Weight-loss drugs only recommended for severe obesity

The benefits of weight-loss drugs only outweigh the risks in people who have (or are at a very high risk for) a medical problem due to their weight.

Dear Dr. Roach: I’m increasingly seeing reports of celebrities like Oprah Winfrey using weight-loss drugs with apparent success. I’m wondering if these drugs are suitable for someone like me, who isn’t a celebrity or obese, but could stand to lose about 20 pounds. What are the risks and benefits to using these drugs for moderate weight loss?

A.M.H.

The risk of being mildly or moderately overweight are minimal as long as you are eating well and exercising. Of course, not everyone who is overweight does those things, but many people of average and below-average weight don’t either. Certainly, the benefits of healthy eating and regular exercise are much more important than the minimal harm of being overweight.

Weight-loss drugs like semaglutide (Wegovy or Ozempic) and tirzepatide (Zepbound or Mounjaro) are not drugs to take without careful consideration. They are effective; the average weight loss is about 15% to 20% of the overall body weight. However, they have side effects, even if they are usually mild. Nausea, diarrhea and vomiting are the most common, but they usually get better over time.

These drugs are expensive (often not covered by insurance) and are normally taken by injection. They only work when you take them, so I tell my patients that they should expect to be on them long-term. If you take these medicines and lose 20 pounds, you can be pretty sure that you will start to regain some, all, or even more of the weight that you lost as soon as you stop the medicine.

I recommend these drugs (or even weight-loss surgery) for people with severe obesity or those who already have a metabolic complication due to their obesity, such as obstructive sleep apnea or diabetes. I don’t recommend them for healthy people who want to lose a little weight.

In the future, we may have better long-term data that will get me to recommend these drugs more widely, or there may be better drugs available. But for right now, the benefits only outweigh the risks in people who have (or are at a very high risk for) a medical problem due to their weight.

Dear Dr. Roach: My wife recently had an ultrasound done on her shoulder and neck “to alleviate and eliminate her pain.” I argued that the ultrasound is diagnostic, not curative, and that her diminished pain was unrelated to the ultrasound.

G.G.

While you are certainly correct that ultrasounds are used to take pictures of many soft tissues within the body, therapeutic ultrasounds have been used for decades.

Like any power source, ultrasound waves generate heat. Occasionally, this can be a concern while taking images, but we can use this therapeutically during physical therapy to warm up soft tissues of the body, especially muscles, tendons and ligaments. It was this effect, commonly used by physical therapists, that likely helped your wife. The heat reduces inflammation and helps muscles heal, especially in combination with other physical therapy modalities like exercise and massage.

Higher-potency ultrasounds can be used to destroy tumors, reduce prostate tissue in men with enlarged prostates, break up kidney stones, and even ablate areas in the brain that are overactive in people with Parkinson’s or familial tremors.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]


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