Unexplained or unintended weight loss should prompt a visit to your doctor. While the desire to lose weight quickly is pervasive, the use of drugs to achieve this goal can be fraught with danger. The history of weight loss medication is littered with drugs that seemed like impressive, easy solutions - at first. This article explores the complex relationship between drug use and rapid weight loss, examining both prescription medications and illicit substances, their mechanisms of action, potential side effects, and the long-term consequences of their use.
GLP-1 Agonists and Other Weight Loss Medications
In recent years, glucagon-like peptide-1 (GLP-1) agonists have gained prominence in the treatment of both type 2 diabetes and obesity. These drugs, including semaglutide (Ozempic, Wegovy) and liraglutide, mimic the GLP-1 hormone, which is released after eating. GLP-1 triggers the release of insulin from your pancreas. In people with type 2 diabetes, the body's cells are resistant to the effects of insulin, the body does not produce enough insulin, or both. GLP-1 agonists work by increasing insulin production (lowering blood sugar), slowing down the movement of food from the stomach to the small intestine (hence a feeling of fullness), and acting in the brain to reduce hunger. These effects can lead to weight loss, which can be an important part of managing diabetes. More recently, the FDA has approved several GLP-1 agonists for weight loss in people with obesity who do not have diabetes. Ten GLP-1 drugs are FDA-approved to treat either type 2 diabetes or weight loss.
While GLP-1 drugs have proven effective, they are not without side effects. Common side effects include nausea, vomiting, fatigue, diarrhea, and constipation. Most patients nudge up to the recommended dose, slowly adjusting to the drugs to minimize discomfort. In some cases, more serious side effects can occur, such as pancreatitis, bowel obstruction, and gastroparesis (delayed stomach emptying). There have also been headlines warning of increased suicidal ideation associated with semaglutide.
It's also important to note the phenomenon of "Ozempic face," where skin on the face sags and wrinkles due to rapid weight loss. If weight is lost in a more gradual way, these changes may not be as noticeable.
Other weight loss medications include:
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- Phentermine: The oldest and most widely used weight loss medication. Works at the brain level to decrease hunger. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor.
- Phentermine-Topiramate: A combination medication that decreases hunger and increases fullness. Side effects include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth. It cannot be taken during pregnancy.
- Naltrexone-Bupropion: Another combination medication that can help with fullness and cravings. The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
- Orlistat: A lipase inhibitor that blocks the enzyme that breaks down fats consumed through food, thereby inhibiting the absorption of dietary fats. The undigested fat is then passed through the body.
- Tirzepatide: Increases feelings of fullness and helps people maintain a more restrictive diet. Common side effects include constipation, upset stomach, bloating, and diarrhea. Potential serious side effects also include stomach problems, kidney problems or failure, gallbladder problems, pancreatitis, or hypoglycemia, among others.
Eligibility for weight loss medications is typically based on body mass index (BMI). For semaglutide or liraglutide, a patient must must be an adult or child age 12 or more, with a BMI of 30 or greater or with a BMI of 27 or greater with comorbidities such as high blood pressure, diabetes, or high cholesterol. People who have a BMI of 30 or above do not need to have a chronic disease associated with their BMI, because obesity is considered a chronic disease. Requirements are similar for many other weight loss medications, including phentermine, naltrexone-bupropion, and orlistat, although not all are FDA-approved for use in children. The more recently approved tirzepatide is approved only for adults with a BMI of 30 or greater.
A significant percentage of people taking semaglutide or liraglutide for weight loss stop within a year, often due to side effects, cost, or shortages of the medications. Because stopping one of these medications comes with a high risk of weight regain, a person taking them should understand the risks.
The Dark Side: Illicit Drugs and Weight Loss
While prescription medications are designed (though sometimes flawed) to manage weight under medical supervision, the use of illicit drugs for weight loss is a dangerous and often overlooked issue. Many individuals still support the connection between substance use and weight loss solely on the appetite inhibitor potential of most drugs. The subject is controversial and disagreements between findings are not uncommon. Studies largely depend on the subjects which present a myriad of variables (i.e. In reality, there are many contributing factors beyond a plain lack of appetite.
Drugs like cocaine, methamphetamine, and ecstasy are known to suppress appetite and increase energy expenditure, leading to rapid weight loss. However, the consequences of using these drugs are devastating.
- Cocaine: This stimulant suppresses appetite and increases energy but leads to addiction, malnutrition, and heart problems. One of the side effects of the continuous use of cocaine is weight loss. However, using cocaine to get skinnier is not a good plan. First, you can easily become addicted to cocaine, and a struggle with drug abuse is tougher than battling your weight. A study released by Addictive Behaviors found that half of the women who used cocaine did so to lose weight; of this group, 72% had eating disorders.
- Methamphetamine (Meth): Causes severe weight loss by drastically reducing appetite and increasing activity levels, often at the cost of extreme physical and mental health decline.
- Ecstasy: Also leads to appetite suppression and increased energy, with the risk of severe psychological and physical health problems.
Beyond appetite suppression, these drugs disrupt metabolism, sleep patterns, and eating habits.
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- Metabolic Changes: Drug use can alter the way the body processes macronutrients (carbohydrates, proteins, and lipids), leading to imbalances in hormone release and energy storage. For example, a study published by Appetite observed that chronic cocaine use created an imbalance between fat intake and fat storage. Nutrition and Metabolism: Journal found a link between dopamine activity and weight management. Their findings validate dopamine’s crucial role in eating behavior. The study connected the lack of dopamine to obesity and concluded that releasing more dopamine would lead to weight loss.
- Sleep Disruption: People struggling with addiction have inconsistent sleeping patterns and remain awake for more extended periods. In addition, using drugs lowers the quality of your sleep. All of these changes in your sleep reverberate on your overall health, including weight control. As mentioned above, using drugs disrupts your sleep cycle which has a domino effect on your metabolism. That is because not sleeping enough dysregulates your circadian rhythms. Circadian rhythms work as your body’s internal clock sending messages and cues that control physical, mental, and behavioral changes throughout a 24-hour cycle. A study published by Cambridge University proved how our circadian rhythms cascade into other systems in the body including your metabolism and disturb glucose-insulin metabolism, leptin and ghrelin concentrations, appetite, and food reward.
- Altered Eating Habits: When you are high, the least of your worries is eating. Second, not only will you eat less, but using drugs can lead to poor food choices. One can become more careless about nutrition and focus time, money, and energy on seeking your next dose instead of the next meal.
The lifestyle of people struggling with substance use has more risks compared to people that don’t. Short-term use creates a lot of harm to one’s health, but long-term drug use can have far-reaching consequences such as cardiovascular disease, stroke, HIV/AIDS, Hepatitis B and C, and lung disease to name a few. When added with weight loss and poor nutrition, one’s health becomes even more fragile and the immune system becomes extremely compromised. The results can be catastrophic.
Eating Disorders and Societal Pressures
The societal pressure to look a certain way creates numerous issues in people’s psyche which have devastating results on their mental and physical health. A report from Harvard University found that 28.8 million Americans will have an eating disorder in their lifetime which can start as young as 5 years old to over 80 years old. The desire for thinness is pervasive in today's culture. The societal pressure to look a certain way creates numerous issues in people’s psyche which have devastating results on their mental and physical health. This pressure can lead to disordered eating patterns and the misuse of drugs for weight loss.
Eating disorders, such as anorexia and bulimia, are often linked to drug misuse. A study released by Addictive Behaviors found that half of the women who used cocaine did so to lose weight; of this group, 72% had eating disorders. Body dysmorphia, an anxiety disorder characterized by a distorted perception of one's appearance, can also contribute to the misuse of weight-loss drugs.
Long-Term Consequences and Seeking Help
Weight loss is a dangerous side effect of drug addiction and a reminder of how fragile our bodies become while struggling with drugs. While weight loss may seem like a desirable outcome, the long-term consequences of drug use far outweigh any perceived benefits. Addiction, organ damage, mental health disorders, and even death are all potential risks.
It is important to recognize the signs of drug addiction and seek professional help if you or someone you know is struggling. Overcoming addiction to weight-loss drugs requires a structured and professional approach.
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- 2. 3. 4. Physical Recovery: Programs include monitoring and treatment for drug-induced damage, such as heart strain, organ dysfunction, and bone health issues.Mental Health Support: Focused care for co-occurring conditions like anxiety, depression, and body dysmorphia:Mindfulness and stress-reduction techniques to improve mental health and emotional well-being.Lifestyle Rebuilding: Guidance on creating a balanced, fulfilling life without dependence on drugs:Goal setting for career, relationships, and personal growth.Developing routines that promote physical and emotional wellness.
The Importance of a Holistic Approach
It’s important to remember that the injection alone is not a solution. To be clear, eating a lot less does drop the numbers on the scale. But exercise is still important - for your heart, bones, brain, and more. And the nutritional quality of your food matters, not just the quantity. Talya Kurzion, MS, RD, a clinical dietitian with UCSF Health, says patients taking GLP-1s should prioritize fruits and vegetables; whole grains; lean protein; and the healthy fats found in olive oil, nuts, and seeds. Of course, it’s tough to put all that advice into practice. “The time and effort component of cooking healthy meals is a big barrier,” Kurzion says.
Weight loss medications can be helpful in promoting and maintaining weight loss as part of a comprehensive obesity treatment plan. However, there are side effects, so it’s essential to help patients consider the pros and cons to find the right fit for them.