Do Weight Loss Pills Work?
By Britni Vincent, RD, LD
January 9, 2024
Are you considering Ozempic or another one of the popular prescription weight loss drugs for losing weight or for weight management? These weight loss medications have been all over the media and you might be wondering if they are too good to be true.
Are weight loss drugs the answer to help people lose weight?
Do weight loss medications work?
Well, I’m here to break it all down for you to give you the facts on how these weight loss medications work and the potential drawbacks. I’ll also provide some alternative options which have lasting results, are more affordable than weight loss medications and don’t have the undesirable side effects.
What Are Weight Loss Drugs?
When considering prescription weight loss medications like this it’s important to understand how weight loss medications work. Most people assume that the weight loss drugs are pills, but some of the medications are injectables so I will use the term weight loss drugs or medications.
Semaglutide is the active ingredient in Ozempic and Wegovy, the popular FDA approved weight loss medications in the media right now. They are weekly injectables and part of a group of medications called GLP-1 agonists. They are the same drug just different doses.
When prescribed for diabetes, the drug is under the name Ozempic, which has been available in the U.S. since 2018. When it’s prescribed as a weight loss medication, it’s under the name Wegovy. Ozempic can also be prescribed as an off-label use for weight loss. These are the two prescription medications that have been talked about the most, but there are other prescription medications that also fall into this category, like Trulicity (Dulaglutide), Byetta (Exenatide), and Victoza (Rybelsus). Monjouro (Tirzepatide), another popular option, is a medication in a similar class called GLP-1/GIP receptor agonists.
How Do Weight Loss Drugs Work?
GLP-1 agonist prescription medications, like Ozempic, work by mimicking the GLP-1 that’s naturally produced in your body. GLP-1 is a peptide, which is a small little protein, primarily produced in your small intestine and colon. GLP-1 aids in weight loss through multiple mechanisms:
Appetite Suppression
GLP-1 is released after eating and is part of what makes you feel full and tells your brain it’s time to stop eating. Specifically, GLP-1 binds to a GLP-1 receptor and stimulates neurons that cause changes in the gut that create some gut distension and make you feel full.
Increasing Insulin Secretion
GLP-1 stimulates insulin secretion when your blood sugar starts to rise from eating. Insulin gets made and released by the pancreas to carry glucose into your cells to create energy. This will lead to lower blood sugar.
If you have type 2 diabetes, this process of transporting glucose into cells can work inefficiently or even be absent, which is why these medications can be prescribed by your health care provider as diabetes medications.
Delaying Stomach Emptying
The results of this delay help you feel fuller faster and longer, reducing food consumption. The delayed stomach emptying also helps to reduce blood sugar spikes from food.
Blocking Glucagon Secretion
Glucagon is a hormone your body uses to raise your blood sugar levels when necessary. Through this mechanism, GLP-1 prevents more glucose from going into your bloodstream.
Weight Loss Drugs Work By Mimicking GLP-1
GLP-1 agonist medications work by mimicking this hormone. In medication terms, an agonist is a manufactured substance that attaches to a cell receptor and causes the same action as the naturally occurring substance. In other words, GLP-1 medications bind to GLP receptors to trigger the effects (or roles) of the GLP-1 hormone. The higher the dose of the GLP-1 agonist, the more extreme the effects.
What Are The Side Effects And Drawbacks To These Weight Loss Drugs?
While these weight loss drugs have helped with weight loss or diabetes management for diabetics, as more information is coming out about these medications, it's clear there are many potential drawbacks to a weight loss drug:
Commonly Reported Side Effects of Weight Loss Medications:
Fifty percent of users have some form of digestive symptoms and can be severe enough to impact your quality of life.
Nausea, vomiting, and diarrhea that could lead to an acute kidney injury are the most frequently reported side effects (1).
Dizziness, mild tachycardia (fast heart rate), infections, headaches, and indigestion can also occur (1).
More severe side effects include gastroparesis, or stomach paralysis, and bowel obstruction, which can lead to surgery.
Weight Reduction Due To Large Amounts Of Muscle Loss:
It is normal to lose some lean body mass during weight loss, but losing too much is a concern. Lean body mass is your bones, organs and muscle — basically everything that isn’t body fat. Having more lean body mass is healthier and having more muscle means a better metabolism. When you lose a large amount of weight in a short amount of time you lose more lean body mass along with body fat.
If your body isn’t getting enough energy from food, it’s going to pull energy from your muscle along with fat just so your body can continue to function. This means your metabolism slows down, making it harder to maintain weight loss and even more likely to regain the weight that WAS lost.
Losing a large amount of muscle may change your appearance, making you look older. You end up with more loose skin including on your face, which has been called “Ozempic face”. It's been noted that about forty percent of weight loss from these drugs is from muscle loss.
Risk Of Weight Regain:
Once you go off of the weight management medications you will most likely regain the weight you lost. The weight gain is from increasing body fat. So your total body weight might be the same as before taking the weight loss medication, but now your metabolism is slower because you have less muscle, making your body composition and metabolism worse off from when you started. The current recommendation for most individuals is to stay on the weight loss drugs indefinitely to maintain results.
One of the studies often cited when discussing the benefits of the GLP-1 agonist medications, Step 1, did an extension trial. The study included 327 participants. They monitored them for one year after stopping Semaglutide, Ozempic or Wegovy, and the lifestyle interventions included in the Step 1 trial. After one year of stopping the weight loss medications, participants regained two-thirds of their prior weight loss and cardiometabolic improvements for preventing heart disease, like lowering high blood pressure, went back to baseline for most participants (2).
Cost:
These weight loss medications are expensive and many of them are not covered by health care insurance, so the out-of-pocket cost could be great, especially if you need to stay on them indefinitely. The cost is often as high as $1700 per month.
Limited Studies For Long-Term Use:
Like mentioned above, Ozempic has been available since 2018 in the United States, but that means we haven’t really seen what happens when the body is on these medications long term. The longest study is sixty-eight weeks and side effects from prescription weight loss drugs might not appear until you're on them for much longer.
How To Achieve Sustained Weight Loss Without Side Effects
#1. Real food
Real food is an affordable, sustainable weight loss and weight management solution without negative side effects or serious health problems. By eating real food you can heal the body from the inside out to support a healthy metabolism.
Not only does a real food approach help with weight loss, but real food also decreases weight related health conditions, reduces inflammation, improves cholesterol levels, reduces risk of heart disease, improves hormone function, and increases energy amongst many other benefits. Not only does your waistline start to shrink, but you generally feel a lot better.
Real food is food naturally found in nature and includes healthy fats (avocadoes, butter, nuts, seeds, olive oil, olives, coconut oil), protein (meat, eggs, dairy if tolerated, seafood and fish), and carbohydrates (vegetables and smaller quantities of starchy vegetables, fruit, beans, lentils and grains).
#2. Naturally increase the amount of GLP-1 your body produces
You can increase your own natural GLP-1 production by eating fiber and protein.
Not only does fiber increase GLP-1 production, but fiber itself also slows down your digestion, increasing satiety and keeping your blood sugar balanced. Fiber rich foods include vegetables, berries, beans, lentils, avocado, nuts and seeds.
Protein has also been found to increase GLP-1 production. Protein itself promotes a feeling of fullness and helps regulate appetite. Clinically, we see when individuals increase their protein intake throughout the day, they can decrease cravings and have a decreased appetite. Organic, grass-fed, free-range, pasture-raised meat, dairy and eggs and wild-caught fish and seafood are preferred to increase nutrients and reduce toxin exposure.
#3. Naturally reduce insulin resistance
Eat carbohydrates cautiously:
Eating protein and fat along with carbohydrates reduces the blood sugar spike from carbohydrates. A good rule of thumb is to never have a carbohydrate alone. Carbohydrates convert to sugar, increasing blood glucose and triggering insulin release from the pancreas. This insulin acts like a key, attaching to glucose and unlocking cell receptors to facilitate energy production in your cells.
Insulin resistance happens when you eat a lot of carbohydrates and sugar over time; the body's normal process becomes less efficient. To compensate, your body outputs more insulin and your body craves more carbs and sugar in an attempt help your cells create more energy. This becomes a vicious cycle.
Reducing Insulin Resistance is Essential to Prevent Gain Weight:
Insulin resistance can be thought of as a spectrum and eventually will lead to type 2 diabetes if not reversed. When your body produces excess amounts of insulin because of insulin resistance this causes a lot of fat storage and weight gain, specifically in the mid-section. Large amounts of insulin dramatically increases inflammation systemically.
Naturally reduce insulin resistance:
You can reverse insulin resistance with lifestyle changes like diet and exercise.
Step 1 is focusing on real carbohydrates and reducing or eliminating processed carbohydrates (bread, pasta, crackers, desserts, muffins, cereal, etc.). Focus on vegetables as your primary source of carbohydrates.
Step 2 is eating protein and fat with your carbohydrates.
Step 3 is increasing your fiber intake to help stabilize your blood sugar.
Over time your body’s production of insulin will reduce and your cells will heal. Clinically, we regularly see clients reverse insulin resistance without a weight loss drug. We have even had clients reverse their type 2 diabetes with a real food diet.
#4. Maintain muscle mass
Eat adequate protein:
Eating adequate protein is key to maintaining or increasing muscle mass. Protein is the building block of muscle. If you don’t get enough protein your muscles can’t build and repair or maintain themselves. We recommend at least 14 ounces of protein (about 100 grams) each day (this amount is measured after the protein is cooked).
Incorporate resistance training:
Resistance training is also key to maintaining and gaining muscle. Incorporating exercise, especially some form of resistance training, can also help to speed up weight loss. You can do body weight exercises, use resistance bands, or incorporate weightlifting into your lifestyle changes.
Best Supplements For Weight Loss:
Along with some basic key supplements we recommend as part of a healthy lifestyle (like a multi-vitamin, vitamin D3, probiotics, omega-3s, and magnesium), there are some supplements that can aide in helping people lose weight and increase GLP-1 production.
Supplements don't replace good nutrition:
Weight loss supplements don't replace a healthy eating plan of real food (which is essential for overall health and weight management). Working with a nutritionist or a health care provider will help you decide if supplements are a right choice for you.
Weight Loss Supplement: Berberine
Berberine has been compared to Ozempic in the media lately. It does not work in the same way as Ozempic or the other weight loss medications, but it can improve blood sugar levels and reduce insulin resistance. Berberine helps glucose get carried into your cells more efficiently, therefore reducing blood sugar levels and the production of insulin.
There have been many studies showing the health benefits of berberine. One meta-analysis looked at 12 different studies and concluded that berberine significantly reduced body weight and excess weight around the waist (3).
Another meta-analysis included 27 randomized controlled clinical trials with 2569 patients. The researchers concluded that berberine has comparable therapeutic effects on type 2 diabetes, high cholesterol and high blood pressure than first line prescription drugs treatment with no serious side effects. The group that combined lifestyle interventions, like diet and exercise, plus berberine had lower glucose levels and hemoglobin A1C than the group doing lifestyle changes alone, indicating that berberine helps to reduce insulin resistance and health problems related to insulin resistance (4).
Weight Loss Supplement: HiPhenolic
This is a new professional grade supplement made by Ortho Molecular. It helps with weight loss through various mechanisms, which includes increasing GLP-1 production. Similar to Ozempic, HiPhenolic helps to reduce appetite and increase satiety. Along with that, it can help to support lower blood pressure to healthy levels.
One of the ingredients, Metabolaid®, increases GLP-1 production. In an eight week, double-blind, placebo-controlled trial of overweight individuals, those who received 500 mg of Metabolaid® daily (a blend of hibiscus and lemon verbena extract) had a statistically significant increase in the satiety hormone GLP-1 compared to the placebo group (5).
HiPhenolic also contains green coffee bean extract, which has also been shown to help people lose weight (6). These ingredients work synergistically to increase energy sensor AMPK. AMPK increases cellular metabolism, helping glucose uptake thereby reducing insulin resistance.
Tea For Weight Loss: Yerba Mate
This isn’t a supplement per se. Yerba mate is a type of tea that’s popular in Latin and South America. Like black and green tea, it does contain caffeine. It has been found to increase levels of GLP-1 and increase leptin levels. Both of these mechanisms help to increase satiety and decreased appetite (7,8). Avoid smoked varieties of yerba mate as they are possibly carcinogenic.
The effects of yerba mate on GLP-1 are going to be much lower than the weight loss drugs or HiPhenolic supplement, but if you enjoy the taste of it, incorporating 1-2 cups per day may be an easy addition to your routine.
The Best & Healthiest Way To Lose Weight
To recap, weight loss drugs approved by the FDA were created to assist individuals with diabetes and are being marketed as weight loss medications because of the way they mimic GLP-1.
As more information is coming out about these weight loss drugs, it's clear that they don't come risk free. The drawbacks to these weight loss medications are the list of commonly reported side effects (like nausea, vomiting, digestive and kidney diseases, abdominal pain, and other chronic disease), muscle loss, cost, and the potential weight gain if you stop taking them. The current recommendation for most individuals is to stay on these medications long-term to maintain the results.
Real food is a more sustainable, affordable weight loss solution.
A healthy approach would be focusing on whole, nutrient dense foods, eating protein and fiber to help your body make its own GLP-1, maintaining (and building!) muscle through exercise, balance blood sugar to reduce insulin resistance.
We recommend talking with a dietitian or nutritionist about supplements that might be supportive with your nutrition efforts. We have thousands of clients who have lost weight with diet and exercise and you can lose weight holistically, without the use of prescription weight loss drugs.
For more information on how to lose weight without weight loss drugs, check out these resources:
Take: Nutrition 4 Weight Loss Program
Read: Top 3 Ways Alcohol Affects Weight Loss - how to treat alcohol and lose weight
Listen: Key Nutrients for Weight Loss
References
- Collins, L., & Costello, R. A. (2023, January 3). Glucagon-like peptide-1 receptor agonists - statpearls - NCBI BOOKSHELF. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK551568/
- Wilding, J. P., Batterham, R. L., Davies, M., Van Gaal, L. F., Kandler, K., Konakli, K., Lingvay, I., McGowan, B. M., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., & Kushner, R. F. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The step 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725
- Asbaghi, O., Ghanbari, N., shekari, M., Reiner, Ž., Amirani, E., Hallajzadeh, J., Mirsafaei, L., & Asemi, Z. (2020). The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes: A systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition ESPEN, 38, 43–49. https://doi.org/10.1016/j.clnesp.2020.04.010
- Lan, J., Zhao, Y., Dong, F., Yan, Z., Zheng, W., Fan, J., & Sun, G. (2015a). Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. Journal of Ethnopharmacology, 161, 69–81. https://doi.org/10.1016/j.jep.2014.09.049
- Boix-Castejón M, Herranz-López M, Pérez Gago A, et al. Hibiscus and lemon verbena polyphenols modulate appetite-related biomarkers in overweight subjects: a randomized controlled trial. Food Funct.2018;9(6):3173-3184. doi:10.1039/c8fo00367j
- Haidari F, Samadi M, Mohammadshahi M, Jalali MT, Engali KA. Energy restriction combined with green coffee bean extract affects serum adipocytokines and the body composition in obese women. Asia Pac J Clin Nutr.2017;26(6):1048-1054. doi: 10.6133/apjcn.022017.03. PMID: 28917230.
- Gambero A, Riberio ML. The positive effects of yerba maté (Ilex paraguariensis) in obesity. Nutrients. 2015 Feb; 7(2): 730–750. Published online 2015 Jan 22. doi: 10.3390/nu7020730. https://www.mdpi.com/2072-6643/7/2/730.
- YouTube. (2022, July 27). What is GLP-1 & How Does it reduce appetite & promote weight loss? | dr. Andrew Huberman. YouTube. https://www.youtube.com/watch?v=B8staZOc_xQ
