Injectable weight loss drugs gained widespread media attention in 2023 and the attraction and conversation doesn’t appear to be slowing down.
We see more and more “before” and “after” pictures. We hear some information about the side effects. But educated minds should wonder about their long-term suitability and sustainable success.
Are injectable weight loss drugs destined to fail?
Dr. George Bray, a highly recognized expert in obesity, provides his findings from decades of study in the field.
“The benchmark for preferred weight loss is what we can achieve with surgery, which is about 25% of body weight loss (as standard loss),” he said. He confirmed that the latest drugs are a breakthrough in the field of weight loss as “the problem with most drugs that were on the market prior to these recent injectable ones…were that they did not produce sufficient weight loss.”
Ultimately, “anything that gets close to the benchmark is as good as we are going to get,” he continued.
The newest injectable weight loss drugs “are using mechanisms that are quite potent” and “clearly tapping into biologically important mechanisms,” Bray explained.
He said that researchers have “known for a long time that gastrointestinal feedback was important in regulating food intake even before injectable drugs came along.” To simplify, “these drugs have been designed so they last longer in the body” which make them “work more effectively as weight loss agents.”
One of the noticeable problems from the get-go when it comes to tackling weight loss on a global scale is experts’ and individuals’ conflicting visions for outcome.
“Most people who have a weight problem want to lose more weight and more rapidly than they can usually successfully do,” Bray said.
Back in 1997, a famous study was undertaken where individuals were asked prior to beginning a weight loss trial to verbalize what they would rate a “success” versus “a failure.”
The answers were as follows:
Dream weight – 32% less than starting point
Ideal weight – 27% less than starting point
Acceptable weight – 20% less than starting point
Losing less than 17% would be considered unsuccessful
17% is a considerable (and highly successful) percentage weight loss through my eyes, while 32% is an extreme percentage.
Bray, very well versed in the field, clarified, “Now very few people prior to these drugs could lose 17% by any technique other than with surgery.”
Think about that.
What did this mean?
“There was a big disconnect; it’s a big mis-match.” What experts and researchers attempting to treat obesity were able to provide patients with and what patients desired and expected were vastly different.
It’s common given this scenario that trial participants drop out or go through “a weight cycle – down and up, down and up” of pounds.
There really is no magic pill or injection. Every solution comes with a do-it-yourself manual, so to speak. You have to put in the work, be injected, swallow a pill, take the time, follow the steps, monitor your health with doctors, etc. The one and done model, to my knowledge, has not been developed.
What are the biggest flaws and problems with the injectable weight loss drugs?
“The major problem at the moment is cost,” Bray said. “If we had a health care system that was a reasonable one and we were to pay for it, it would bankrupt the system.”
Are the injectable weight loss drugs good for individuals?
“It may well be a good therapy”; but the bigger question is: “Will people continue them long term?” Bray stated that is an “interesting question” but he foresees the problem “being the economic cost of continued duration.”
The injectable weight loss drugs are “far too expensive for anyone but the really rich to really do.”
Let’s look back at the popularity of Fen-Phen in the 1990’s and the nightmare crisis that ensued with that weight loss “solution.”
Bray explained that a study was done during Fen-Phen’s boom, prior to discovering its correlation with “unfortunate cardiovascular outcomes” in the long run.
“When the drug was working, it was producing 15-20% weight loss.”
In the 1990’s a Fen-Phen study was conducted involving a group of executives who had prepaid $5,000 for the year. At the one-year mark, they had lost more than 15% of body weight. A success, right? Bray stated that the experts and researchers involved in the study thought that participants “should continue for another year so they would maintain their weight loss.”
Very few participants wanted to sign up for year two of Fen-Phen. Why?
They stated:
1- “They already conquered the weight loss problem. They didn’t need any more help as they were already there in achieving weight loss.
2- They had learned so much about the weight loss process via Fen-Phen they could manipulate it and produce the results themselves.”
In 1997 the FDA issued a public health advisory describing cardiovascular events associated with Fen-Phen and removed it from the market.
By this point in time, “millions of people had taken Fen-Phen.”* A few years later a “$4.75 billion settlement was approved by the court to cover medical monitoring and compensation for patients who suffered”* as a result of taking Fen-Phen.
What happened when Fen-Phen trial participants stopped the drug after one year, results being 15% down in body weight?
They regained the weight. The weight gain was expected by experts. Participants did not see it coming.
Weight loss drugs can be stopped at any time. Regaining weight is common.
“Weight loss surgery – you can’t reverse.” That’s where bariatric surgery serves as the benchmark.
When you give yourself a weight loss injectable drug or you take a weight loss pill, you are in full control, can start or stop at any time. From Bray’s perspective, “that’s the biggest pitfall for all of these therapies is long term adherence to it.”
The human body “has a set [weight] point that our bodies want to defend,” Bray stated.
“When you lose weight, a lot of things are triggered that would lead you to regain weight,” he stated.
Triggers can include:
- Hormones
- Energy expenditure
- Appetite
Majority of people “don’t gain a lot of weight quickly. They gain weight slowly over a period of time. And once you get to a certain level reversing that level is very difficult,” he concluded.
From an expert standpoint, stopping the use of injectable weight loss drugs or weight loss drugs in pill form have proven to lead you right back to where you started weight-wise.
In “Obesity research pioneer shares 5 tips to lead a healthier life,” Bray explains his top advice for living a healthier lifestyle.
Time, research, and trials will ultimately lead us in the future to sustainable, cost-effective weight loss options in the form of injectables/pills.
In the meantime, starting and maintaining a healthy eating plan can only improve your health.
I hope this expert insight provides you with a better grasp of the history of injectable weight loss drugs as well as a great starting point for future questions to ask a doctor if you choose to start an injectable weight loss drug.
Dr. George A. Bray has played a pivotal role in obesity research and working to improve society’s health. He is a longtime advocate for patients and early explorer of the biology that underlies individuals’ personal struggles with excess body weight and the consequences which cascade therefrom. Bray has received significant awards throughout his career some including: The Johns Hopkins Society of Scholars, Joseph Goldberger Award from the American Medical Association, the Stunkard Lifetime Achievement Award. He has authored/co-authored more than 1,700 publications.
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