Ozempic, weight loss drugs reshaping Atlanta’s health and fitness community

Novo Nordisk, maker of the weight-loss drug Wegovy, said this week at least 25,000 people are starting to take the drug weekly in the US, up from 5,000 in December, prompting the maker to ramp up manufacturing to keep up keep up with demand. Another obesity drug maker, Eli Lilly, which makes Zepbound, also raised its sales outlook this week. While many GLP-1s have been around for years to treat diabetes, they are only recently driving sales of obesity treatments, which could top $80 billion by 2030, according to Bloomberg Intelligence.

Currently, less than 1% of Americans take GLP-1 drugs for weight loss, although equity analysts at Morgan Stanley expect that number to grow to 10% by 2034.

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Not all doctors are taking the opportunity to prescribe medication to their patients. The Atlanta plastic surgery decided not to become a prescriber because of liability concerns about the drugs’ potential side effects, Nguyen said. Instead, the practice refers patients to primary care physicians.

Still, he estimated that 10% to 20% of his business comes from successful patients who lose weight after taking the drugs. Most of these 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 after learning a client is taking a weight-loss drug, according to medical director Desire McCarthy-Keith. They have become popular in the past year. Despite the data, it can affect pregnancy and fertility.

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For some overweight clients, losing weight with drugs can increase ovulation and reduce the medical problems faced by women with polycystic ovary syndrome, which lowers fertility, said McCarthy-Keith, MD, a gynecologist and reproductive endocrinologist. Losing weight also reduces the risk of high blood pressure, diabetes, miscarriage and pregnancy complications. But doctors advise caution when getting pregnant.

A study published in JAMA Internal Medicine in December reported that the use of medications such as GLP-1 drugs does not increase the risk of birth defects compared to the use of insulin.

But more studies are needed. For now, doctors recommend that patients stop taking the drugs before trying to get pregnant.

This class of drugs can stay in your system longer, so trying to stop pregnancy for two months after stopping weight-loss drugs is recommended, he said. The extra time allows the drug to leave the body, reducing the risk to the fetus. It can be difficult for them, McCarthy-Keith said of couples seeking fertility treatment. They are anxious to get pregnant. It’s hard to put your plans on hold.

Fertility specialists also recommend that clients stop using weight-loss drugs up to two weeks before fertility treatments that require anesthesia, such as IVF, she said.

Dr. Jessica Rubin of Reproductive Biology Associates in Atlanta has also seen an increase in women using weight-loss drugs to reach the recommended body mass index for starting fertility treatments. I would estimate that an average of 2 to 5 patients per week have recently been on weight loss medication.

It is not a cure for weight loss

The drug is also used to supplement bariatric surgery, according to Dr. Benjamin Flink of Bariatric Innovations, a general and bariatric surgeon specializing in the medical management of weight loss.

Flink said he prescribes drugs, including the new injectable GLP-1, to those seeking them for weight loss and to patients using them to jump-start 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 don’t want to take obesity medications, are tired of taking them, or aren’t achieving the weight loss they want with medication alone, Flink said. There are also patients who do not respond to medical weight loss or who have not lost weight with multiple different medications.

He described how a patient took the injectable drug for 9 months, lost enough to be considered a healthy weight, but then experienced severe stomach pains and had to stop taking the drug.

Many people think that weight loss drugs, including new injectable drugs, are a cure for obesity. They don’t consider that these are maintenance drugs that only work while you take them and the potential long-term effects of taking these drugs for an extended period of time.

He advises patients using the drugs to work with a nutritionist and exercise so they don’t lose excessive muscle mass, which is one of the drug’s potential long-term side effects.

Abby Jellinek-Johnson of Harmony Nutrition described two types of patients she sees with the drug. First, those who start taking the drugs without first seeking a nutritional assessment lose weight and then flatten out. It suppresses their appetite, so they forget to eat. We need to re-teach our patients how to feel hungry and remember to eat small, balanced meals throughout the day 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 do not see the weight loss they are working towards. Sometimes diet and exercise aren’t enough. And we find that in some cases these medications are the right choice for them as an individual. Many of these patients end up having long-term weight loss success when they combine a medical approach with diet and lifestyle changes.

Vicki Feldman has a similar philosophy. As with any transformation, nothing really works without lifestyle changes, 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 about three dozen clients, he is currently helping four people develop healthy habits while taking the weight-loss drug.

Muscle loss is a major concern. As we age, it is natural to lose muscle mass. But that can be exacerbated by rapid weight loss, he said. The people I work with are very focused on maintaining or increasing their lean mass because they know it will be the key to maintaining their weight.

Many of the meds probably aren’t aware of the risk of muscle loss, said Maxim Nazaire, founder and owner of Safe Haven Fitness in Roswell. He estimates that about 10% of his 120 clients have tried weight loss drugs at some point. Trainers often learn about their clients’ medication use when reviewing fitness and wellness goals with them.

To build lean muscle, trainers focus on multi-joint exercises, such as squats, deadlifts, deadlifts and chest presses, he said. We control the intensity to also manage the safety of the exercise.