Frank Serna talks about how the weight loss drug Zepbound helped him lose 60 pounds and how it gave him time to develop better eating and exercise habits.
In his late 20s, Frank Serna knew what he did next could reshape the course of his life.
Having struggled with high blood pressure for the previous three years, the Oak Forest resident learned during his annual checkup this year that he was also prediabetic and had elevated cholesterol levels.
“I was at the age and at the point where I could still reverse it, so I knew I had to do something,” he said.
At 270 pounds, Serna decided to try Zepbound, one of several weight-loss medications for those struggling with obesity. Zepbound is an injectable medication that has gained popularity for its ability to help people lose weight by reducing appetite and changing how the body processes sugar and fat.
“Zepbound is a very effective medication that is FDA approved for chronic weight management in people with body mass index above 30 kg/m2 or above 27 kg/m2 when weight-related comorbidities are present,” said Dr. Briee Kulesa, ambulatory care clinical pharmacy specialist with Franciscan Physician Network.
People are also reading…
Other weight loss drugs such as Wegovy have similar BMI requirements for adults who take the drug: A BMI of 30 or higher or 27 or higher with a weight-related comorbidity. Examples of comorbidities include hypertension, obstructive sleep apnea or type 2 diabetes.
At the end of August, Zepbound manufacturer Eli Lilly & Co. announced it would make 2.5-mg and 5-mg single-dose vials available at a discount for self-pay patients with an on-label prescription to expand the medication’s supply in response to high demand.
More than 100 million adults are considered obese, according to the U.S. Centers for Disease Control and Prevention, with more than 22 million adults considered severely obese.
Tough beneficial, weight-loss medications are only part of the journey for many, including Serna.
Food noise
As a grant specialist at a local university, Serna spends much of his day sitting at his desk. Though he routinely walks his dogs, it doesn’t provide the level of physical activity needed to significantly boost his fitness.
He began taking 2.5-mg weekly injections of Zepbound in February, eventually working his way up to 5-mg. Serna began noticing he no longer had cravings for unhealthy foods, and instead wanted salad and chicken.
“That food noise really went down,” he said. “When I was nearing my next dose, the food noise would begin to return, but then go away again.”
Serna initially lost 10 pounds, but it wasn’t until May when he started exercising that he began to shed more.
That’s not surprising to registered dietitian Kelly Devine, president of Devine Nutrition, who says her patients who have combined weight-loss medications with a healthy diet and exercise often have the most success.
“It’s not a magic pill,” she said. “I have some people who didn’t lose anything until they started exercising and improved their diet.”
Zepbound is a brand name for semaglutide and mimics the action of the hormone GLP-1, which helps regulate appetite, increase feelings of fullness and lower blood-sugar levels.
In addition to Zepbound, the Food and Drug Administration has approved the semaglutide Wegovy specifically for chronic weight management.
The FDA has also approved the semaglutide medications Ozempic and Rybelsus for the treatment of type 2 diabetes, though some have used these drugs off-label for weight management.
“The positives of these medications are that they really do help decrease appetite and take away that food noise, leading to possible weight loss,” Devine said. “Food isn’t something they’re thinking about 24/7.”
Now weighing 204 pounds, Serna stopped taking Zepbound in August after he developed gallstones and had to have his gallbladder removed. He said doctors aren’t sure whether the medication may have led to the health issue.
In addition to weight management drugs that have semaglutide as the active ingredient, some patients use GLP-1 receptor agonists such as liraglutide (branded as Saxenda for weight management and Victoza for diabetes) and dulaglutide (branded as Trulicity) off-label for weight loss.
These medications also help regulate appetite and blood-sugar levels, making them a potential option for individuals looking to manage their weight in addition to treating diabetes.
However, weight-loss medications come with potential side effects, Kulesa says.
“The most common side effects include gastrointestinal symptoms such as nausea, vomiting, constipation, indigestion and diarrhea,” Kulesa said. “These often occur when starting or increasing the dose and often improve over time.”
Because of these side effects, doctors may not recommend these medications for anyone with gastrointestinal issues, especially severe conditions. Other contraindications include a family history of medullary thyroid carcinoma, a history of pancreatitis and hypersensitivity to active ingredients found in the drugs, among others.
Several lawsuits currently in federal courts also allege that manufacturers of weight-loss drugs such as Ozempic, Wegovy and Mounjaro failed to warn patients about the drugs’ risks, including severe gastrointestinal issues.
“Any side effects or concerns should be reported immediately to your primary-care provider,” Kulesa said.
Rapid weight loss itself can lead to health problems, Devine said.
“Any time when someone isn’t exercising and not eating enough protein, and they have rapid weight loss, you’re going to lose muscle mass,” she said. “And when you lose muscle mass, it lowers your metabolic rate, so your ability to maintain that weight loss goes way down.”
When patients eventually stop taking the medication, those food cravings can return, she says.
“They haven’t learned how to eat, they haven’t exercised and they haven’t learned to meal prep,” Devine said.
A recent study by Epic Research found that while many patients maintain weight loss a year after they stop taking semaglutide or liraglutide, a significant number regain some weight.
Researchers looked at data from more than 20,000 patients who lost at least 5 pounds while on weight loss medications. Nearly 20% had regained all the weight they had lost in the 12 months after stopping the drug. Another 26% had regained at least a quarter of their original weight.
Serna notes the food noise he experienced before taking Zepbound has returned, but by working with Devine, he has learned how to manage it.
“I’ve still maintained my good habits, but before, I was a big binge eater at night while watching TV,” he said. “Kelly has given me the education to avoid that and showed me how to eat smaller meals throughout the day and higher doses of protein to avoid night-time hunger boredom.”
Devine says she recommends that anyone taking a weight-loss medication work with their health-care teams to ensure their nutritional needs are being met.
“(Weight loss medications) can help, for sure, but exercise and getting enough protein to make sure you aren’t losing muscle mass and staying as healthy as you can are important,” she said. “I also really want our kids and teenagers to see healthy habits at home … Seeing mom and dad eat healthy should be something we are promoting to our kids.”
Serna says he wants others to know that though Zepbound jump-started his weight loss journey, every person’s path is different.
“Once you begin seeing the weight loss, you want to continue with it,” he said. “It was a big motivator for me.”
