• Gallbladder disease: gallstones and an enlarged gallbladder

• Kidney disease: caused by high blood pressure and diabetes (both of which are common complications of obesity)

• Infertility: including lower sperm count and sperm quality in men; PCOS in women

The World Obesity Federation’s 2023 Atlas predicted alarming projections by indicating that within the next 12 years, it was expected that over four billion people will be either overweight or obese. So clearly, this has been a growing problem worldwide. There have been several weight loss medications throughout the years: Dextrim, Fen-Phen, Phentermine, Contrave..

The latest craze is Semaglutide and Tirzepatide and most recently Retatrutide. What are these drugs and what has the medical community so excited about them? Let’s start with the drug that started it all.. Semaglutide.  It was introduced to the world as a medication to treat diabetes. It mimics the action of the GLP-1 (glucagon like peptide 1). GLP-1 is a naturally occurring hormone that plays a pivotal role in regulating appetite and food intake. By enhancing this hormone’s action, if effectively signals the brain to reduce hunger and increase the feeling of fullness after eating. In addition it can support weight management practices.  In clinical trials participants taking Semaglutide lost an average of 15% of their body weight over 68 weeks.  However, research does suggest that people will need to continue taking the drug to maintain the weight loss.

Tirzepatide, a new medication, earned FDA approval as diabetes treatment in 2022 under the brand name Mounjaro.  In late 2023 it earned FDA approval for weight control.  Tirzepatide also acts on GLP-1 like Semaglutide. But it also works on another hormone, glucose dependent insulinotropic polypeptide or GIP. It boosts the effects on appetite and weight loss. The GIP molecule has more work to do as it has an anti-emetic/anti-nausea effect which may explain why people taking Tirzepatide experience less side effects than Semaglutide.  It has also been found to have other benefits such as being neuroprotective, increases bone formation, decreases stomach acid secretion, increases insulin release, and stimulates fatty acid synthesis. In clinical trials participants taking Tirzepatide lost an average of 20% of their body weight over 72 weeks.

Lastly, there is the newest medication, Retatrutide which only recently came on the marker and I was fortunate enough to be partnered with a pharmacy that was one of the first to produce it. Retatrutide as been nick named a “triple threat”. Not does act on the GLP-1 hormone as well as the GIP hormone but it also acts on glucagon, which influences blood sugar. Retatrutide also affects certain biological pathways related to metabolism, appetite regulation, and fat storage, leading to a reduction in body weight. It also offers additional health benefits, such as improvements in insulin sensitivity and cardiovascular risk factors. In clinical trials participants taking Retatrutide lost an average of 24% of their body weight over 48 weeks.

Each of these medications have been proven to facilitate, especially when taken in conjunction with adopting a healthier diet, staying well hydrated and doing routine exercise. Each medication is slightly different and attempts have been made to keep the side effects down. Nothing compares to Tirzepatide and Retatrutide in terms of weight loss and weight regain. Now that we’ve seen what these medications it’ll be interesting to see what the pharmaceutical world does next.