Who should be taking weight-loss drugs? Doctors share best candidates

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Weight-loss drugs continue to grow in popularity, with market researchers predicting that global demand for the medications could reach $150 billion by 2035.
GLP-1 agonists — including semaglutides like Ozempic and Wegovy and tirzepatides like Mounjaro and Zepbound — are intended to treat type 2 diabetes and obesity.
Recent studies, however, have linked these medications to additional benefits, such as a reduction in heart disease and dementia risk, as doctors recommend them to a growing number of patients.
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Even so, recent Yale research found that only 3% of eligible adults received a prescription.
Most adults who have obesity are good candidates for these medications, according to Dr. John Anderson, an internal medicine physician and diabetes specialist at the Frist Clinic in Nashville, Tennessee.
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"However, the most important group that we really want to address are the patients who have obesity alongside other comorbid conditions, such as type 2 diabetes, hypertension, obstructive sleep apnea and significant osteoarthritis," Anderson, who is also a board member of the Diabetes Leadership Council, told Fox News Digital.
"Anyone who wants to lose weight who is obese is a good candidate, but from a medical standpoint, we're most concerned about this higher-risk patient population."
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To qualify for a weight-loss drug, the patient should first work with a physician to make lifestyle changes in the areas of diet, exercise, sleep and stress management, according to Dr. Michael Aziz, a board-certified internist and regenerative medicine specialist based in New York City.
"A healthy, balanced diet with plenty of vegetables and low-sugar fruits should be the first step in weight loss," he told Fox News Digital.
"But some people, despite their best efforts, can't lose weight. This could be related to injuries that prevent them from working out or a slow metabolism."
Insurance pays for weight-loss medications if the patient's body mass index is over 27, according to Aziz.
(Patients are considered overweight if they have a BMI of 25 to 29.9, and are considered obese if the number is greater than 30, according to the National Institutes of Health.)
Beyond the high-risk groups, Anderson said he'd like to see these medications made "available and affordable" for a vast majority of patients impacted by obesity.
"By treating obesity earlier, we can prevent disease progression," he said. "GLP-1s have been shown to reduce progression from prediabetes to type 2 diabetes by 94%, and significantly reduce the risk of major cardiovascular events."
He added, "Obesity is connected to 200 comorbidities, including heart disease, kidney disease and 40% of all cancers, which is why addressing the disease early is key."
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Patients don't have to be diabetic to benefit from GLP-1 medications for weight loss, according to Dr. Wiljon Beltre, a board-certified bariatric and metabolic surgeon and the founder of Beltre Bariatrics in Orlando, Florida.
"I also agree that patients with lower levels of obesity (BMI lower than 30) can derive great benefits from these medications," he told Fox News Digital.
"These patients can turn out to be excellent candidates for GLP-1s, since they seem to lose weight faster and notice a change almost immediately."
Several ongoing studies are exploring the use of weight-loss medications to treat a range of conditions, including alcoholism and addiction, Alzheimer's and dementia, liver disease, and more, according to Anderson.
"The way these medications work is by slowing stomach emptying so that you feel fuller longer, but they also have feedback to the appetite center of hypothalamus in the brain, which turns off the food noise," he said.
"Experts across the country are finding that it also seems to reduce cravings for alcohol in patients — that their reward center is turning off the desire for alcohol."
More research is needed to confirm this effect, but Anderson said these drugs could potentially be "life-changing" for those battling addiction.
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Aziz noted that GLP-1 drugs have also been shown to reduce the risk of both heart attacks and stroke by 20%.
"They also help to reverse a fatty liver and improve sleep apnea," he added.
Diabetes and obesity medications are widely known to cause gastrointestinal issues in some patients — primarily nausea, with some reporting vomiting, constipation and diarrhea.
"Most of those occur when doing dose escalation, and the vast majority are able to get through that," Anderson said. "This typically occurs early in therapy and tapers off over time."
Patients with a family history of medullary thyroid cancer or pancreatitis should avoid these medications, according to experts. Pregnant women are also advised against taking them.
Some patients have also reported a loss of muscle mass, hair thinning or shedding, mood changes and other unwanted outcomes.
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"People should understand that GLP-1 is not a magic solution to weight loss, but one leg of a three-legged stool — it needs to be combined with healthy eating habits and exercise," said Beltre.
It's also important for patients to understand that they cannot take these medications forever, the doctor noted.
Many doctors, however, report that the benefits outweigh the potential side effects.
"Importantly, I'm seeing many patients now able to participate in activities for the first time in many years following significant weight loss — ice skating, going on walks, canceling knee replacements and dropping blood pressure medications," Anderson noted.
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Those interested in weight-loss medications should consult with a physician to explore potential benefits and risks.Original article source: Who should be taking weight-loss drugs? Doctors share best candidates