With so much airtime being dedicated to the truly remarkable benefits of GLP-1 Receptor Agonists like Wegovy® for weight loss and Ozempic® and Mounjaro^TM for diabetes, we often run the risk of getting caught up in the good without thoroughly evaluating the risks and consideration. Similarly, news and other online outlets are starting to target these weight loss drugs by exposing their potential side effects with as much vigor as they once covered their benefits.

We understand that there might be lots of confusion out there. This article is meant to educate our patients on what they can expect while taking weight loss medications so that they can ensure the safest therapy with the fewest side effects. Of course, we will discuss these potential risks and considerations during your upcoming consultation and monitor you for them, so please do not use this as a definitive guide for your treatment. Always follow your doctor’s instructions.

Before continuing, however, we must discuss the overarching need for lifestyle change regardless of your weight loss method. Yes, these drugs can help you lose up to 15% of your body weight, but importantly, they provide a framework to change your life and lifestyle by improving your diet, exercising more, and building muscle. If you develop these habits while using the drugs, they will enhance your life immeasurably and for the longer term.

Common Avoidable, Temporary, or Reversible Considerations

Hair loss of telogen effluvium is common when on these weight loss medications. This is not a result of the drug itself but rather a phenomenon that most patients experience when they lose a significant amount of weight quickly. Hair loss usually resolves in time unless the underlying cause is genetic, known as androgenic alopecia or male pattern baldness. Peak hair loss occurs around three to five months and may stabilize and begin regrowing after six to 12 months as the body adjusts to the new lower caloric reality. Increasing protein intake can often stem hair loss or allow hair to regrow more quickly.

Muscle wasting and skeletal bone weakening, known as osteoporosis, is also a concern with these weight loss medications. Because patients feel full and don’t necessarily want to eat very much, they may not be getting sufficient nutrition. They may not have the energy to work out regularly, including strength training. This can lead to significant muscle mass loss and bone density issues. This can be mitigated by committing to a diet and exercise program that prioritizes protein intake and strength training.

Strange dreams, including vivid dreams about celebrities, have also been reported in patients using these drugs. Remember, these weight loss medications are changing the hormonal balance in our bodies, and it stands to reason that there may be a psychological effect as well. Why patients have been reporting celebrity dreams specifically is unknown but may be tied to coverage of celebrities and other well-known figures using these drugs. These vivid dreams should subside as the body achieves hormonal homeostasis.

More concerning, common and generally milder side effects

“Ozempic face,” as it has been coined, is a genuine aesthetic concern. Because of significant and often rapid weight loss, patients may lose fat stores unevenly around their bodies. While most are looking to lose fat around the stomach, arms, and thighs, the reality is that we often lose fullness in the face sooner, causing a gaunt or hollow appearance. This does not occur in all patients; however, there is no natural solution without cosmetic intervention.

Nausea, vomiting, and other GI issues. Many patients will experience some degree of nausea and possibly vomiting. For most, this resolves in the first few weeks of injections. Patients who experience vomiting or diarrhea should know that this can cause severe dehydration, so always hydrate adequately. Nausea is the most common side effect, with up to 44% of Wegovy patients experiencing it versus 16% with placebo. Vomiting, diarrhea, constipation, and abdominal pain may occur in between 20 and 30% of patients versus placebo rates of 6 to 16%. In clinical trials, under 7% of patients discontinued use due to these side effects.¹

Rare but problematic concerns

Only two contraindications exist for Wegovy; one revolves around the risk of thyroid cancer (the other is an allergic reaction). This cancer risk was observed in rodent studies but has not been confirmed in humans. Out of an abundance of caution, patients with a personal or family history of medullary thyroid carcinoma (MTC) or patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should not take this medication.¹

Pancreatitis or inflammation of the pancreas is a known serious side effect of GLP-1 receptor agonists and must be addressed immediately. Any issues associated with the pancreas can be mitigated by stopping the medication and getting appropriate care. One study shows that pancreatitis risk may be nine times higher in patients taking the drug. The overall risk of this concern is low, however, at .5%²

Gastroparesis is essentially the paralysis of the stomach, leading to delayed emptying of metabolized food into the small intestine. While rare, at under 1% incidence,² this concern has been in focus since the worldwide rollout of semaglutides for weight loss. Gastroparesis can be problematic because there is no definitive cure, and we are unsure if the stomach will regain some of its lost motility and function after stopping the medication. While gastroparesis can be treated surgically, it is not a definitive solution.

Last but certainly not least is a more recent investigation, having been opened by both European and UK regulatory agencies regarding the potential for suicidal ideation and thoughts of self-harm associated with weight loss drugs. While the investigations have been open, we do not have concrete data to support the outcome. The FDA has not pursued a similar investigation, publicly at least. However, if you experience any of these thoughts, discontinue use and call your doctor immediately.

Other side effects and concerns can be discussed at your consultation and found on the product’s warning label.

What if I stop taking these medications?

This is the million-dollar question we do not yet have the answer to. Of course, you should speak to your doctor or consult your instructions before altering any medication regimen. However, if you decide to stop taking these medications, you will likely begin to regain weight as hunger sets in once again. This weight regain may be slow or fast; you can avoid it through change. Patients taking the opportunity to implement appropriate diet and exercise changes while on these medications will likely minimize weight regain and maintain their weight loss long-term. Again, we can’t stress strongly enough how important it is to make these lifestyle changes to reinforce or enhance the weight loss benefit of these drugs.

Next Steps

The warnings and side effects mentioned above are not meant to scare you or tell you that weight loss medications are not the right option. After all, living with significant excess weight can cause a host of metabolic issues that can lead to severe disability and early death. Instead, we want you to be fully informed so that you understand what to expect from this medication, but you can also advocate for yourself in the rare case of a severe side effect.

Ultimately, we believe that addressing excess weight and obesity is one of the most critical challenges in modern-day society. Whether weight loss medication or other interventions are best for your circumstance, speaking to a doctor specializing in weight loss is your next best step.

Of course, if you or a loved one have suicidal or self-harm thoughts, please call the Suicide and Crisis Lifeline at 988. If you believe someone is an imminent danger to themselves or someone else, call 911 immediately.

Meet Dr. Allison Burton

Dr. Allison Burton completed her medical school at Ross University School of Medicine in Dominica, West Indies. She completed her residency in Family Medicine at Virginia Commonwealth University and Riverside Regional Medical Center in Newport News, Virginia

Dr. Burton was born in Idaho and moved to Maine, but most of her childhood and adult years were spent in Tampa, FL.  She attended the University of Florida in Gainesville for pre-med. In her spare time, she enjoys being a mom and sharing quality time with her family.

Disclaimer: This post is not a substitute for medical advice, diagnosis, or treatment from a licensed medical professional.

¹https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/215256s003lbl.pdf

²Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA. Published online October 05, 2023. doi:10.1001/jama.2023.19574<?em>