In-demand weight-loss drugs are no magic bullet, UCI Health experts say
Reports of serious side effects warrant caution when using Ozempic and Wegovy
July 28, 2023
Orange, Calif. — The hugely popular weight-loss medications now taking the nation by storm may be highly effective, but they aren’t a "magic bullet" to cure obesity and they may pose serious health risks, say UCI Health digestive health experts.
Without accompanying lifestyle changes, the pounds will likely return when Ozempic, Wegovy and other GLP-1 medications are stopped. But beyond their high cost and the likelihood of recidivism, some patients are experiencing significant side effects, says Dr. Kenneth J. Chang, executive director of the UCI Health Digestive Health Institute and an expert in endoscopic approaches to bariatric surgery.
The drugs, which include semaglutide, can cause food to move too slowly through the gastrointestinal (GI) tract. Called delayed gastric emptying, this may result in stomach paralysis, or gastroparesis. This condition impairs the motility of the stomach, leading to fullness, bloating, nausea and vomiting. It is a debilitating disorder that can result in life-threatening complications.
Dr. Ninh T. Nguyen, a UCI Health bariatric surgeon and past president of the American Society for Metabolic and Bariatric Surgery, says more data are needed to determine whether Ozempic, in particular, which was developed to treat diabetes, induces gastroparesis or exacerbates an existing underlying condition. Normally, the incidence of gastroparesis in people with type 2 diabetes is about 1%.
He urges patients and their physicians to be extremely cautious with these medications, citing as an example the so-called “miracle” diet drug of the 1990s, fen-phen. It was pulled from the market in 1997 after serious cardiovascular complications and heart valve abnormalities emerged in some patients.
“I understand the initial enthusiasm for these new drugs because of their high efficacy for weight loss,” says Nguyen, chair of the UCI School of Medicine Department of Surgery and associate director of the Digestive Health Institute.
“But this is a chance for us to take a pause and institute further studies to determine if Ozempic and similar medications have a higher risk for gastroparesis.”
Tracking side effects
In clinical studies of the drugs, side effects included nausea, fatigue, mild to moderate diarrhea, vomiting, constipation and abdominal pain in some people. The U.S. Food and Drug Administration (FDA) now is closely tracking reports of delayed gastric emptying and gastroparesis.
Concerns over these side effects recently prompted the American Society of Anesthesiologists to recommend that people stop taking the medications at least a week before undergoing elective surgery to reduce the risk of aspiration from stomach contents refluxing through the esophagus while under anesthesia. Delaying surgery should also be considered if there any GI symptoms are present on the day of the procedure.
In June, with Ozempic and Wegovy in short supply, the FDA issued a warning about turning to compounding pharmacies for generic versions of semaglutide, which mimics a natural hormone produced after eating.
European health officials also announced that they are investigating whether Ozempic and other weight-loss drugs pose a risk for suicidal thoughts and self-harm.
No simple solutions
“The whole world is Ozempic-crazy right now,” says Chang. “But is this a magic bullet that is going to take obesity off the map? I think we can say the answer is a strong ‘No.’
“These medications have allowed people to lose more weight than any of the other drugs used in the past. But they are costly and they have side effects. For people who want to come off the drugs, the weight is likely to come back.”
Chang calls for a more comprehensive approach for people struggling with obesity. “We need to look beyond Ozempic. Here at UCI Health, we help people consider all their options.”
This multifaceted approach gives people access to bariatric surgeons, interventional gastroenterologists, dietitians, social workers, psychologists, exercise and training programs, as well as lifestyle modification, mindfulness and even cooking classes, he says.
“That’s right, we even show people how to prepare food in healthier ways.”
For people who find that lifestyle modification and medications are not enough but they don’t qualify for or are reluctant to have bariatric surgery, UCI Health also offers an alternative treatment called endoscopic sleeve gastroplasty (ESG).
A nonsurgical outpatient procedure that takes about 60 minutes, it is performed with an endoscope inserted through the mouth and esophagus, requiring no external incisions. ESG patients experience an average 15% reduction in their total body weight. Some patients may benefit from combining an ESG procedure with medications, which can boost the weight loss to 20%, which is about what patients achieve with traditional bariatric surgery.
Make no mistake, though, maintaining a healthy weight requires long-term lifestyle changes, Chang says.
“Keeping the weight off requires ongoing healthy food choices, limiting calories to about 1,200 a day for most adults, regular exercise, ongoing health checks and accountability.”
About UCI Health
UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system in Orange County. Patients can access UCI Health at primary and specialty care offices across Orange County and at its main campus, UCI Medical Center in Orange, Calif. The 459-bed, acute care hospital, listed among America’s Best Hospitals by U.S. News & World Report for 22 consecutive years, provides tertiary and quaternary care, ambulatory and specialty medical clinics, behavioral health and rehabilitation services. UCI Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook, Instagram, LinkedIn and Twitter.