The Latest on Medications for Weight Loss and Type 2 Diabetes
This article is part 2 in a 2-part series. Part 1 focused on changes in how obesity is assessed, along with its causes and complications.
With more and more weight-loss drugs entering the marketplace in recent years, the obesity epidemic has been taking a turn for the better. However, the headlines proclaiming an end to obesity as we know it are exaggerated, says Dr. Erica Phillips, an internist and obesity medicine specialist at Weill Cornell Internal Medicine Associates. ’s also a professor of clinical medicine and the Jack Fishman Professor of Cancer Prevention at ĢƵ.
“Even the most effective medications are treatments, not prevention,” she says. “Obesity is a condition that already exists, and weight-loss drugs may produce a desirable result. But prevention and treatment are not the same thing.”
Dr. Phillips goes on to explain that every treatment has a “bell curve”—a statistical model of probability. At each end are the two extremes. In the case of weight-loss drugs, patients at the left-most end of the spectrum experience no response, while those at the right-most end are extremely responsive to the medications. In fact, they may lose too much weight, and their treatment will need to be adjusted accordingly. But most patients fall somewhere between the extremes, and many do quite well, especially with the newer drugs on the market.
What is causing the obesity epidemic?
It ’t about self-control. It ’t about poor choices. Some people have lived with excess weight since childhood. Some women gain weight during pregnancy and find it extremely difficult to lose afterwards. But one of the main drivers of the obesity epidemic is our food system, Dr. Phillips says.
Full of additives like high-fructose corn syrup, ultra-processed “big food” is a direct cause of obesity. Like the tobacco industry, big food targets low-income communities of color—especially in New York City and the New York Metropolitan area. “Our genes haven’t changed,” she says, “but our food system has. ’s the critical piece of the obesity story that has yet to be addressed.”
In the meantime, anti-obesity medications have an important role to play, so ’s review ɳ’s on offer.
A quick history of weight-loss medications
The list of FDA-approved weight-loss medications is fairly long—and it will likely get longer in the near future, with several anti-obesity drug candidates in the pipeline. ’s where that list stands as of today:
- phentermine (Adipex-P or Lomaira)
- orlistat (Xenical or Alli)
- phentermine-topiramate (Qsymia)
- naltrexone-bupropion (Contrave)
- liraglutide (Saxenda)
- semaglutide (Wegovy)
- tirzepatide (Zepbound)
Phentermine
Dating back to 1959, phentermine is a short-term treatment ٳ’s still being prescribed today.
Orlistat
Decades later, the FDA approved orlistat, which works by decreasing the amount of fat absorbed through food. Orlistat was the first long-term medication to be approved for weight loss. Here, long-term means the drug is designed to be taken for 12 months or longer.
Qsymia
Next came Qsymia, a combination of phentermine plus an appetite suppressant called topiramate. Qsymia was approved in 2012.
Contrave and Saxenda
The pace of discovery accelerated with the approval of two additional medications in 2014: Contrave and Saxenda.
Contrave combines bupropion, an anti-depressant, with naltrexone, a drug that helps people stay off opioids and alcohol. And Saxenda was the first GLP-1 drug—a forerunner to Wegovy and Ozempic. Here, GLP-1 stands for glucagon-like peptide-1, a hormone that regulates blood sugar levels and appetite.
Ozempic and Wegovy
Semaglutide is a synthetic version of GLP-1, and both Ozempic and Wegovy are semaglutide-based drugs. Ozempic was approved for the treatment of type 2 diabetes in 2017, followed by Wegovy in 2021 for weight loss. Ozempic has often been prescribed off-label for the treatment of obesity. But Wegovy offers a higher dose of semaglutide, plus ’s prescribed specifically for weight loss.
Mounjaro and Zepbound
Two more approvals ensued: Mounjaro in 2022 and Zepbound in 2023. Mounjaro and Zepbound follow the same pattern as Ozempic and Wegovy. Both are versions of the same drug (tirzepatide), but Mounjaro is approved for diabetes, while Zepbound is approved for obesity, as well as for people who are overweight with a weight-related medical condition, such as obstructive sleep apnea.
Who is a candidate for weight-loss medication?
Weight-loss medications are recommended for people diagnosed with obesity or for those considered overweight who also have a weight-related medical condition, such as high blood pressure, high LDL cholesterol, low HDL cholesterol or high triglyceride levels.
The purpose of these medications is not just to drop down a clothing size. The goal is to improve weight-related conditions. Even a modest weight loss of 5 to 10 percent can make a big difference, says Dr. Mohini Aras, an assistant professor and assistant attending physician at ĢƵ who treats patients at the institution’s Comprehensive Weight Control Center.
Who shouldn’t take them?
- anyone with a history of thyroid cancer
- anyone with an underlying gastrointestinal condition, such as reflux or pancreatitis
- pregnant individuals
- people with kidney disease
- people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2
What are the side effects of the newer weight-loss drugs?
The new drugs act directly on the digestive system by slowing gastric emptying. That means food sits in your stomach longer before traveling to the intestines. As a result, people feel fuller sooner and stay full longer. Unfortunately, ٳ’s also where their side effects come in.
Because food is sitting in the stomach longer than usual, it can cause:
- acid reflux
- nausea
- a feeling of over-fullness
- diarrhea or constipation
Still, the majority of people tolerate the medications well, says Dr. Aras. “’s also important to reduce portions and eat slowly to mitigate their side effects.”
Does insurance cover weight-loss medications?
Coverage for weight-loss medications varies by insurance plan. Many insurance providers don’t cover medications used strictly for weight loss, according to the Obesity Medicine Association. But if you have type 2 diabetes, your insurance may cover medications like Ozempic or Mounjaro for the treatment of that condition. Weight loss can be a welcome “side effect” of these drugs.
A promising future
“Obesity ’t one simple disease,” Dr. Aras says. “It affects people differently. And treatments affect people differently as well. Patients’ responses to lifestyle changes, medication and even bariatric surgery vary widely.
“The new medications have been incredible in their ability to produce sustained weight loss for many individuals, along with improvement in their obesity-related risks and complications,” she continues. “The pipeline for newer anti-obesity medications is very promising. We need even more therapeutic options, given the magnitude of the obesity epidemic and the toll it takes on people’s lives.”
See Part 1 in the series here.
To make an appointment with an obesity medicine specialist at Weill Cornell, there are two main options: ĢƵ’s Comprehensive Weight Control Center (646-962-2111) or the Weight Management Practice at Weill Cornell Internal Medicine Associates (WCIMA), which requires a referral from your primary care physician.