The Truth About Weight Loss Drugs: Insights from Dr. Ellie Chuang

Obesity is a chronic and complicated disease, and many look to anti-obesity medications or weight loss drugs for the “easy fix.” In our recent podcast, Dr. Ellie Chuang, an endocrinologist and obesity medicine specialist from Southern New Hampshire Weight Management, dispels that myth and explains the pros and cons of weight loss drugs.

Obesity: A Chronic Disease Requiring a Personalized Approach

Obesity is not simply a result of poor lifestyle choices; it is a chronic disease like diabetes or hypertension. Dr. Chuang explains that effective management requires a multidisciplinary approach that includes medical expertise, personalized treatment plans, and lifestyle modifications. Rather than focusing on temporary solutions, the goal is to help patients achieve and maintain their "best weight" — a sustainable, healthier weight that they can maintain long-term. 

Misconceptions about Weight Loss Drugs

There are several common misconceptions about weight loss drugs that Dr. Chuang is quick to debunk: 

They’re a magic bullet: One of the biggest misconceptions is that these medications are a quick fix for weight loss. As Dr. Chuang emphasizes, "They are not a magic bullet." While these drugs can be highly effective for some, the response to medication can vary significantly between individuals. Some people are "hyper-responders" and lose a lot of weight, while others may not see much effect at all. 

You can stop after a few months: Many believe that anti-obesity medications can be just a temporary boost to get started with weight loss. However, Dr. Chuang explains that obesity is a chronic condition, and most patients will need to stay on these medications long-term to maintain their weight. Studies show that stopping the medication often leads to weight regain within a year or two. 

Medications alone are enough: Another misconception is that these medications can be taken without any lifestyle changes. Dr. Chuang stresses that while medications can help, they should not be used in isolation. The most successful outcomes occur when patients also work on foundational healthy lifestyle habits, such as balanced nutrition and regular physical activity. 

All drugs are created equal: Many patients are unaware of the distinctions between FDA-approved drugs and compounded versions of popular medications like semaglutide. Dr. Chuang warns against using medications obtained from med spas or online services that offer non-FDA-approved versions, as these may not be safe or effective. Always consult a healthcare provider before starting any weight loss drug. 

Who is a Candidate for Weight Loss Drugs?

Not everyone struggling with weight is a candidate for weight loss drugs. Dr. Chuang outlines the following criteria: 

• BMI guidelines: A person with a body mass index (BMI) of 30 or above is considered to have obesity and may be eligible for these medications. For those with a BMI between 27 and 30, anti-obesity medications may be recommended if they have at least one obesity-related condition, such as high blood pressure, diabetes, or high cholesterol.
• ​Waist circumference: Even if BMI is not excessively high, an elevated waist circumference can indicate excess fat, and medications may be indicated. 

People meeting one or both of these criteria and unable to reach their goals or sustain their weight loss through diet and exercise may be a good candidate for weight loss medications. 

Types of Weight Loss Drugs

Dr. Chuang goes over several classes of medications that are currently FDA-approved for obesity treatment, explaining how they work and their effects on the body:

GLP-1 Receptor Agonists (Incretin Mimetics):

• Medications: Ozempic, Wegovy, Zepbound, Mounjaro
• How they work: These medications were originally developed for type 2 diabetes but were later found to aid in weight loss by mimicking gut hormones that help suppress appetite, make patients feel full sooner, and reduce cravings.
• Results: Clinical trials show up to 21% weight loss in some patients, making them the most effective weight loss drugs available.

Stimulants: 

• Medications: Phentermine and Vyvanse
• How they work: These drugs suppress appetite and can be particularly effective for people with slow metabolism. Vyvanse, which is primarily used to treat ADHD, is also FDA-approved to treat binge eating disorder.
• Side Effects: Similar to drinking too much caffeine, side effects include jitteriness, anxiety, dry mouth, and increased heart rate. 

Combination Drugs:

• Medications: Qsymia (phentermine + topiramate), Contrave (bupropion + naltrexone) 
• How they work: These drugs combine different mechanisms to help curb cravings and suppress appetite, with specific effects tailored to individual patient needs.

Other Options:

• Orlistat: Blocks fat absorption in the gut and is available over-the-counter under the brand name Alli.
• Plenity: A medical device in pill form that expands in the stomach to make patients feel full faster. 

Side Effects and Risks

All medications come with potential side effects, and anti-obesity drugs are no different. Dr. Chuang highlights the most common side effects, especially those associated with GLP-1 medications, which include nausea, diarrhea, and constipation. Other classes of drugs, like stimulants, may cause increased anxiety or insomnia. It is crucial to have regular check-ins with a healthcare provider to monitor these side effects and adjust the treatment as necessary. 

How Long can Patients Safely Stay on Weight Loss Drugs?

Since obesity is a chronic condition, most people need long-term treatment to sustain their weight loss. Medications like incretin mimetics have been around for nearly 20 years, first developed for diabetes, and have been shown to be safe for extended use. Phentermine, another common weight loss drug, has also been on the market for decades without evidence of long-term harm. 

The Role of Obesity Medicine Specialists

Given the complexities of managing weight loss through medications, Dr. Chuang advises working closely with an obesity medicine specialist. Specialists have the training and expertise to select the best medication and lifestyle plan for each patient based on their unique health profile and to monitor their progress over time. Regular follow-up visits every one to two months are essential to track effectiveness, manage side effects, and adjust treatment plans as needed. 

How to Get Started with Southern New Hampshire Weight Management

If you're considering anti-obesity medications and want to learn more, Dr. Chuang recommends speaking with your healthcare provider for a referral to Southern New Hampshire Weight Management. You can also call their office at 603-577-3275 to sign up for an informational session, fill out an intake questionnaire, and schedule your first appointment.

Weight loss drugs can be a powerful tool for those struggling to lose weight, but they are not a one-size-fits-all solution. A combination of personalized medical care, lifestyle changes, and long-term commitment is the key to achieving lasting results. Be sure to consult with a healthcare professional before starting any weight loss medication to ensure it's the right fit for you. 

Dr. Ellie Chuang is board-certified in Endocrinology, Diabetes, and Metabolism, Clinical Lipidology, and Obesity. She practices at Southern New Hampshire Weight Management.