You’ve probably seen ads on TV or on the subway for the new weight loss medications, or learned about them through social media. Doctors say these medications have earned their name recognition for good reason: They work.
Weight loss on its own is notoriously difficult—a reality reflected in the sheer number of diets, programs, and products promising results. These medications offer something more proven, helping patients achieve meaningful, clinically significant weight loss.
In this Q&A, Tia B. Vincent, MD, a board certified obesity and family medicine physician, answers some of the most frequently asked questions, including who can benefit from these medications and why most patients will need to keep taking the medication even after they lose weight, much like medications for other chronic conditions such as high blood pressure. She sees patients ranging in age from their 20s to those in their 80s for weight loss through Mount Sinai Virtual Primary Care.
“I’ve seen tremendous success for many patients,” she says. “Not only from a physical standpoint, but also from an emotional and mental health perspective.”
Tia B. Vincent, MD
Who is eligible for treatment with weight loss drugs such as Zepbound® ,Wegovy®, and Foundayo®?
Many of my patients have been trying to lose weight through dieting and exercising. But they either feel defeated by seeing minimal results or find that they are able to lose weight but quickly gain it back, creating a yo-yo of their weight over time.
To be a candidate for these medications, you must fall into one of the following categories:
- Body Mass Index (BMI) of 27 or above, along with at least one weight-related medical issue such as hypertension, high cholesterol, diabetes, pre-diabetes, sleep apnea, cardiovascular disease or metabolic dysfunction-associated steatotic liver disease (previously called “fatty liver disease”)
- BMI of 30 and above
Also, patients must have tried a calorie-restricted diet combined with 150 minutes of cardiovascular exercise per week for at least three to six months without weight loss success. We see many patients for weight management consults; some are at the very beginning of their weight loss journey and others have been at this point for most of their adult lives.
You body mass index alone doesn’t tell the whole story. Some patients carry an elevated body fat percentage that their BMI doesn’t fully capture. But they still face meaningful cardiovascular risk, and we take that into account. For this reason, BMI serves as a starting point for determining eligibility rather than a definitive threshold, with each case evaluated individually. Additionally, certain ethnic groups, including people of Asian descent, including South Asian, East Asian, and Southeast Asian populations, are at greater risk for metabolic disease at lower BMI levels. They may qualify for weight loss medications at a lower BMI cutoff than standard guidelines suggest.
I see patients of many ages and backgrounds. For example, I’ve taken care of men and women in their 30s and in their 60s who are trying to improve their health. I’ve taken care of women who are post-menopausal and having difficulty with weight loss. I’ve had patients who were unable to lose weight after pregnancy as well as women who want to lose weight before becoming pregnant. I’ve taken care of adolescents who have been struggling with weight as long as they’ve seen their pediatrician.
Are the medications the primary therapy?
In addition to the medications, diet, exercise, and lifestyle changes are the essential components of healthy living. We encourage our patients to see a nutritionist and work towards more active lifestyles while taking the medication. The medications are one tool for success. But other changes need to be made to get the most benefit
What are the different medications available, and how do they work?
The medications are a bit different.
- Ozempic® and Wegovy® are brand names for the generic drug, semaglutide. Ozempic® is an injectable drug approved by the Food and Drug Administration (FDA) for diabetes. Wegovy® is approved for weight loss in patients who are not diabetic. These are called GLP-1 drugs because they mimic the action of a hormone called GLP-1 that controls blood sugar levels while decreasing appetite and slowing the digestive process. Wegovy® comes in both injectable and pill form.
- Foundayo® (orforglipron) is a newer GLP-1 agonist medication. It is currently only FDA approved for weight loss.
- Victoza® and Saxenda® are brand names for liraglutide, another GLP-1 receptor agonist that is prescribed in diabetes and for the treatment of obesity/overweight.
- Mounjaro® and Zepbound® are the brand names for tirzepatide, which is a GLP-1/GIP dual agonist drug which means that it works on two receptors that stimulate two separate hormones that control blood sugar levels and curb appetite. Zepbound® is FDA-approved for weight loss, while Mounjaro® is approved for diabetes.
Are there risks to these weight loss medications?
With any medication, there are risks and potential side effects. While taking into account each patient’s individual history, we also follow a specific set of clinical guidelines developed in collaboration with Mount Sinai’s Division of Endocrinology, Diabetes and Bone Disease to make sure that there are no contraindications for individual patients. The biggest contraindications include a personal history of pancreatitis or family history of medullary thyroid cancer, multiple endocrine neoplasia (MEN) syndromes, or endocrine cancers.
Currently these medications are not recommended during pregnancy or while breastfeeding. Women who plan to become pregnant are recommended to stop GLP-1 medications two months before trying to conceive.
What about side effects?
The most common side effects are gastrointestinal, such as nausea, vomiting, diarrhea and constipation. For patients who have never received GLP-1 therapy, we always start patients off at the lowest dose and follow them closely to increase the dose as needed throughout their weight loss journey.
These medications, in part, work by slowing down your GI tract so that food stays in the stomach for longer, causing you to feel full for longer. As a result, reflux, bloating, nausea and constipation sometimes occur. For example, some patients may experience a change in their bowel movements from a baseline of going every day to going every other day. We encourage hydration, a high-fiber diet, fiber supplements such as Metamucil® or Benefiber®, and exercise to keep the gut moving. Often times the side effects can be managed with dietary and lifestyle changes. Sometimes over-the-counter or prescription medications are required to calm or improve side effects.
How often do you see patients for follow-up?
Initially, patients are seen monthly, or sooner if they experience side effects. We start at the lowest dose and then increase the dosage every four weeks until they reach a dose that produces a healthy, sustainable rate of weight loss. Our goal is to strike the right balance: avoiding rapid, unhealthy weight loss while ensuring patients are still making meaningful progress toward their goals.
Every patient responds differently. Some patients are able to lose weight on the lowest dose. Some patients plateau after two or three months, and require a dose increase. Others may not see significant progress until reaching higher doses. Once a patient’s treatment plan is well established, we may have a follow up appointment with them every three months. Ultimately, check-ins remain essential for everyone to ensure that weight loss stays on track within a safe, healthy range.
How do patients take these weight loss medications?
These medications can be taken by injection and as a pill.
The injectable medications currently include Zepbound® and Wegovy® which are self-administered once per week, and Saxenda® which is self-administered once per day. The injections are generally pre-filled pens that come with a thin, short needle and patients are able to administer these injections themselves, at home. These are not painful injections; all you should feel is a pin-prick. Usually, you inject it in your belly or the lateral side of your upper leg. The medication comes with an instruction manual with pictures, and there are videos with step-by-step instructions. We do have clinical pharmacists who offer video visits to walk patients through how to do it if they need assistance. There are also two pills: Wegovy® and Foundayo®. In studies, the injectable versions of tirzepatide and semaglutide (Zepbound® and Wegovy®) produce greater weight loss than the oral options.
What results have you seen?
Some of my most meaningful moments have come from patients who spent years burdened by arthritis, uncomfortable and frustrated in their own bodies, who lost enough weight to start moving again, and in doing so, rediscovered a more active, fulfilling life.
Many patients who came to me with high cholesterol, prediabetes, or high blood pressure have been able to dramatically reduce those risk factors. It’s very rewarding to reach the point where we can lower or even discontinue blood pressure or cholesterol medications altogether. Several patients with sleep apnea have lost enough weight that they no longer need a CPAP machine. I’ve also taken care of several women with polyendocrine metabolic ovarian syndrome (PMOS, previously called PCOS or polycystic ovarian syndrome) who have been able to lose weight prior to conceiving, which is highly rewarding.
But beyond the number on the scale, the labs and the prescriptions, what stands out most is watching someone’s relationship with their own health transform. For so long, effective and sustainable weight loss felt out of reach for many people. Having a tool that actually works has been a privilege to be part of.
How long do patients stay on these medications?
This is probably one of the most common questions I encounter. Ultimately these medications are recommended for long-term or chronic use. The goal is to start them to help you lose weight, then continue them—sometimes at a reduced dose—to help you maintain the progress you’ve worked so hard to achieve. Many people come to me hoping they can take a GLP-1 medication for a few months, lose weight, then stop taking them. It’s a reasonable wish. But unfortunately, research shows that most people who stop the medication this way regain the majority of their lost weight within a year of stopping the GLP-1. Like any medication, in order to continue to receive the benefits of the GLP-1 medication, you need to continue to take it. Think of it like blood pressure medication. We don’t prescribe blood pressure medications until someone’s blood pressure is controlled and then abruptly stop the medication; we start the medication, confirm it’s working, and recommend continuing it to keep blood pressure at a healthy level. Obesity is a chronic, relapsing condition, and for most of my patients, this isn’t the first time they’ve fought this battle. Weight loss and regain has often been a lifelong struggle. That reality deserves a long-term treatment approach, not a short-term fix.
That said, I don’t want anyone to feel discouraged or intimidated by the idea of long-term medication. If you can lose weight and maintain a healthier weight, you may dramatically reduce your risk of developing high blood pressure, diabetes, heart disease, stroke, and sleep apnea as well as certain cancers that are associated with obesity (such as endometrial cancer, esophageal cancer, renal cell carcinoma, and pancreatic cancer). Staying on a GLP-1 isn’t just about the number on the scale; it can genuinely improve your overall health.