Christine Fennema, 42, has dieted off and on since she was 7. The Burke resident has tried Weight Watchers, Jenny Craig, tracking calories with the MyFitnessPal app, and working with a nutritionist — all to no avail.
“These things will work to an extent, but then they won’t, and then I’ll go get even heavier,” says Fennema. “I don’t think people who never struggled with their weight understand that I know how to lose weight. I know to try to cut down on the carbs and the sugar and all that, and I do it. The problem is that I’m still really freaking hungry. … My brain is always going, ‘What am I going to eat?’”
Fennema was hoping to lose around 100 pounds, so in October 2024 she spoke to her doctor about starting an injectable weight-loss medication. She decided on Zepbound — one of four brands used to treat obesity — and she says she lost 20 pounds in eight weeks.
“I call it my miracle drug,” Fennema says. “I don’t have any emotional attachment to the food that I feel like I previously had. I never had that in my life. … The cravings have just been completely turned off in my brain. That’s wild. That’s awesome.”
Although many of their patients share Fennema’s enthusiasm, health care professionals are quick to point out that these medications are part of a long-term plan that includes major lifestyle adjustments in regard to dietary choices and exercise.
“I don’t want to feed into the narrative that people are out there just looking for a quick fix, because that’s really not what we see. There is no quick fix,” says Dr. Pamela Brandt, director of obesity medicine and nonsurgical weight loss at Inova. Obesity “is a complicated disease that is difficult to treat, and that’s why we need tools to give to help people with that.”
Dr. Eric Thorn, a physician at VHC Health who is board certified in internal medicine, cardiology, nuclear cardiology, and obesity medicine, says using these drugs is no different than treating other chronic diseases: “You have a medicine for your diabetes, a medicine for your blood pressure, a medicine for your cholesterol. Now I have a medicine for your obesity.”
Ozempic is probably the best known of the four main weight management drugs, even though it’s not approved by the Food and Drug Administration for that purpose. In 2017, the FDA approved it for the treatment of Type 2 diabetes, although doctors can prescribe it for off-label use — namely, weight loss. Ozempic’s manufacturer — Danish pharmaceutical company Novo Nordisk — developed a sister drug called Wegovy, which got the FDA’s blessing in 2021 for weight management.
Both medications are the brand names for semaglutide, a glucagon-like peptide-1 (GLP-1) agonist that mimics the GLP-1 to help regulate appetite, blood sugar, and digestion. The main difference is that Ozempic is designed for Type 2 diabetes treatment, and Wegovy is available in higher doses for weight management in people ages 12 and older.
Zepbound maker Eli Lilly and Co. jumped on the bandwagon, getting FDA approval in 2022 for Mounjaro to treat Type 2 diabetes and Zepbound for weight loss a year later. They are based on tirzepatide, another antidiabetic drug, which activates the GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) hormone receptors to help regulate body weight.
The biggest barriers to using the drugs are insurance coverage and accessibility, although supply increases have improved recently, and the drugs are no longer on the FDA’s drug shortage list. Without insurance, though, they can cost $900 to $1,300 a month. In November 2024, President Joe Biden proposed a bill that would require Medicare and Medicaid to cover weight loss medications, paving the way for 7.4 million people to have access to the drugs.
About 6 percent of U.S. adults, or about 15.5 million people, say they have used medication to lose weight, according to the Gallup National Health and Well-Being Index, but as many as 136 million could be eligible for Ozempic, a study published in JAMA in November 2024 found. About 74 percent of adults in the U.S. are overweight or obese, according to the CDC.
The drugs come with criteria for the patients most likely to benefit from them. For instance, Wegovy and Ozempic are indicated for people with a body mass index (BMI) of at least 30 or who have a BMI of 27 and also at least one weight-related ailment.
“Prescribing a medication, any weight loss medication, but specifically these, has to be individualized for the patient,” says Dr. Pamela Alexander, an internal medicine physician at the Tysons Corner location of Kaiser Permanente. “It’s a complex disease, and it’s multifactorial. … It’s not as easy as just starting a medication.”
All three physicians emphasize the need to use the medicine as part of holistic lifestyle changes that include better nutrition and increased exercise.
For instance, Kaiser has a lifestyle medicine team with providers who work with patients to identify possible triggers for overeating, nutritionists who counsel on diet changes, and physical therapists who assist with movement and exercise.
“Over 30 percent of the weight loss is from muscle and bone and not adipose [fat] tissue,” Alexander says. “So, it would be important that people would be committed to daily aerobic exercise, to lifting weights for at least 30 minutes twice a week.”
The drugs aren’t right for everyone, either. Side effects such as nausea, constipation, bloating, headache, and dizziness can be a turn-off, and people with medullary carcinoma of the thyroid or a history of pancreatitis or gallbladder issues could experience severe complications.
Additionally, because the drugs are relatively new, many people have concerns about their long-term effects. Thorn says it’s possible that negative experiences will emerge over time, but the medication is worth the risk because, “I sure know the negative effects of continued uncontrolled blood pressure, bad cholesterol, diabetes, and weight gain.”
Reports have come out about the weight-loss drugs helping with other illnesses such as hypertension and fatty liver disease. In March 2024, the FDA approved Wegovy for use in reducing patients’ heart attack and stroke risk (specifically, in adults who are overweight or obese), and a paper published in the November 2024 edition of The New England Journal of Medicine found that tirzepatide, in Mounjaro and Zepbound, can help prevent, not just treat, Type 2 diabetes.
Although Alexander attributes those gains to the weight loss — “It’s not specific to the medication,” she says — Brandt says it’s important to do a cost-benefit analysis because the drugs’ benefits might outweigh the risks, even for patients with underlying conditions.
“With this disease of obesity, we tend to overweigh the potential downsides of treatment and undervalue the potential benefits,” Brandt says. “About 40 percent of the cancers in this country and in Western societies in general are directly related to obesity, and those are often the types of cancer that are very difficult to treat: colon cancer, breast cancer, endometrial cancer, pancreatic cancer. So, treating this disease is still a worthwhile proposition if we’re doing it in a mindful and reasonable way where we’re taking into account all those risks.”
People who don’t want to or can’t take the medications still have options, Brandt adds. Alternatives include medications such as Qsymia, Saxenda, Contrave, and Orlistat. Bariatric surgery is another, albeit invasive, option. Procedures include gastric bypass, sleeve gastrectomy, gastric band, and duodenal switch. Intragastric balloons, which is the nonsurgical placement of a saline-filled silicone balloon in the stomach, is another possibility.
Ultimately, the drugs’ success rates depend on the person taking them, Thorn says. “Much more important is the mindset when you’re on the medicines that, ‘This medicine is going to help me get the job done with what I’m trying to do, with improving my foods and increasing my exercise.’ But it doesn’t replace that,” he says. “And if you’re doing all those things, you may get to a point where maybe you don’t need the medication.”
Fairfax Station resident Rebecca Geller has been on Mounjaro since 2022, in addition to eating healthier food and working out at least five days a week. She says she’s lost 70 pounds but isn’t sure when or if she will stop the drug.
“It’s really important to me to make sure that I can continue to maintain …my goal weight,” Geller says, adding that she’s an “open book” about her weight loss journey to normalize the conversation. “There’s a lot of negative stigma and perceptions people have around these medications, and it frustrates me, because for a lot of people who have battled weight over their entire lives, this really is a game changer. We would never look down upon someone who was taking blood pressure medication or cholesterol medication, and in many ways, obesity is the same thing. [These drugs are] something that should be celebrated as a success for science and for people to be able to better control their health.”
Feature image, stock.adobe.com
This story originally ran in our February Issue. For more stories like this, subscribe to Northern Virginia Magazine.
