The surging popularity of weight loss injectables such as Ozempic, Wegovy, and other GLP-1 prescription drugs have inadvertently reshaped related business. From plastic and bariatric surgeons to nutritionists and personal trainers, several of Atlanta’s health and fitness specialties are feeling the ripple effects of the nation’s latest obsession with drug-based diets.
“They are very trendy. It’s been great for plastic surgeons,” said Dr. Jonathan Nguyen. The drugs are still relatively new, he said, and he expects their popularity to continue rising along with his bottom line at Atlanta Plastic Surgery.
Obesity affects about 4 in 10 American adults, according to the Centers for Disease Control and Prevention in Atlanta. The new class of obesity medicine, known in the medical world as glucagon-like peptide 1 (GLP-1) receptor agonists, decreases appetite. They can potentially reduce calorie intake up to 20 percent, which can result in a similar drop in body weight, according to Morgan Stanley research on the drugs’ impact on consumer trends.
Novo Nordisk, manufacturer of the weight-loss drug Wegovy, said this week at least 25,000 people are starting on the drug weekly in the U.S., up from about 5,000 in December, causing the maker to boost manufacturing to keep up with demand. Another obesity medicine maker, Eli Lilly, which makes Zepbound, also raised its sales outlook this week. While many GLP-1s have existed for years to treat diabetes, they are only recently driving sales for obesity treatments, which could soar above $80 billion by 2030, according to Bloomberg Intelligence.
Currently, less than 1% of Americans are on the GLP-1 drugs for weight loss, though Morgan Stanley equity analysts expect that figure to grow to 10% by 2034.
Not all doctors are jumping at the chance to prescribe the medication for their patients. Atlanta Plastic Surgery decided not to become a prescriber because of liability concerns about the drug’s possible side effects, Nguyen said. Instead, the practice refers patients to primary care doctors.
Still, he estimated that 10% to 20% of his business comes from patients’ success losing weight after taking the drugs. Most of those patients request body contouring to remove excess skin after weight loss, he said.
Change of plans
Almost daily, Shady Grove Fertility in Sandy Springs has to revamp its treatment plan upon learning a client is taking a weight loss drug, according to medical director Desireé McCarthy-Keith. “They’ve become popular in the past year. Notwithstanding the data, it may affect pregnancy and fertility.”
For some overweight clients, shedding pounds on the drugs can increase ovulation and reduce the medical issues experienced by women with polycystic ovary syndrome, which decreases fertility, said McCarthy-Keith, an ob-gyn and reproductive endocrinologist. Losing weight also reduces the risk of high blood pressure, diabetes, miscarriage and pregnancy complications. But doctors advise caution when trying to get pregnant.
A study published in JAMA Internal Medicine in December reported the use of medications such as GLP-1 drugs does not raise the risk of birth defects when compared to insulin use.
But more studies are needed. For now, doctors recommend patients stop the drugs before trying to get pregnant.
“This class of medication can stay in your system longer, so it’s recommended to try to put off getting pregnant for two months” after stopping the weight-loss drugs, she said. The extra time allows the drug to work its way out of the body, reducing the risk to the fetus. “It can be hard on them,” McCarthy-Keith said about couples seeking fertility treatment. “They are anxious to be pregnant. … It’s difficult to put their plans on hold.”
Fertility specialists also recommend clients discontinue using weight loss drugs for up to two weeks before fertility treatments that require anesthesia, such as invitro fertilization, she said.
Dr. Jessica Rubin of Reproductive Biology Associates in Atlanta also has seen an increase in women using weight loss medicine to achieve the body mass index recommended to start fertility treatments. “I would estimate an average of 2 to 5 patients a week have recently been on the weight loss medications.”
Not a ‘cure-all’ for weight loss
The medication is also being used to supplement bariatric surgery, according to Dr. Benjamin Flink of Bariatric Innovations, a general and bariatric surgeon who specializes in medical weight loss management.
Flink said he prescribes medications, including the new injectable GLP-1s, to those seeking them for weight loss and to patients who use them to kickstart their weight loss before bariatric surgery. Doctors generally recommend bariatric surgery to patients who have severe obesity or weight-related health problems, according to the Mayo Clinic.
Bariatric procedures remain an effective option for those who do not want to take obesity medicine, are tired of taking it, or don’t achieve the weight loss they desire from the medicine alone, Flink said. There are also patients who do not respond to medical weight loss or have not lost weight on multiple different medications.
He recounted how a patient took the injectable medicine for 9 months, losing enough to be considered a healthy weight, but then experienced severe stomach pains and had to stop taking the drug.
“A lot of people think of weight loss medications, including the new injectable drugs, as a cure-all for obesity. They don’t consider that these are maintenance drugs that only work while you are taking them and the potential long-term effects of taking these medications for a prolonged period of time.”
He advises patients using the drugs to work with a nutritionist and to exercise so they don’t lose excessive muscle mass, which is one of the potential long-term side effects of the medicine.
Abby Jellinek-Johnson of Harmony Nutrition described two types of patients she sees on the medication. First, those who start on the drugs without first seeking a nutrition assessment, lose weight and then plateau. “It suppresses their appetite, so they forget to eat. … We have to re-teach our patients what hunger might feel like and to remember to eat small balanced meals throughout the day in order to maintain their lean muscle mass and metabolism.”
The second type of patient will work with a nutritionist before starting weight loss medication. “There is a small subset of patients who are very diligent in implementing lifestyle changes and still don’t see the weight loss they are working towards. Sometimes diet and exercise just isn’t enough. And we find that in some cases these medications are the right choice for them as an individual. Many of these patients do end up being successful with long-term weight loss when they combine a medical approach with dietary and lifestyle changes.”
Vicki Feldman has a similar philosophy. “Like with any transformation, none of it really works without changing lifestyle,” said the Marietta health coach, personal trainer, and group exercise instructor. Feldman works at two large gyms and for a leading weight loss program that recently partnered with a prescriber of the new drugs. Among some three dozen clients, she is currently helping four people develop healthy habits while taking the weight loss medicine.
Muscle loss is a prime concern. “As we age, it’s natural to lose muscle mass.” But that can be compounded by the rapid weight loss, she said. “The people I’m working with are very focused on maintaining or increasing their lean mass because they know that’s going to be the key to maintaining their weight.”
Many on the medicine probably aren’t aware of the muscle loss risk, said Maxim Nazaire, founder and owner of Safe Haven Fitness in Roswell. He estimates about 10% of his 120 clients have tried the weight loss drugs at some point. Trainers often learn about their clients’ use of the medication when reviewing fitness and wellness goals with them.
To build lean muscle, trainers focus on weight-bearing, multi-joint exercises such as squats, deadlifts, shoulder and chest lifts, he said. “We monitor the intensity to manage the safety of the exercise as well.”
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