Prescription Weight Loss Medications: Myths and Facts

​​Myths and misconceptions about weight and weight loss medications are pervasive in the media, popular culture, and older scientific literature. These unsupported beliefs can be downright dangerous, so we enlisted the support of the Hello Alpha expert clinical team, including Dr. Mary Jacobson, Chief Medical Officer and an expert in obesity medicine, to address some of the most widespread myths.

Myth: Prescription weight loss medications are “the easy way out.”

Reality: This can be one of the most devastating myths, as it reduces excess weight and obesity as matters of personal failure instead of accurately categorizing them as a complex medical condition. The notion that prescription weight loss medication is a shortcut plays into fat shaming–the harmful practice of criticizing and harassing someone based on their weight. Fat shaming tends to backfire: it leads to feelings of shame that can make it harder for someone to prioritize their health. Most critically, however, it dehumanizes people and displays the deep prejudice our society has for people that don’t meet an arbitrary and stereotypical beauty standard.

Prescription medications are intended to be used alongside lifestyle and behavioral changes, such as diet and exercise. People see the most success through a combination of medication and comprehensive care. They are absolutely not an “easy way out.”

Myth: Prescription weight loss medications aren’t safe.

Reality: GLP-1s may be relatively new to the media and in popularity, but they’ve undergone extensive testing and studies by the FDA. GLP-1, or glucagon-like peptide 1, has been studied since 1987, initially as treatment for type 2 diabetes. Recent media coverage has raised the issue of side effects, “Ozempic face,” and mental health symptoms experienced by people on these medications. It’s important to contextualize sensational headlines and address concerns with a licensed healthcare provider.

Like any medications, prescription weight loss drugs can have side effects and, in fact, the most significant drawbacks of prescription weight loss medications are the potential side effects. Often, side effects are short-term and improve as your body adjusts to the medication. Not everyone will experience side effects. It’s important to check with your provider for guidance on how to manage any side effects you may experience.

The most common side effects are gastrointestinal such as nausea, vomiting, abdominal discomfort, bloating, gassiness, constipation and diarrhea. Other potential side effects include insomnia, anxiety, irritability, suicidal ideation, dry mouth, headaches and hypertension.

The safety and efficacy of these medications depend on factors such as individual health, medical history, and adherence to prescribed guidelines. It’s vital for people considering weight loss medication to discuss potential side effects with their healthcare provider.

It’s important to make sure any medication is authentic and from the appropriate manufacturer. At Hello Alpha, we work with a licensed third-party pharmacy for mail order prescriptions and encourage patients to use state-licensed pharmacies if they choose their own.

Myth: Having to take weight loss medication long-term is a bad thing.

Reality: Weight loss medications can be effective in helping individuals lose weight, but maintaining weight loss requires ongoing lifestyle changes. It’s very possible to regain weight after stopping medications, particularly if unhealthy habits resurface, but even with maintained healthy habits, weight gain remains a possibility. The goal is to adopt sustainable lifestyle changes for long-term success.

Sustainable weight loss requires a holistic approach and should leverage the four pillars of obesity medicine: nutrition, physical activity, behavioral modification, and pharmacotherapy. Prescription medicine is just one piece of an overall strategy.

If a patient does need to go off the drugs or restart the same or a different type of weight loss medication, a healthcare provider who’s familiar with the nuances of weight loss management in general can help manage this process. People with diabetes have other medicines that they can take to help control blood sugar levels and a skilled healthcare provider, possibly in partnership with a registered dietitian, can help with lifestyle changes to maintain weight loss without the support of these medications.

Myth: Prescription weight loss medications are suitable for everyone.

Reality: These medications are not appropriate for everyone. In fact, the following people should explicitly avoid prescription weight loss meds:

• Individuals for whom weight loss would be contraindicated, such as patients with a history of anorexia or bulimia, patients who are a healthy weight, or patients who are healthy and overweight (BMI between 27–29.9).
• Patients with a personal or family history of medullary thyroid cancer or of MEN2 Syndrome should not take injectable medications like Mounjaro, Wegovy, Ozempic, Saxenda, and Victoza. (MEN2 Syndrome is a rare genetic disorder that affects the endocrine glands and can cause tumors in the thyroid gland, parathyroid glands, and adrenal glands.)
• Patients with a history of blood-pressure related stroke, “ischemic” (clogged artery) heart attack or narrow angle glaucoma should not take prescription weight loss medicines like phentermine, phendimetrazine or diethylpropion.
• Clinical guidelines restrict the use to certain medications for children whose BMI are above the 95th percentile for their age and gender.

Myth: You can take higher doses of weight loss medications for faster results.

Reality: The speed and amount of weight loss for an individual is highly dependent on a lot of different things: the type of medication, the dose, dietary choices, physical activity levels, sleep amount and quality, stress levels, other co-occurring medical conditions, and more.

That said, the dosage levels of weight loss prescriptions can have an impact on total weight loss. With Qsymia, for example, a weight loss drug that combines phentermine and topiramate, study results have shown average weight loss ranging from about 5% at lower doses to around 10% at higher doses. With injectable weight loss meds like semaglutide, marketed under the brand names Ozempic and Wegovy, and tirzepatide, marketed under the brand names Mounjaro and Zepbound, are generally started at lower doses and then slowly increased to minimize side effects; higher doses tend to result in more weight loss.

It’s important to note that increasing the dosage beyond the prescribed amount can be dangerous. It’s crucial to follow the healthcare provider’s instructions and not self-prescribe or adjust the dosage without professional guidance.

Myth: Prescription weight loss medications are only for people with extreme obesity.

Reality: It’s simple: clinical guidelines state that medications for weight loss are appropriate for patients with excess body fat. People with chronic illnesses like diabetes or high blood pressure can also benefit from additional support from weight loss medication.

It’s important to note that obesity or excess body fat is a chronic condition, not a lifestyle choice or a weakness of willpower. According to the Obesity Medicine Association, obesity is defined as “a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.” In simpler terms, obesity is a medical condition that affects different aspects of our health and wellbeing.

One way that healthcare providers screen for overweight and obesity is with Body Mass Index, or BMI. BMI is calculated by taking a person’s weight and dividing it by the square of their height. A high BMI can indicate a high level of body fat, but it doesn’t necessarily reflect body fat percentage.

Your provider may prescribe a medication to treat your overweight or obesity if you are an adult with:

• a BMI of 30 or greater
• a BMI of 27 or greater, plus you have weight-related health problems such as high blood pressure or type 2 diabetes

While it’s a common metric in many healthcare settings, BMI is not the only measurement for diagnosing overweight or obesity. A trained provider will take into account your individual health history, race, ethnicity, and other factors to evaluate your health condition.

In general, the decision to prescribe and use weight loss medications should be a personal decision made in partnership with a trusted healthcare provider and based on an individual’s overall health and risk factors.

Myth: All weight loss medications work the same way.

Reality: Different weight loss medications have distinct mechanisms of action. Some may suppress appetite, while others interfere with nutrient absorption or increase metabolism. Every body is different, so your provider may prescribe medication depending on your desired results, side effects, and health condition. Here are the most commonly prescribed:

• Semaglutide, known by the brand names Wegovy or Ozempic. Semaglutide medications are in the GLP-1 class of drugs, which mimic the action of a hormone called glucagon-like peptide-1. This medication acts on several systems to decrease appetite by producing feelings of fullness. It affects the appetite centers of the brain and slows down how quickly the stomach empties, which leaves you feeling full for longer. Semaglutide also acts on the pancreas to increase insulin secretion and decrease glucagon. (This reduces blood sugar levels, after you eat.) Another way semaglutide works is converting white fat-storing cells into brown fat, which increases energy expenditure. Semaglutide medications are taken once weekly via injection.
• Tirzepatide, known by the brand name Mounjaro or Zepbound. Like semaglutide, tirzepatide mimics GLP-1 but also includes GIP (glucose-dependent insulinotropic polypeptide). Tirezepatide works similarly to semaglutide medications to reduce appetite and increase feelings of fullness. It is also taken once weekly via injection.
• Liraglutide, known by the brand name Victoza. Like both semaglutide and tirzepatide, it mimics the GLP-1 hormone to slow down the process of stomach emptying. This medication is taken via a daily injection.
• Orlistat, known by the prescription name Zenical or the over-the-counter in a lower dose under the brand name Alli. As a gastric and pancreatic lipase inhibitor, this medicine reduces the amount of fat your body absorbs.
• Phentermine is similar to an amphetamine. It stimulates the central nervous system (nerves and brain), which increases your heart rate and blood pressure and decreases your appetite. This medicine is for short-term use only.
• Phentermine/Topiramate, known by the brand name Qysmia. This is a combination drug that can help you feel fuller, make foods taste less appealing, and help your body burn more calories.
• Naltrexone/Bupropion, known by the brand name Contrave. Naltrexone, typically used to reduce cravings for people with substance use disorder, can also curb hunger and food cravings. Bupropion is an antidepressant medicine that can also decrease appetite.
• Gelesis-100, known by the brand name Plenity. This pill (considered a medical device) is composed of cellulose and citric acid to absorb water and expand in your stomach and small intestine. This creates a feeling of fullness and increased satiety.

It’s important for individuals considering prescription weight loss medications to have open and honest discussions with their healthcare providers, who can provide personalized advice based on their health status and goals.

About Hello Alpha

Hello Alpha is a virtual primary care platform that specializes in inclusive, expert care for all by bridging the gaps in women’s health. With a personalized approach catering to an individual’s unique health goals, Hello Alpha can treat more than 100 conditions ranging from allergies to eczema and diabetes to menopause. Additionally, Alpha providers will proactively help identify and manage deprioritized conditions while connecting patients to labs, specialists, and other essential resources. The aim is to ensure that patients feel as healthy and vibrant as possible.

Hello Alpha’s approaches weight management through the lens of primary care. The popularity of new weight loss medications have shined a spotlight on the weight loss industry as a whole and the complicated science of weight management. There is a promising shift away from characterizing excess weight as personal failings to chronic medical conditions. Attributing health issues solely to excess weight is an incomplete picture — health is more than just a number on a scale. Visit https://www.helloalpha.com/weight-loss to learn more.

For more information about weight loss medications, please check out our other blog posts:

• Experts Discuss How GLP-1 Medications Are Revolutionizing Obesity Treatment and Coaching
• A Guide to Zepbound™, Approved by the FDA for Weight Loss
• The High Cost of GLP-1 Weight Loss Medications: a Broken System
• What Happens If You Stop Taking GLP-1s?
• From a Chief Medical Officer: What Employers Should Know about GLP-1 medications
• Hello Alpha Reddit AMA on Weight Loss Medication
• Dear Dr. J: What should I know about weight loss medication?

PLEASE NOTE: THIS BLOG DOES NOT PROVIDE MEDICAL ADVICE.

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