Dropping a Few Pounds With Weight Loss Medications: Safe or Risky?

It’s rare to go anywhere these days without noticing a colleague or acquaintance who’s shed significant pounds — often from GLP-1 agonist receptor medications like Ozempic®, Wegovy®, Mounjaro® and Zepbound®.

Weight loss drugs are quickly becoming the clinical standard of care for obese patients. But what about using Ozempic® for those who want to shed a few pounds but aren’t obese? Do the benefits outweigh any possible side effects or risks?

It depends, says Gianluca Iacobellis, M.D., Ph.D., an endocrinologist at the University of Miami Health System.

The use of anti-obesity medications (AOMs) has surged since they gained popularity for their effectiveness in managing type 2 diabetes and obesity. In 2023, pharmaceutical expenditures in the US grew 13.6% compared to 2022, with semaglutide ranking as the year’s top drug, according to the American Journal of Health-System Pharmacy. While their popularity has led to shortages, supplies are expected to meet the huge demand.

Emerging research indicates that GLP-1 medications might offer significant benefits even for individuals who aren’t overweight or obese but are at risk for cardiovascular disease.

Studying GLP-1 benefits for heart health

In 2017, Dr. Iacobellis published results of a study showing fat tissue around the heart, namely the epicardial fat, has receptors that would be activated directly by the GLP-1 RA medications.

Epicardial fat that surrounds the heart is needed for heart muscle function. Excess epicardial fat is connected to metabolic and cardiovascular disease and can be influenced by genetic factors. It’s more common among people with obesity and those with abdominal obesity, but it may be present even in individuals who are not visibly overweight.

For those who have excess epicardial fat, GLP-1 medications like Ozempic® improve heart function and reduce the risk of cardiovascular disease. This dual action particularly helps individuals with abdominal fat accumulation who are not necessarily overweight.

These findings have been translated into large clinical trials. One randomized controlled study that included 17,604 people found that fat was reduced by about 20%, significantly lowering cardiovascular risk, even in patients who are not diabetic. “One mechanism to explain these improvements is the medication’s effect on adipose tissue, particularly around the heart,” says Dr. Iacobellis.

Expanding the benefits of Ozempic beyond weight loss

The traditional view of diabetes treatment and weight loss as the primary benefits of these medications is evolving. Dr. Iacobellis recalls being questioned in an interview a few years ago about those who use GLP-1 medications just to lose a few pounds.

“It was controversial because people said it was shameful to take it away from those who need it, but losing even 5% of visceral fat can be beneficial. Clinical trials have shown that weight loss is an important component, but it’s not the only benefit.”

While weight reduction remains a critical outcome, Ozempic’s improvements in cardiovascular health are equally significant.

Even a modest reduction in visceral fat — fat in the abdominal cavity around internal organs — has substantial health benefits for your heart. “Postmenopausal women who gain a few pounds and men with abdominal fat — even if they look fit — are at higher risk of cardiovascular disease and benefit greatly from these medications,” says Dr. Iacobellis.

Challenges in access

Despite the promising study findings on weight loss drugs’ benefits for heart health, obtaining GLP-1 medications remains fraught with challenges. “Insurance companies are not keeping up with new findings. Unless you have very good private insurance, patients struggle to get coverage,” says Dr. Iacobellis.

Established medications like Ozempic and Wegovy are somewhat easier to get approved, but newer ones like Mounjaro face more resistance. This discrepancy creates a barrier for many patients who could otherwise benefit from these treatments.

Additionally, the high demand for these medications has led to shortages, complicating treatment plans. Patients often have to adjust to whatever dosage is available and can lead to side effects from incorrect dosage.

“Patients end up taking whatever dosage is available, which is not ideal. For example, jumping from 2.5 to 10 milligrams can cause side effects because the dosage should be increased gradually,” says Dr. Iacobellis.

Beware of counterfeit medications

High demand has led to a rise in counterfeit Ozempic, which can be unsafe due to the lack of clinical testing. Be cautious and ensure you’re receiving proper prescriptions from legitimate sources.

“Patients might think they’re getting the real thing, but they’re not. It’s dangerous and not recommended,” says Dr. Iacobellis.

What are the risks of GLP-1 medications?

It’s possible to experience side effects from GLP-1 medications, such as nausea and constipation. These often diminish over time. Losing too much lean mass could be a concern, particularly for the elderly or those with poor diabetes control, says Dr. Iacobellis.

“Individuals with obesity tend to have higher lean mass, along with higher fat mass, than normal weight subjects, making it common for obese individuals undergoing any weight loss interventions to lose unnecessary muscle mass, too. Whether and to what extent long-term treatment with GLP-1-RA can affect lean mass is still unknown,” says Dr. Iacobellis.

The medications are currently not recommended for those with a history of medullary thyroid cancer or pancreatitis.

Large studies have shown no significant differences in mood changes or suicidal ideation between patients on GLP-1 medications and those on other treatments. “Most patients experience improved well-being due to weight loss and better health outcomes, though some may feel frustrated if they do not achieve their desired results,” says Dr. Iacobellis

Importance of professional oversight and follow-up

Given the complexities of treatment, it is crucial for patients to see experienced health care providers. While endocrinologists are ideal, cardiologists and primary care doctors with expertise in managing cardiovascular risk can also prescribe these medications effectively. Follow-up is essential to adjust dosages and monitor side effects. Ideally, patients should have follow-ups at three months and then every six months.

The use of Ozempic and similar GLP-1 receptor agonists is expanding beyond traditional boundaries, offering significant health benefits even for non-obese individuals. The reduction in visceral fat and the corresponding improvements in cardiovascular health highlight the potential of these medications to address broader health concerns.

As research continues to evolve, these medications may become a cornerstone in preventive care for cardiovascular health.

Wendy Margolin is a contributor for UHealth’s news service.

Tags: cardiology and weight loss, Dr. Gianluca Iacobellis, medical weight loss, weight loss