This is a followup to my summaries of weight loss and drug studies at [study] A Tour Through Google Scholar's Studies On Weight Loss Methods : loseit (reddit.com).
Reddit (including r/loseit) is, as a rule, very much against using FDA-approved drugs for weight loss, viewing them as a dangerous and irresponsible cheat. This view seems very common in society as a whole.
But I think this view should be reconsidered! This is an effortpost meant to persuade others why FDA-approved weight loss drugs, when taken as prescribed by a doctor, actually have a reasonable place in the arsenal of healthy and sustainable weight loss.
The arguments against using such drugs are mostly in four categories, which I’ll tackle in order:
1a ) “You don’t know what the long-term effects of [anti-obesity medication] will be. You could be cutting literal years off your life.”
This is the fully-general counterargument against using drugs for the treatment of chronic conditions. And it’s also a very strong objection to the use of weight loss medications, which is why I address it first.
The argument goes: We can only know what we’ve learned about these drugs from randomized controlled studies, which tend to only run about a year. What if there are very long-term adverse effects that only happen after two years? We wouldn’t know about them!
(Well, that’s not quite right. The FDA does require longer-term post-approval studies, which is how they knew to pull Belviq after it’d been on the market for a few years-- the longer you're able to run studies the more you’re able to detect extremely subtle or long-term impacts on health.)
But anyway, there always is some baseline level of risk. Ultimately, the unknown risks of taking a given drug long-term must be weighed against the known risks of obesity, which are large and known. If you can lose the weight through planning and willpower, this is best; but if you can’t, drugs are second-best. Don’t take my word for it:
> The U.S. Food and Drug Administration (FDA) recommends pharmacotherapy for weight loss when lifestyle interventions (diet, exercise and behavioural therapy) have failed and the body mass index (BMI) is °30kg/m2 with no concomitant obesity-related risk factors, or if the BMI is °27 kg/m2 and the patient has at least one obesity-related risk factor.
1b) “Okay, but obesity drugs are disproportionately risky; have you considered the disasters of phen-fen and DNP?”
These were indeed public health disasters! They are why the FDA nowadays is extremely conservative with approving anti-obesity medications, requiring lengthy trials before they are taken by the general public and revoking approval at the first sign of serious side effect risk. Which is why there are currently a low-single-digit number of FDA-approved anti-obesity medications: these are precisely the ones for which scientists have not found serious long-term side-effects even after extensive study.
2 ) “Drugs might help you lose weight initially. However, you’ll have to go off the drugs eventually, and then you’ll just regain the weight.”
This is true for some drugs, but not all. Qsymia and phentermine are considered to be for short-term use; Contrave, Orlistat and Saxenda are for short or long-term use. Semaglutide (Ozempic) similarly is for long-term use in type-2 diabetes patients, though its usage as an anti-obesity drug otherwise is off-label.
3 ) “Drugs can only treat the symptoms of obesity; the true root cause is a unhealthy psychological relationship with food, which drugs cannot treat.”
I include this argument for completeness, since it is one I’ve seen advanced on Reddit.
The prevalence of obesity in the US is 40%. To the extent that the root cause of overweight and obesity is an unhealthy relationship with food, this is the default state of humans in the United States, and it appears to be extremely difficult to change (in the sense that decades of public health measures haven’t made a dent in the problem). Workarounds are likely to be useful, and this is one of them.
4) “Anti-obesity drugs just exist so that people don’t have to do the work of dieting. They should simply use CICO/Keto/WFPB/other diets to lose the weight naturally, which is cheap, healthy and achievable for all.”
Ultimately, you don’t gain or lose virtue points by losing weight naturally vs. with drugs. It’s your life; if you find that CICO dieting without drugs makes you miserable, you are under no obligation to suck it up and deal with it just because it’s theoretically possible for you to do so. Drugs exist for our well-being, and we shouldn’t be shy about reaching for them for this purpose any more than somebody with depression should “just power through it” without pharmacological aid, or someone with OCD should just “get a grip”.
In conclusion, I of course agree with most on here that people looking to lose weight should first try out dieting; but if that’s ineffective or unsustainably miserable, checking out the current list of FDA-approved weight loss drugs should be something you discuss with your doctor.
