Have you been wondering about the relatively new injectable weight-loss drugs Wegovy or Zepbound? Bariatric surgeon and medical bariatrician Dr. David Voellinger of Novant Health Bariatric Solutions - Elizabeth in Charlotte wants you to know: these medications aren’t magic, but they can be effective under the right circumstances.
Let’s learn more.
Weight loss services that help you achieve a healthy lifestyle.
When should I consider a medication for weight loss?
Let’s say I walk into your office and say, ‘Is an injectable weight-loss drug right for me?’ What’s your answer?
We don’t start with a prescription — we start with questions, because the key to weight loss is a foundation of appropriate lifestyle management.
We have tools — like medication and surgery — to help you lose weight, but a tool is only as good as the carpenter using it. If you don’t have the right foundation, the tool is going to be ineffective.
We have four pillars that we go over with patients:
- Nutrition: Are you eating and drinking the right things?
- Exercise/activity: Are you being active and exercising?
- Behavioral modification: Are you managing your stress and anxiety in a healthy way? Are there any behaviors that you need to change to be healthier?
- Sleep: Are you getting enough?
I’ll also ask: Are you having problems with hunger, cravings or satiety? That’s the feeling of satisfaction at the end of eating.
Some patients are already living a very healthy lifestyle and not seeing results, but usually, patients have a few pillars they need to work on. We’ll come up with a customized plan for them, and send them to try it out.
So a healthy lifestyle needs to be in place before you prescribe a weight-loss medication?
Absolutely. These medications are part of the toolbox — not the only tool. They don’t stand alone; you have to use them alongside a healthy lifestyle. If you’re going to keep drinking daily milkshakes with your Zepbound, it isn’t going to do you any good.
What makes someone a good candidate for a weight-loss medication?
When a patient can lose weight and feel better from lifestyle changes alone, we’re all excited; it’s preferable to avoid the cost and side effects of medication if we can.
But if patients have implemented lifestyle changes for a few months and are still having issues with hunger, cravings or satiety, that’s usually when we’ll add medication.
What are the different medication options for weight loss?
We have a few oral weight loss medications — including phentermine, Contrave and topiramate — and there are patients and circumstances that these work well for.
But the buzz right now is about the injectable medications. The two big ones right now are Wegovy, the brand name for semaglutide. The other is Zepbound, the brand name for tirzepatide.
The way they work is slightly different but they’re both weekly, self-injectable shots that reduce cravings and hunger, and improve satiety. They’re the best weight loss medications we’ve had to date.
Want to learn more about side effects, insurance coverage, and how long these drugs may work? Check out this story: Misconceptions about weight loss drugs
Wegovy and Zepbound: is one right for me?
What’s so great about Wegovy or Zepbound?
They work! When patients are practicing a healthy lifestyle and then add these medicines on top, there’s a synergistic effect and they lose weight faster than they would with lifestyle changes alone.
As they lose weight, they feel more energized, and they’re often able to come down on some of their other medications.
Our patients aren’t losing weight due to vanity; they’re trying to reduce their risk of disease and live longer and better. It’s gratifying to be able to give them tools to do that.
Are there other benefits of Wegovy and Zepbound?
A lot of patients tell me that these medications “turn down the food noise.” They’re satisfied with small portions, and don’t have the cravings, hunger or “need” to eat. They say they didn’t realize how much of their time, effort, and thoughts were geared toward food until they went on these medications and those thoughts went away. Now they can just focus living their life.
Also, there are a lot of subconscious changes patients make because of their weight. Once they've lost some weight, they can do things they weren’t doing before — things like going out and socializing, crossing their legs, buckling the buckle on airplanes, exercising without pain.
So who can take Wegovy or Zepbound?
We can consider these medications for you if:
- Your body mass index (BMI) is over 27.
- You’re already doing well with the “pillars.” (See above.)
- You’re having issues with hunger, cravings or satiety.
- You may be having weight-related health conditions.
- You don’t have any “contraindications.” Those are factors that could make a treatment harmful and inadvisable.
If you have had these health issues, your doctor may require additional monitoring:
- A history of pancreatic disease.
- A history of thyroid disease.
- A history of gall bladder disease.
Who shouldn’t take Wegovy or Zepbound?
If you meet any of these criteria, you should not take these medications:
- A personal or family history of medullary thyroid cancer.
- A personal history of multiple endocrine neoplasia syndrome type 2.
- A personal history of digestive issues like gastroparesis, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), or inflammatory bowel disease (IBD).
If your body mass index (BMI) is over 50, we’ll likely recommend bariatric surgery over injectable medications, although we might recommend medications to help you get to a lower BMI prior to surgery so your surgery and recovery are safer. We try to use every tool we have at our disposal in combination to help every patient be as healthy as possible.
