Weight Management Drugs Show Weight Loss Isn’t About Will Power

Drugs containing semaglutide, like Ozempic and Wegovy, have been touted as everything from a quick fix for an upcoming event to weight loss miracle workers. However, it remains true that there is no silver bullet for weight management.

Brian Wojeck MD, Internal Medicine, Yale New Haven Health, sees patients for weight, sleep, and diabetes and is interested in where they all intersect. “The mentality of many of my patients is what most of us have thought our whole lives — which is our weight is our fault. People are surprised to hear that it is very much not and that starving yourself is not a solution.”

Dr. Wojeck cited a 2016 study published in the journal of Obesity where researchers followed 14 contestants from "The Biggest Loser" during and after one season of the show. They found that the drastic weight loss caused changes that slowed their metabolism for years to come, making regaining the weight inevitable.

“The narrative around obesity has evolved over the years to where it is now understood as a disease that involves multiple factors like sleep, environment, hormones etc. and the body has a weight set point,” said Dr. Wojeck.  “We can’t say with certainty what causes that set point to become dysregulated, but we do know there is a chronic disease process at play.” 

The new class of weight loss drugs mimic a synthetic hormone that tells the brain to feel fuller longer. They yield impressive results for some patients.

Dr. Wojeck cautions that these medicines are not designed for people to drop weight quickly for esthetics. But rather, the goal is to prevent things like fatty liver disease, hypertension and cardiovascular disease and ideally decrease the amount of other medications someone is on. Dr. Wojeck also notes that people must stay on the medicine to keep the weight off. 

“When we treat the underlying causes of weight gain and get patients sleep evaluations, nutritional counseling, and behavioral health services; we can see real markers of health improve,” said Dr. Wojeck,  who points to his patients who have stopped their blood pressure and cholesterol medications.  

While Dr. Wojeck believes the future of weight management will start with primary care, a referral to a specialist can tailor care to a patient’s specific needs including education around medication side effects and other weight loss options such as surgery. 

Weight, health and happiness are not synonyms nor is there one correct way to achieve them — but their management tools are growing.