Are weight-loss drugs tricks or treats?

The history of how the health care industry treats obesity is littered with shame, false starts, harmful drugs and surgeries - but why? Because people who struggle with overweight are saddled with the baggage society puts on them:

You have to get on the scale at the doctor's office. You might need to ask for a seat belt extender on an airplane. You have to shop at plus-sized or "big and tall" stores. No wonder a lot of overweight people are looking for help. (By the way, there's no real need to get on the doctor's scale. Weigh before you go and tell them the number - be honest about it, though.)

I think what's behind the boom is drugs for Type 2 diabetes that have proved themselves to be little miracle workers when it comes to weight loss. And it's all because some of us lost the genetic lottery.

Genes and hormones, oh my

Researchers now know that thinness is a genetic trait. In a study published in 2019, it was found that thin people have some different genetic coding that helps them stay the same weight for life because their genes give them a low risk for obesity. It's just the opposite for people who tend to gain and keep weight.

We also now know that the hormones leptin and insulin play a role in why some people are obese and others are not. Leptin, for example, regulates appetite and tells you when you're full. People who are obese have a lot of leptin in their cells; as a consequence, they are less sensitive to it, so they can't really tell when it's time to stop eating.

This is why calorie-restricted diets are effective for a while - it's not the body saying to stop eating, it's the Weight Watchers plan or Nutrisystem menu.

Treat: The rise of weight-loss drugs

Six years ago, everything changed. That's when Ozempic, known generically as semaglutide, was approved by the U.S. Food and Drug Administration (FDA) for adults with Type 2 diabetes. It works to lower blood sugar by helping the pancreas make more insulin.

People who started taking it noticed that they were losing weight. The drug mimics a hormone called GLP-1, whose molecules go to the brain, telling it you're full. It also slows digestion. It's like getting weight-loss surgery in a weekly injection.

And suddenly, the race was on. People who didn't have Type 2 diabetes asked their doctors for Ozempic so they could lose weight. The pharmaceutical company that created Ozempic came out with Wegovy, a higher dose of the same drug, which was approved for weight loss in 2021.

Now there are many variations on the theme, and you see their ads all over the place: Rybelsus, Saxenda, Xenical, Mounjaro.

And now the tricks

Losing weight, of course, feels great to someone who's struggled with shedding pounds. But there are a couple of catches.

First is the cost. Treatment for Type 2 diabetes may be covered by insurance, but weight-loss drugs (like plastic surgery) are considered "vanity" treatments, so users are on the hook for the $900 to $1,300 a month cost. Some private insurers cover it, but many who need the most help with obesity - the poor and the underinsured - lack access.

Experts anticipate that as more manufacturers enter the marketplace, prices will come down. And insurers may change their minds if the effects of weight loss lead to lower health care costs overall.

The other trick? It's been found that people who stop taking the drugs gain their weight back when their appetites and hormone levels return to normal. So some users may be scared of stopping and, as a consequence, lose more weight than is healthy.

Which way to go?

The first thing to do is talk to your health care provider. Avoid non-FDA approved compounds, supplements that aren't backed by research and unproven over-the-counter medications.

If you are able to get one of the weight-loss medications, use it only as prescribed and monitor your overall well-being (mood, energy, sleep). Meanwhile, prepare yourself for the day when you'll stop taking it by incorporating a few healthier habits:

• Prioritize sleep

• Up your intake of lean protein, fruits and veggies

• Moderate carbs

• Move more

Finally, research shows that people who weigh themselves frequently are more successful at managing their weight. Get a good scale and use the feedback to guide your efforts and get back on track if you fall off.

There may be drugs now, but there's still no quick fix for maintaining a healthy weight. It remains the biggest trick of all.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her book, "How to Be a Healthcare Advocate for Yourself & Your Loved Ones," is available on Amazon. She is offering a free phone consultation to Daily Herald readers; call her at (312) 788-2640 or email teri@northshorern.com.