In recent years, there has been growing interest in the connection between drug use and changes in body weight. This relationship is complex and can be influenced by a variety of factors, including the type of substance used, the individual's overall health, and lifestyle choices. While some drugs may lead to weight loss, others can contribute to weight gain. Additionally, certain medications initially developed for other conditions, such as diabetes, have been found to have weight loss effects, leading to both excitement and concern within the medical community.
The Rise of GLP-1 Agonist Drugs
A new class of drugs known as GLP-1 receptor agonists, including medications like Ozempic and Wegovy, have gained significant popularity. These drugs, initially approved for use in diabetes and weight loss, have shown promise in treating other conditions, such as cardiovascular disease and addiction.
Potential for Addiction Treatment
Researchers are exploring the potential of GLP-1 drugs in treating opioid use disorder. Preclinical studies have shown promising results, and clinical trials are underway to evaluate their effectiveness in human participants. Early findings from a study with participants in a residential treatment facility for opioid use disorder showed a 40% reduction in opioid craving among those taking the GLP-1 drug liraglutide compared to those who received a placebo. Patients reported that these drugs slow down the need for immediate gratification of cravings, allowing them to make better and healthier decisions.
FDA Approval
If clinical trials demonstrate that GLP-1 medications are effective in reducing craving and the return to opioid use, the National Institute on Drug Abuse (NIDA) may prioritize FDA approval of these medications as a treatment for opioid use disorder. Since these medications have already been approved for use in humans, the approval process could be expedited if data show that they are safe and save lives.
The Impact of Substance Use on Nutrition
Substance use can harm the body in two primary ways:
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- The substance itself affects the body.
- It causes negative lifestyle changes, such as irregular eating and poor diet.
Proper nutrition is essential for the healing process. Nutrients provide the body with energy and the substances needed to build and maintain healthy organs and fight off infection. Recovery from substance use can also affect the body's metabolism, organ function, and mental well-being.
Opiates and Opioids
Opiates and opioids, including codeine, oxycodone, heroin, morphine, and fentanyl, can significantly affect the gastrointestinal system. Constipation is a common symptom of substance use, while withdrawal symptoms often include diarrhea, nausea, and vomiting. These symptoms can lead to nutrient deficiencies and electrolyte imbalances. Eating balanced meals with plenty of complex carbohydrates and fiber may help alleviate these symptoms.
Alcohol
Alcohol use is a major cause of nutritional deficiency in the United States, particularly deficiencies in B vitamins (B1, B6, and folic acid). These deficiencies can cause anemia and neurological problems. Heavy alcohol use can also lead to Wernicke-Korsakoff syndrome ("wet brain"), which results from a lack of vitamin B1. Alcohol use damages the liver and pancreas, which are critical for metabolism and nutrition, resulting in imbalances of fluids, calories, protein, and electrolytes. Other complications include diabetes, high blood pressure, permanent liver damage, seizures, severe malnutrition, and a shortened life expectancy. A woman's poor diet and alcohol consumption during pregnancy can harm the baby's growth and development, potentially leading to physical and mental problems.
Stimulants
Stimulant use, such as crack, cocaine, and methamphetamine, reduces appetite and leads to weight loss and poor nutrition. Users may stay awake for days, leading to dehydration and electrolyte imbalances. Returning to a normal diet can be challenging after significant weight loss. Long-term stimulant use can also cause memory problems.
Marijuana
Marijuana can increase appetite, potentially leading to overweight and the need to reduce fat, sugar, and total calories.
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Nutrition and Psychological Aspects of Substance Use
Balanced nutrition can improve mood and health, which is crucial for individuals recovering from alcohol and drug problems. However, drastic lifestyle changes may not be immediately feasible for someone who has recently given up an important source of pleasure. Prioritizing abstinence from substance use is more important than adhering to a strict diet.
Guidelines for Recovery
- Stick to regular mealtimes.
- Eat foods that are low in fat.
- Increase protein, complex carbohydrates, and dietary fiber intake.
- Consider vitamin and mineral supplements (B-complex, zinc, vitamins A and C).
Poor eating habits can increase the likelihood of relapse. Regular meals are essential because drug and alcohol addiction can cause a person to mistake hunger for drug cravings. Encouraging the person to recognize hunger when cravings become strong is important. Dehydration is common during recovery, so adequate fluid intake is crucial. Appetite usually returns during recovery, and individuals may overeat, particularly if they were taking stimulants. Healthy meals and snacks should be prioritized over high-calorie, low-nutrition foods like sweets.
Tips for a Lasting Recovery
- Eat nutritious meals and snacks.
- Engage in physical activity and get enough rest.
- Reduce caffeine and stop smoking.
- Seek help from counselors or support groups regularly.
- Take vitamin and mineral supplements as recommended by a healthcare provider.
Weight Loss as a Sign of Addiction
Rapid weight loss can be a sign of addiction. Substance abuse can produce profound metabolic changes or alter eating habits, affecting food intake. Weight loss due to addiction can be dangerous and even deadly.
How Drugs Cause Weight Loss
Substances of abuse can impact weight by affecting organs, metabolism, and brain function. When drug use becomes the primary focus, unhealthy eating behaviors like skipping meals or consuming nutrient-deficient foods can develop.
Specific Drugs and Their Impact on Weight
- Stimulants: Cocaine, methamphetamine, and MDMA (Molly, ecstasy) are often appetite suppressants and can change the way calories and fat are metabolized. Research suggests that cocaine dependency alters fat processing and storage in the body. Stimulants can also act on the central nervous system, dulling feelings of hunger.
- Alcoholism: Alcohol abuse can damage organs, leading to weight loss. Alcohol's acid can harm the stomach and intestinal lining, inhibiting nutrient absorption and causing chronic diarrhea or vomiting. Alcohol can also overload the liver, causing inflammation, disease, and failure, leading to nausea, gastrointestinal problems, and weight loss.
- Opioids: Opioid addiction can lead to drug-seeking behaviors that overshadow everyday practices like eating regularly, getting enough sleep, and maintaining personal hygiene. Opioid addiction can also harm organs, leading to weight loss through gastrointestinal issues and hindered nutrient absorption. Injecting opioids can lead to infections and diseases like Hepatitis and HIV, which can also cause weight loss.
- Hallucinogens: Hallucinogens like LSD can cause nausea and vomiting, influencing appetite and calorie and fat intake.
- Prescription Pills: Abuse of prescription drugs, especially painkillers containing opioids, can cause weight loss through organ damage and drug-seeking behaviors.
Prescription Weight-Loss Drugs
Prescription weight-loss drugs may be an option for adults with serious health problems related to their weight who have not been able to lose enough weight through diet and exercise. These drugs are not for everyone, and healthcare providers consider individual history and health challenges before prescribing them.
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Long-Term Use and Weight Loss
Prescription weight-loss drugs for long-term use can lead to significant weight loss compared to placebo treatments. Taking these drugs for a year can result in 3% to 12% more total body weight loss than lifestyle changes alone. Losing 5% to 10% of total weight and maintaining it can have important health benefits.
Common Side Effects
Mild side effects like nausea, constipation, and diarrhea are common but may lessen over time. Serious side effects are rare, but it is important to discuss all treatment choices with a healthcare provider. Weight-loss drugs can be expensive and may not be covered by insurance. Many people regain some weight after stopping these drugs.
How Weight-Loss Drugs Work
Most prescription weight-loss drugs work by making you feel less hungry or fuller. Orlistat is an exception.
Specific Weight-Loss Drugs
- Bupropion-naltrexone: This combination drug uses naltrexone, which is used to treat alcohol and opioid addiction, and bupropion, which is used to treat depression and help people stop smoking. It carries a warning about suicide risk and can raise blood pressure.
- Liraglutide: This drug is also used to manage diabetes and is given as a daily shot. Nausea is a common side effect.
- Orlistat: This drug is available in a reduced-strength form without a prescription (Alli). It can cause side effects such as passing gas and having loose stools, and requires following a low-fat diet. In rare cases, it has been linked to serious liver injury.
- Phentermine-topiramate: This combination drug includes phentermine, a weight-loss drug with the potential for misuse due to its stimulant-like effects, and topiramate, an anticonvulsant. Possible side effects include increased heart rate and blood pressure, insomnia, constipation, and nervousness.
- Phentermine: This drug is used for short-term weight loss.
- Semaglutide: This drug is also used to help control type 2 diabetes.
- Setmelanotide: This drug can lessen appetite and make you feel fuller.
Important Considerations
Weight-loss drugs are not an easy solution to weight loss. It's crucial to stay informed on research advancements, health tips, and current health topics, and to seek expertise on managing health.
The Evolving Landscape of Weight Loss Medications
The pharmacological treatment of obesity is rapidly evolving, and healthcare providers must stay current with the latest developments. Before 2012, there were few FDA-approved weight loss medications. In the 2020s, GLP-1 receptor agonists gained significant attention. Newer medications, such as Mounjaro and Zepbound, target both GLP-1 and GIP receptors. Determining if someone is a candidate for weight loss medications begins with assessing their BMI, current health issues, other medications, and family medical history.
Factors Affecting Weight Loss
The average weight loss with these medications varies from 5% to 21%, but most people regain weight if AOMs are discontinued. While some weight loss medications are FDA-approved only for adults, some, including semaglutide and liraglutide, are approved for children 12 and older with a BMI >/= 95th percentile.
Types of Weight Loss Medications
- Wegovy (semaglutide): This injectable medication is approved for use in adults and children aged 12 years or more with obesity or some adults with excess weight who also have weight-related medical problems. The dose must be increased gradually over 16 to 20 weeks to minimize side effects, such as gastrointestinal symptoms, headache, dizziness, and fatigue.
- Zepbound (tirzepatide): This medication is approved to treat obesity in adults with a BMI of 30 or greater. It works by reducing appetite and is meant to be used in combination with diet and exercise.
- Liraglutide: This daily injectable medication acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals. Some patients may lose 5â10% of body weight. It is also approved for Type 2 Diabetes under the brand name Victoza.
- Phentermine: This is the oldest and most widely used weight loss medication. Newer medical guidelines have added it to long-term therapy.
- Phentermine-topiramate: Topiramate can be combined with phentermine to decrease appetite and cravings. Adults with migraines and obesity are good candidates for this medication.
- Naltrexone-bupropion: This medication combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite.
- Orlistat: This lipase inhibitor comes in a capsule. Undigested fat is then passed through the body. An over-the-counter formulation is available.
- Setmelanotide: This melanocortin-4 receptor agonist is indicated for chronic weight management in adult and pediatric patients six years and older with obesity due to certain rare genetic disorders.
- Plenity: This medical device consists of a capsule that releases a biodegradable, super-absorbent hydrogel into the stomach, increasing satiety and enabling the person to eat less.
Future Medications
With growing demand for weight loss medications and rising obesity rates, more medications are expected to enter the market in the coming years. Pharmaceutical platforms predict new GLP-1 launches annually starting in 2026. Lilly is developing orforglipron, an oral GLP-1 inhibitor, and retatrutide, which targets GLP-1, GIP, and glucagon. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity.
Importance of a Comprehensive Treatment Plan
FDA-approved anti-obesity medications are most effective when used as part of a comprehensive treatment plan that includes diet, exercise, and lifestyle modifications. All weight loss medications work best in the context of a healthy eating plan and exercise.
Long-Term vs. Short-Term Use
Some weight management medications are designed for short-term use, while others are for long-term use. Those approved by the FDA for long-term use include orlistat (Xenical, Alli), phentermine-topiramate (Qsymia), naltrexone-bupropion (Contrave), liraglutide (Saxenda), semaglutide (Wegovy, Ozempic), and tirzepatide (Zepbound, Mounjaro).
Cost and Insurance Coverage
GLP-1s are often costly and may not be covered by insurance. Insurance coverage varies and will affect many patientsâ choices about going on weight loss medications. AOMs may counter the effects of metabolic adaptation and prevent weight regain.
Over-the-Counter Options
The only over-the-counter medicine for weight loss currently approved by the FDA is Alli (orlistat). Other over-the-counter products are considered supplements.
The Role of Healthcare Professionals
With prescription medications, a healthcare professional can weigh all factors affecting the patientâs lifestyle and BMI and monitor progress and side effects.
Vitamins and Supplements
While no specific vitamin or supplement is considered a âtreatmentâ for obesity or overweight, certain ones help support metabolic health. For example, studies suggest that calcium and vitamin D may play a role in regulating belly fat.
Antidepressants and Weight
Some antidepressants are associated with weight gain, while others are weight-neutral or weight-negative. Bupropion (Wellbutrin) is considered weight-negative and is often prescribed to assist in weight loss and treat depression.
Considerations for GLP-1 Agonists
The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems. They can also interfere with hormonal birth control.
Risks of Counterfeit Medications
The FDA warns against buying medications from any source other than a state-licensed pharmacy and has banned the sale of âcounterfeitâ semaglutide and tirzepatide. These compounded medications are not FDA-approved.
Nutritional Deficits in Drug Abusers
Many studies have found that drug abusers have nutritional deficits, including weight deficits. The most plausible explanation for these deficits is dietary insufficiency. However, studies using objective measures of dietary intake have failed to provide evidence of dietary insufficiency.
Factors Contributing to Nutritional Deficits
Factors that could account for discrepancies among studies include differences in the types and frequency of drugs abused, differences in rates of infections, such as HIV or hepatitis, and differences between drug abusers who are hospitalized or enrolled in detoxification programs compared to community-living drug abusers.
Studies on Weight and Drug Abuse
- A European study found lower average weights among drug abusers compared to non-drug abusers.
- Needle exchange users in Glasgow, UK had a higher prevalence of low BMI compared to age-matched controls.
- Hispanic, drug-abusing women in Connecticut, USA had a lower BMI than women who were not drug abusers.
- Involuntary weight loss was more common in HIV-positive drug abusers compared to HIV-negative drug abusers.
Malnutrition and Hospitalization
Significant protein-energy malnutrition has been found among drug abusers hospitalized for detoxification, with even greater degrees of malnutrition among drug abusers admitted to hospital for other reasons, including infections.
Types of Drugs and Nutritional Status
The specific types of drugs abused may differ in their impact on nutritional status, including weight. For example, among Hispanic drug abusers in Boston, men who used cocaine or cocaine and heroin, but not strict heroin or methadone users, had a lower BMI compared to HIV-positive non-drug abusers.
Overweight and Obesity in Drug Abusers
The weight of drug abusers appears to be increasing in parallel with the prevalence of overweight in developed countries. However, in some regions, a high percentage of drug abusers have a BMI below normal.
Dietary Intake and Drug Abuse
Studies of dietary intake have not provided clear evidence that energy deficits can explain the lower weight of drug abusers. Some studies have found that energy intake was greater than estimated need in both HIV-positive and HIV-negative drug abusers, despite self-reported involuntary weight loss. While drug abuse appears not to affect average energy intake, it may affect the frequency of meals and nutritional quality of the foods eaten.
Non-Dietary Factors
Non-dietary factors that could affect the weight of drug abusers include infection with hepatitis, malabsorption, increased resting energy expenditure, and increased physical activity.
Conclusion
Nutritional deficits, including weight deficits, are reported among drug abusers in many studies, though the direct causes are still not clear. This implies that drug abusers with HIV and other wasting diseases may have difficulty maintaining their weight or regaining weight following bouts of illness.
The Hype and Hope Surrounding Weight Loss Drugs
Drugs like Ozempic and Wegovy have generated both excitement and debate. Some worry that they deepen biases against fat and diminish patients' dignity and joy, while others see them as a long-awaited solution for people with obesity.
A History of Pharmaceutical Failures
The history of weight loss medication includes drugs that initially seemed promising but later proved to have serious side effects. Fen-phen, amphetamines, and other drugs have been linked to vascular and cardiac issues, high blood pressure, heart complications, anxiety, and addiction.
How GLP-1 Drugs Work
The latest treatments, which mimic the hormone glucagon-like peptide-1 (GLP-1), may offer a more effective solution. GLP-1 curbs hunger, slows down the movement of food from the stomach to the small intestine, and increases insulin production, lowering blood sugar. Over time, patients lose roughly 12% of their body weight on Wegovy (semaglutide) and about 18% on Zepbound (tirzepatide).
Health Benefits
These drugs can be life-changing for people with obesity, a condition linked to various health risks. Studies have shown that semaglutide helps people with obesity lower their high blood pressure and reduce their odds of heart attacks or strokes. Early evidence suggests the drugs might also improve depression and substance abuse disorders.
Potential Side Effects
The potential side effects of GLP-1 drugs include nausea, vomiting, fatigue, diarrhea, and constipation. Some patients have experienced more severe side effects, such as dehydration, exacerbation of atrial fibrillation, stomach paralysis, and bowel obstructions.
Approved Use and Insurance Coverage
The new weight loss medications are approved by the FDA only for obesity, defined as a body mass index of 30 or greater, with exceptions made for patients with related conditions like high blood pressure. However, the soaring demand for GLP-1s has created shortages, leading to compounding pharmacies producing generic versions and telehealth companies selling the drugs at lower prices.
Concerns About Telehealth Companies
There are concerns that telehealth companies rarely provide meaningful medical supervision for patients prescribed GLP-1s, leading to problems with side effects and emergency room visits.
The Importance of Lifestyle Changes
Eating less does lead to weight loss, but exercise is still essential for heart, bone, and brain health. The nutritional quality of food also matters, not just the quantity. Patients taking GLP-1s should prioritize fruits and vegetables, whole grains, lean protein, and healthy fats.
The Impact on Mental Health
The potential for GLP-1s to help people transform themselves aesthetically has received significant attention. However, it's essential to have realistic expectations and address the underlying social pressures to look thin. Eating disorders can affect people of all sizes, and a well-intentioned weight loss journey can become an obsession.
Long-Term Use and Maintenance
Once you start taking GLP-1s, the drugmakers suggest you stay on them. People who go off the drugs eventually regain much of their lost weight.
The Complex Factors Fueling Excess Weight
The factors fueling excess weight are complex, including social, environmental, and genetic factors. Humans evolved in scarcity, making it difficult to resist indulgent foods in today's abundant food environment.
A Shift in Understanding Obesity
GLP-1 medications have the potential to usher in much-needed nuance in how Americans understand obesity, shifting away from attributing the problem to individual willpower and recognizing the complex factors at play.