Weight loss has been one of the most talked about topics of 2023 and it’s certain to heat up even more in the new year.
Florida is now blanketed with med spas, weight management clinics, and online pharmacies that sell Ozempic, Wegovy and drugs that contain the compound, semaglutide, that squelches hunger and food cravings. In 2024, new weight loss drugs are on their way to the Sunshine State as are new diets and more ways to get medications for dropping pounds with minimal effort.
“I think we are going to see more of these drugs and more side effects,” said Dr. Eneida Roldan, an obesity specialist, professor and associate dean of Florida International University’s Herbert Wertheim College of Medicine.
The hype over weight loss drugs took hold in 2023, fueled by celebrities posting their before and after Ozempic photos on social media. Comedian Tracy Morgan had this to say: “I went and got a prescription, and I got Ozempic. And I ain’t letting it go … It cuts my appetite in half. Now I only eat half a bag of Doritos.”
Ozempic, a drug used to treat diabetes, and Wegovy, a drug for obesity, are being used off-label to help people drop pounds fast — whether 10 pounds or 100. These drugs work by reducing the appetite and allowing users to feel full sooner.
Floridians have joined the national craze, even forming Ozempic support groups on Facebook where they swap tales of their weight-loss journeys. Mounjaro also has joined the drugs intended for diabetes but being used by Americans for weight loss. Its active ingredient is tirzepatide and like Ozempic, it is given as a once-weekly injection in the stomach, thigh or arm.
Mounjaro sells for a list price of about $1,023 per fill, which is equal to a month’s supply or four injector pens, according to Eli Lilly. Wegovy is slightly more costly with a list price of $1,349 for a month’s supply. Many private health insurance plans still do not cover obesity medications and shortages of the drugs have limited supply for consumers. For now, Medicare is forbidden to cover such medications, but efforts by lawmakers are underway to change that.
A look ahead for weight loss
In 2024 more weight loss drugs are on the way.
In November, the Food and Drug Administration (FDA) approved Zepbound, a new drug for chronic weight management that contains the same compound as Mounjaro. Similar weight-loss medications are in the pipeline with a half-dozen or so candidates in this same drug class now making their way through clinical trials. There also are pill versions of existing weight loss drugs in the works.
“Having more medications that are slightly different is a good thing, because some people may respond better to one and some may respond better to another,” Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian, told TODAY.com.
As the new year rings in, health experts expect more Floridians to turn to weight-loss drugs. Already, Florida ranks fourth for residents searching online for Ozempic, according to Kaly.com. Floridians are conducting 1,310 average monthly searches per 100,000 residents, Google data shows.
While these drugs grow in popularity, researchers only now are studying how healthy these weight-loss methods are for the general population, how they may affect certain populations, and whether they are sustainable. People have to keep taking the drugs for them to work, otherwise they eventually regain most of the weight that was lost.
Reported side effects include nausea, constipation, diarrhea, vomiting, indigestion and stomach pain, according to the manufacturers and posts on social media. There are also less common but more severe side effects such as allergic reactions, changes in vision and pancreatitis, and Ozempic includes a warning for the risk of thyroid C-cell tumors.
Specialists, like FIU’s Roldan, say although the medications are being prescribed off-label for weight loss rather than severe obesity or diabetes, there isn’t enough evidence yet to know whether they might be beneficial or harmful for people who fall outside of the FDA’s criteria.
Start with a doctor’s visit
Experts say too many people rely on the weight-loss drugs rather than learning healthy eating habits that will keep off the pounds over the long term.
“Medications are tools. Bariatric surgery is a tool. But there is no quick fix,” Roldan said “Like everything else it’s a game of numbers. The more individuals start using these drugs, the more complications we will see.”
People who resolve to lose weight in 2024 should start with a physician consultation, Roldan says. She says the popular diet, intermittent fasting — fasting daily for a set amount of time — could be helpful for some people if they are not in danger of hypoglycemia. So could reducing sugar and fatty foods.
“Anything you want to try should be done in consultation with a professional who can give you a baseline of your physical and mental condition,” she said. “The bottom line is what makes you lose weight is getting to know yourself, your habits, your lifestyle, how you react to stress.”
Exercise-mimicking drug sheds weight
In North Florida, Thomas Burris, a University of Florida professor of pharmacy, may have discovered another weight loss breakthrough.
He is working on a new weight-loss drug tested in mice that mimics aerobic exercise and increases endurance. Known as SLU-PP-332, the drug boosts a natural metabolic pathway that gets activated when someone exercises. In effect, the drug makes the body act like it is training for a marathon, leading to increased energy expenditure and faster metabolism of fat in the body.
So far, the drug has been tested in mice and hasn’t shown any severe side effects. Burris says the greatest hope for the new drug might be in maintaining muscle mass during weight loss. He believes pairing it with one of the new weight-loss drugs could be beneficial.
“When you reduce food intake, you reduce protein intake, and you lose muscle mass and muscle function unless you increase exercise at the same time,” he said. “A combination of these drugs could be the next step for anti-obesity drugs.”
For now, Burris warns Floridians to scrutinize any weight-loss medications that aren’t brand name, noting that all kinds of businesses are advertising their own versions of drugs with semiglutide at discounted prices and in various doses (often marketed as Ozempic alternatives). “I worry when you see compounding,” he said. “You don’t know if it’s the real thing or a modification. These drugs are expensive to manufacture, so when people are offering what they say are the same drugs at substantial discounts, you have to think how can they do that?”
Bariatric surgery is still an option
Before this new class of weight-loss drugs drew attention, bariatric surgery had been embraced as an option for the obese. Dr. Raul Rosenthal, a bariatric surgeon at Cleveland Clinic Weston, says the surgery continues to be performed on the severely obese. However, he says it can be costly and not everyone who is obese is a candidate. For some patients, he prescribes the new weight-loss drugs. “They are welcome by bariatric surgeons as another tool in our toolbox. I think we still need to define who will get it, who will not, and define who will prescribe this medication,” he said.
Rosenthal said the drugs represent a medical revolution, a less costly, more universal way to address the disease of obesity.
“So far these medications are injectable. I foresee in the near future either oral medications or dermapatches. and they will be cheaper, so more patients can be treated,” Rosenthal said.
Along with stories of rapid weight loss from Ozempic, there are people who have expressed on Facebook and Tik Tok how they “wished they had never touched it,” claiming the drug has led to stomach paralysis, loss of muscle, and excessive vomiting.
Another way to lose weight
Dr. Terri DeNeui, founder and Chief Medical Officer of EVEXIAS Health Solutions, says anyone who wants to lose weight in the new year should look into the root cause of why they have gained pounds — and that may be a hormonal imbalance.
“These medications are a game-changer in the weight-loss world,” she said. “But trying to address weight loss without addressing hormone deficiency is futile. You can jump start weight loss with the medications, but keeping it off is different.”
After 40, she says, hormone imbalances are more common.
“Adjusting hormone levels can be the cornerstone for weight loss, but you also need to look at dietary changes,” she said. “With these medications, people aren’t changing their lifestyle, just eating less. After awhile they report the drugs are not working anymore. They can get desensitized and they haven’t made the lifestyle changes.”
Some scientists also are looking into fermentable fiber as the “magic” behind the drugs that have triggered weight loss. They believe that particular types of fibers trigger GLP-1 release (the same receptor that Mounjaro targets). By eating more of this fiber, their theory is that it will create a feeling of fullness similar to the medications. So far, the fiber in barley, oats and rye have shown promise.
Change your mindset to lose weight
Dr. Adedapo Iluyomade, a preventative cardiologist at Baptist Health Miami Cardiac & Vascular Institute, believes weight loss needs to be seen as a chronic condition that should be addressed in an ongoing manner — through food choices and daily exercise.
“Targeting weight loss is a very important goal for someone headed into the new year if they are overweight or obese,” he said. “Being overweight can affect their health in a multitude of ways.”
In recent years, high-fat, low-carb diets have become popular.
Lluyomade advises against them: They have been shown to elevate cholesterol to unsafe levels and increase a person’s cardiovascular risk.
Although he has prescribed weight-loss drugs to some patients, he believes the best way to lose weight is to reduce calorie intake and increase physical activity.
“Just get up and move and do something,” he said. “It will build momentum.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
