Guidelines Backlash, the Biggies — Drugs, Part 2

“Side effect” is a tricky term. For instance, a drawback of traditional appetite suppressants is that they probably exacerbate high blood pressure, or at the very least, do nothing to lower it. This is a negative side effect. On the other hand, a drug can have a side effect that is considered positive.

Side effects lead to what is called “off-label” use, until the point when the establishment does enough research to deem a drug officially suitable to be prescribed for whatever secondary use it is good for. As we have seen, the class of drugs known as GLP-1 agonists, used mainly to treat diabetes and other endocrine disorders, provide not only insulin sensitivity but appetite control. They imitate a peptide produced in the human gut that helps to regulate glucose in the system, and also contributes to a feeling of fullness. This in turn facilitates weight loss for some people.

Side effects, plural

Now that some drugs of this type have been approved to treat obesity, weight loss is no longer a side effect, but their primary purpose. Unfortunately, they still have other side effects, some of which are merely annoying, and may diminish with continued use as the body acclimates to the drug. Other side effects are more serious and even debilitating. In deciding whether or not to get involved with this type of pharmaceutical, several factors must be considered.

For instance, one of the recently approved drugs of this kind, whose generic name is semaglutide, is said to enable adolescents to reduce their BMI, or body mass index, by about 16%, which is a lot. But under any circumstances, rapid weight loss alone can stir up metabolic issues, hormone imbalance, and a malfunctioning gall bladder. In addition, experts have warned that the newer drugs can cause kidney problems, vision changes, and increased risk for rare forms of thyroid tumors.

As of February 2023, another such drug is on the way, having been set on the approval fast track by the Food and Drug Administration. Tirzepatide is another generic semaglutide whose brand name (if approval is granted) has not yet been chosen. Like its brothers, it works by slowing the passage of food through the digestive track, which allows the patient to feel sufficiently fed on a smaller amount of food.

The previous record of a semaglutide, causing an average weight loss of 16%, has been deemed impressive, but the newest contender beats that. A phase 3 trial chalked up weight loss as high as 20% of the person’s starting body weight, which in some cases translated into the loss of as much as 80 pounds.

There had already been concern over a version of semaglutide often prescribed to diabetes patients under the brand name Ozempic. Then, along came a jacked-up version of this injectable, approved by the FDA for long-term weight loss. When prescribed for that purpose it is branded Wegovy, about which we will have more to say.

Your responses and feedback are welcome!

Source: “The upsides and downsides of blockbuster weight loss drugs,”, 02/01/23
Source: “’Ozempic face?’ Dr. Siegel warns of popular diabetes drug’s bizarre side effect,”, 01/29/23
Image by Jernej Furman/CC BY 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
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Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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