One of the hottest Hollywood trends is losing weight with the fast-acting type 2 diabetes drug, Ozempic, and the semaglutide, obesity drug, Wegovy.

Jimmy Kimmel joked about this craze among celebrities at the Academy Awards. “Everybody looks so great. When I look around this room, I can’t help but wonder ‘Is Ozempic right for me?’”

Even Elon Musk tweeted that Wegovy is his go-to magical weight loss method.

Other celebrity a-listers, such as Andy Cohen, Remi Bader, Amy Schumer and Charles Barkley have all tried one of these two popular weight loss drugs.

If you have weight to lose, you might be wondering how you, too, can get your hands on them. Ozempic is approved for people with type 2 diabetes. Wegovy and Saxenda, although similar to Ozempic, are the only two injectable medications that are approved for the treatment of obesity, especially for those who have health conditions related to excess weight. They aren’t right for everyone dealing with overweight and obesity; they require a lifelong commitment to sustain the weight loss and may not always be covered by insurance.

So, to get the skinny on this topic, we sat down with Dr. Tiffany Lowe Clayton, a WakeMed Medical Weight Loss provider with WakeMed Bariatric Surgery & Medical Weight Loss, to learn more about prescription drugs and when they are indicated for safe weight loss.

What are the most popular weight loss drugs today?

While several anti-obesity medications are available, one class, in particular, that is very popular among celebrities is GLP-1 receptor agonists (GLP1-RAs). This class of medications was originally intended for the treatment for diabetes.

Dr. Lowe Clayton provides a bit more history. “Researchers found that when patients were treated for diabetes, the unintended positive side-effect of weight loss was also achieved. From this data, two GLP-1 RAs, in particular, Wegovy and Saxenda, have now become FDA approved for the treatment of obesity.”

They are effective against weight loss but can be costly if not covered by insurance; as a result, outside competitors have begun to market what they claim is generic and a less expensive version of Wegovy, otherwise known as semaglutide, to meet the demands from the masses.

The issues are many:

• First, there is no generic form of Wegovy. The pure form of this medication is only available by its’ brand name.
• Second, the generic form of semaglutide has not been approved or regulated by the FDA, so the potential side-effects may be inconsistent or even harmful to patients.

Prior to starting any medication, it is always best to speak with a trained clinician, receive a proper assessment and a prescription for an FDA-approved drug.

For most patients, GLP-1 drugs are not indicated. Instead, medical providers typically prefer anti-obesity medications to suppress appetite or control cravings. Some do a combination of both. The most popular for decreasing appetite are Phentermine medications. Popular combination appetite suppressant and craving control medications include Wellbutrin and CONTRAVE.

Could you explain how GLP-1 RAs work?

Eating and hunger triggers are regulated by hormones. These hormones go between the stomach and the brain, otherwise known as the gut-brain axis. When a person is in a fasted state, he/she has an increase in the hunger hormone called ghrelin. Ghrelin sends a signal to the brain to tell the person he/she is hungry. After eating, the body then releases hormones that give the body a signal of satiety or fullness. One of these hormones is GLP-1. The body naturally makes the hormone GLP-1, and it works as a very potent appetite suppressant. The problem is that native GLP-1 levels begin to decline rapidly after a person begins to feel full — within approximately 90 seconds to two minutes.

“We’re finding more benefits from the GLP-1 class of medicines because they work in multiple ways. One way is by affecting gastric motility, influencing appetite and satiety to stave off hunger, leading to weight loss. The increased time for food to pass through the belly makes people feel fuller longer, working as an appetite suppressant.

“Additionally, GLP-1 RAs do a really good job of working in the brain centers that deal with food cravings. This can control how much a person eats as well as what a person wants to eat. It works as a dual neurotransmitter to suppress appetite and control cravings. In office, we’ve seen weight loss benefits from 5% to 17% with these medications. That’s why people want them.”

What medication manufacturers have done is isolate these hormones and make modifications to the hormone molecule to allow the drug shelf life to last longer. Patients can now take many of these medications once a week as opposed to every day.

Should people use anti-obesity drugs if they struggle with overweight or obesity?

Obesity is a chronic disease state. Anti-obesity medication is a very viable part of a comprehensive weight loss plan, serving as an adjunct to lifestyle modification. It is critical that patients not see these drugs as magic pills, but instead focus on overall health. This would include:

• Modifying food choices
• Increasing physical activity
• Monitoring stress levels
• Engaging in healthy lifestyle behaviors

Would a prescription help me lose weight?

There is no one-size-fits-all medicine. Something may work effectively for one person, but it may not work as effectively for another person. When thinking about anti-obesity medications as an adjunct to lifestyle modification, it’s critical to get to the “why behind the what?”

Why?

• Why is a person engaging in certain behaviors?
• Why is the patient not eating healthy and nutritious foods? Is access an issue?
• Why does this patient not engage in an active lifestyle? Is affordability, time or mental health an issue?

What?

• What are the eating triggers for this patient?
• What are the missing social determinants of health for this patient?
• What medical insurance does the patient have available to make medication affordable?

“Some of the newer generic medications for weight loss, often available through compounding pharmacies or diet clinics and spas, are simply not FDA-approved though they are more affordable, so a patient has to be very careful if considering these medications as the long-term risks may outweigh the benefits. Currently, Wegovy and Saxenda are the only two anti-obesity medications FDA-approved for weight loss. Some other medications are on the precipice of approval and will likely be approved by the end of this year.”

How would a patient go about finding the right provider to administer the safest medications?

“Providers who are trained in obesity medicine will rarely prescribe the generic forms because we know that there is no long term data. Instead, we will work with patients to ensure their care is individualized and, when necessary, we will utilize the most effective and safest medication to help patients meet their goals.”

All anti-obesity medications, including GLP-1 RAs, have possible side-effects, such as constipation or diarrhea, but these symptoms are typically mild to moderate and transient. Patients should seek established medical providers practicing obesity medicine who will determine what medication is best for each patient and will closely monitor usage.

“At WakeMed, our Medical Weight Management providers can help patients achieve actionable and sustainable weight loss. Insurance may require a patient to see a primary care provider first. Thereafter, if it is warranted, a patient can request a referral to a medical weight loss provider.”

The goal is to ensure patients are educated about their options in order to make the best decision for themselves, their weight loss journey and their overall health.

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About Tiffany Lowe Clayton, DO

Dr. Tiffany Lowe Clayton (Dr. Tiffany) is dually board certified by the American Board of Osteopathic Family Physicians and the American Board of Obesity Medicine. She is also an assistant professor in the department of family medicine at Campbell University- School of Osteopathic Medicine in Buies Creek, N.C. She obtained her medical degree and completed her residency training in family medicine from the University of Medicine & Dentistry of New Jersey, School of Osteopathic Medicine (now a part of Rowan University) in 2003.

After years of working with patients and their families as a primary care physician, in recognizing the impact that an unhealthy weight has on a patient’s health, Dr. Lowe Clayton received specialized training in the management of obesity to be able to address those needs. She aims to assist patients in losing weight with a comprehensive nonsurgical approach and offers both one-on-one counseling and support group sessions to help them prevent disease, improve their overall health and reverse chronic obesity related medical illnesses.

A consummate teacher at heart, she is committed to empowering her patients to reach their health goals by utilizing her training as an osteopathic medical physician to address the needs of the “whole person”. Her motto is that “healthy living is more than just a physical principle.” By helping patients understand and attend to the underlying factors that may have contributed to the struggle with their weight, she seeks to equip them with the skills needed to reach and sustain their health and wellness goals.

On a personal level, Dr. Tiffany believes in the importance of self-care. She enjoys spending time with her family and friends, writing, motivational speaking and recreational boxing.

About WakeMed Medical Weight Management

Losing weight isn’t easy. Having the support of a physician whose primary training is in helping patients lose weight by identifying barriers, focusing on metabolic factors, and much more is a highly effective approach. Medical weight loss (often referred to as bariatric medicine) allows patients to partner with our bariatric-trained physicians and team of support specialists to develop a customized approach to achieving a healthy weight.

WakeMed Bariatric Surgery & Medical Weight Loss offers a multidisciplinary, non-surgical approach that may include the use of many tools such as metabolic testing, nutrition counseling, exercise, psychology and medications. Our weight management program focuses not only on weight loss, but puts a new focus on your overall health care, making sure weight management is factored into the treatment of other health conditions you may have. We are passionate about being proactive with your health and aim to treat current ailments as well as decrease or prevent the future occurrence of weight-related issues.

Do you have questions? We have answers. See responses to our frequently asked questions.

About WakeMed Primary Care

WakeMed Physician Practices features board-certified primary care, internal medicine and family medicine physicians conveniently located throughout the Triangle.

Our exceptional and compassionate providers and care teams pride themselves on developing long-term relationships with their patients and their families. Specializing in:

• Chronic disease & medication management
• Annual check-ups & screenings
• Acute illnesses like flu, cold, sinus infections and sore throats
• Mood & depression assistance
• Physician-directed weight loss
• And much more

We look forward to caring for you and your family and to being your family’s medical home. Call or schedule online an in-person or virtual visit with one of our primary care providers.

Medical Weight Management