Why Don’t Weight Loss Drugs Work For Everyone?
Second-generation weight loss medications like Ozempic and Wegovy are sometimes touted as ‘miracle’ cures for overweight and obesity. There are several problems with over-hyping these kinds of drugs, but one big problem is the unfortunate truth that these medications don’t work equally well for every person.
In one study, only 86.6% of patients who received weekly injections of semaglutide (the active ingredient in Ozempic and Wegovy) for over a year lost 5% or more of their total body weight. That means that 13.4% of patients barely lost any weight. Only 75.3% of patients lost at least 10% of their total body weight, and just 55.8% lost at least 15% of their total body weight. What this means is that, even in clinical trials where patients also receive help with diet and exercise and are monitored by experts, a lot of patients don’t lose the weight that they hoped to lose. It also means that if you have not succeeded with your weight loss goals on Wegovy you are not alone. Around half of the people who started this medication have also not been able to achieve the highest level of expected success.
When you see a headline proclaiming (for instance) that a certain weight management drug causes 16% weight loss, it’s important to remember that this 16% number is an average, and that many patients lose less than this.
So why do weight loss drugs work for some people but not others? The difference can come down to a lot of factors. Diet and exercise can play a role. So can compliance, comorbidities, and other factors such as genetics and how quickly your body can metabolize drugs. Let’s go through these different factors together.
Diet and Exercise
What role do lifestyle factors play in the success of weight management drugs? It turns out that, contrary to what some influencers and media outlets report, these factors play a big role.
For one thing, it’s important to remember that in all of the studies touting the benefits of new weight management medications, the people running the studies also helped patients to make dietary changes and exercise more. Many offered patients access to dietitians and psychologists. In fact, none, of these studies actually study the effect of the drug without lifestyle modification. So, significant lifestyle modification is essential to have the best opportunity to achieve results that are similar to the study results.
These medications were always intended to be paired with lifestyle changes like diet and exercise. If a person takes Ozempic or Wegovy but doesn’t also improve their diet and exercise more, then their weight loss may be limited.
Some people may assume that the only dietary changes they’ll need to make will be to eat less food, which the medications will help them to do naturally. But this isn’t true. A diet high in sugars and refined or fatty foods is still unhealthy, even if medications mean that a person is eating less of those foods than they were before. For your best chance at losing weight, you should be eating plenty of protein and vegetables, and avoiding alcohol and tobacco as well as fatty and sugary foods and drinks.
Compliance
One fact about these medications that often isn’t stressed enough by influencers and news outlets is that, if a patient wants to lose weight and keep it off by taking medication, then they will have to take those medications forever. One 2022 study found that, when patients stopped taking semaglutide, they regained two-thirds of their lost weight within a year.
As Dr. Steve Heymsfield, a professor of metabolism and body composition at Louisiana State University, writes, “This treatment is meant for lifetime unless you are willing to return to your original weight.”
But taking these medications forever can be very hard for some patients. Side effects can be intense and even, in some cases, life-threatening. Almost half of patients report side-effects, and even the moderate side effects such as diarrhea, nausea, and vomiting are not fun to deal with. Few people want to struggle with nausea for the rest of their lives.
There’s also the issue of cost. These medications cost $500-$1,300 per month, or about $6,000-$15,000 per year. That’s a high cost for one year of weight loss. But what if you want to lose the weight and keep it off for five years, or ten, or even more? The ongoing cost of these medications can spiral into the six figures.
Comorbidities
One unfortunate fact is that patients who suffer from comorbidities may lose less weight with weight management medications relative to patients who don’t suffer from comorbidities. This is especially frustrating for people who suffer from obesity, who often struggle with comorbidities such as sleep apnea and hypertension as a result of their weight.
What underlying health issues can influence the effectiveness of prescription weight loss drugs? As doctors at the Advisory Board write, “comorbidities, such as early-onset severe obesity in childhood, endocrine disorders, developmental delays, and early trauma, could all make a patient less responsive to weight-loss drugs.”
One big factor affecting weight loss is whether or not the patient suffers from diabetes. Second-generation weight loss medications are what’s known as GLP-1 receptor agonists, meaning that they stimulate the production of insulin. Insulin is secreted by the pancreas after a meal, and so stimulating the production of insulin makes patients feel full for longer and reduces their hunger. But for patients who suffer from diabetes, their bodies struggle to respond to GLP-1 or to stimulate insulin secretion, and so these medications are less effective.
In studies of Orforglipron, patients lost substantially more weight when they did NOT have type 2 diabetes than did diabetics. Non-diabetics lost an average of 12.4% of their total body weight, while diabetics lost just 6.3% of their total body weight.
Other Factors
The fact remains that obesity is a complex problem with lots of moving parts; and while researchers are learning more about obesity every year, we still don’t know everything. The same goes for why some people have an easier time losing weight than others. Part of the reason may have to do with genetic factors, epigenetic factors, differences in the microbiome, different sensitivities to hormones, and the fact that some people metabolize drugs more quickly than others. Other factors might include interactions between these weight loss medications and other medications that patients are taking, which researchers don’t fully understand yet.
(It is important to note that these medications have gotten better over time as we’ve learned more about obesity. For more on this topic, see our page on the evolution of weight loss drugs).
A Better Alternative: Bariatric Surgery
If you’ve struggled with your weight, either with or without weight management drugs, please do not give up hope or blame yourself. The fact is that losing weight on your own is hard, and sometimes these medications simply don’t work for patients, even if they do everything right.
However, if you do want your best chance to lose weight and keep it off, then there is a better alternative: bariatric surgery. Bariatric surgery remains the gold standard for long-term life-transforming weight loss and metabolic health. In fact, in a recent head-to-head study, bariatric surgery resulted in 5 times as much weight loss as GLP-1 medications. Bariatric surgery has helped lots of patients just like you to lose 65-90% of their excess body weight and keep it off. That can translate to weight loss of 100-150 pounds or even more.
Bariatric surgery is also extremely safe. Complications are rare and generally minor; and where they do happen, our double-board-certified bariatric surgeon, Dr. Joshua Long, personally commits to helping you through them.
You deserve to live a beautiful and radiant life. You deserve a life that is filled with love, laughter, and new beginnings. If you feel like a prisoner in your own body, then bariatric surgery can help.
Most of our patients report that the decision to undergo bariatric surgery was among the best decisions they ever made.
“We were no longer prisoners in our own bodies, we were no longer handicapped by our weight, we were living and moving and feeling better than we had felt in so many years.”—Lisa and Chris Chesrown, duodenal switch patients.
At the BMCC, we are now accepting patients from Arizona, Colorado, Idaho, Kansas, Montana, Nebraska, North Dakota, Oklahoma, Utah, and Wyoming. If you’re suffering, don’t wait. Contact our Denver office today.
