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The hype surrounding new weight loss drugs like Ozempic, Wegovy, and Mounjaro is off the charts. So, too, is demand.

They work tremendously well for some people, who lose up to one-quarter of their body weight. The meds have been described as bariatric surgery without the surgery.

Still, there is much reason for caution. The proverbial saying, “If it’s too good to be true, it probably is,” springs to mind.

Semaglutide (sold under the brand names Ozempic and Wegovy by Novo Nordisk) are useful drugs for some people with type 2 diabetes because they stimulate the pancreas to produce insulin. Weight loss is a bonus, but also helps people living with diabetes, many of whom struggle with their weight.

Semaglutide imitates the hormone GLP-1 which, in addition to stimulating insulin production, inhibits glucagon production, and slows digestion, helping people feel fuller longer.

In short, you don’t feel hungry, so you eat less and lose weight.

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Tirzepatide (brand name Mounjaro, a product of Eli Lilly) works in a similar manner. But, in addition, to GLP-1, it stimulates GIP, which was previously believed to encourage obesity. While the inner workings of this (apparently counterintuitive) mechanism are unclear, it seems to produce even more weight loss than competitors’ drugs.

The drugs are simple enough to use: A self-administered injection in the stomach once a week. (A daily pill is also in development.)

While the weight loss these drugs can produce is well documented, and amplified by anecdotes, less discussed are the side effects.

They are many, and they are common: nausea, dehydration, constipation, diarrhea, heart palpitations. There are also rare, but grave, side effects, including thyroid tumours and kidney failure.

Some patients taking Ozempic or Wegovy eat so little that they suffer from malnutrition, so users take multivitamins and protein powder as supplements.

Women of child-bearing age should also be aware that, in animal studies, these drugs cause miscarriage and damage to the fetus. This is noteworthy because the main clientele – like all diet products – is young women.

To be fair, people with diabetes and obesity can also suffer a host of health problems, from gastrointestinal distress, to heart and kidney damage, to trouble conceiving, that are as bad or worse as those caused by the drugs.

When these diabetes/weight loss drugs are promoted in ads and supermarket tabloid headlines, there is rarely mention of the cost, which is substantial.

Ozempic, Wegovy and Mounjaro sell in the $800 to $1,250 a month range in the U.S. In Canada, it’s more like $250 monthly (because this country has price controls on drugs).

Roughly $15,000 a year (or even $3,000) can be a bitter pill to swallow, especially if it’s for life. Remember, studies show that when people stop taking these appetite-suppressing drugs, they put most of the weight back on.

We don’t have a good sense yet of the health impacts of taking weight loss drugs for an extended period.

What we do know is that every weight loss “miracle” – the grapefruit diet, Scarsdale, Slim Fast, Weight Watchers, fen-phen, carb cutting, calorie counting, bariatric surgery, paleo – become a little less miraculous over time.

It’s maintaining the eat-less lifestyle that’s the real challenge.

Some researchers are warning that the current mania for GLP-1 inhibitors has eerie parallels to the rage for “rainbow diet pills” in the 1960s, and the fen-phen weight loss treatment disaster of the mid-1990s.

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Rainbow pills were a dreadful combo of amphetamines, digitalis, thyroid hormone and diuretics. Women lost weight all right, but being stoned on speed took a horrible toll on their physical and mental health.

Fen-phen, touted on the cover of Time magazine as “The New Miracle Drug,” was a combination of fenfluramine and phentermine that stimulated the release of serotonin, which, among other things, made people feel satiated.

Sold under the brand names Pondimin and Redux, the drugs promised, and delivered, dramatic weight loss, and people clamoured for it. But it was withdrawn after only a year after it turned out it could cause heart valve problems and fatal pulmonary hypertension. More than US$13-billion was paid out to settle lawsuits.

It’s a reminder that rare and dangerous side effects usually only come to light when large numbers of people take a drug.

Prescription drugs have a place in our medical response to obesity, but they need to be used judiciously.

Ultimately, it’s the quantity and quality of what goes into our mouths (and stomachs) that matters.

In our obesogenic environment, that can be a massive challenge, one that can’t be managed with a weekly injection or daily pill alone.

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