Weighing Risks and Benefits:
Taking anti-obesity medications is not a DIY project!
Putting pharmaceuticals into the human body always comes with risks.
Practicing medicine involves weighing the risks of the various treatment options with the risk of doing nothing. Over and over again. Rinse and repeat.
This retrospective study released yesterday tells us that people taking semaglutide have a much higher risk of developing nonarteritic anterior ischemic optic neuropathy (NAION) than those who aren’t taking it. It doesn’t demonstrate or rule out causation (those studies will follow) but it’s data. Fairly solid data.
These types of reports always make us pause in medicine. We counsel patients and using shared decision-making, weigh the risks and benefits of continuing or starting the medication.
This doesn’t happen when you get a prescription from an online bot. It doesn’t happen when you get the medication from an aesthetician whose primary role is to make clients happy and generate revenue for the med spa.
Before you throw a drug into your body, stop and decide if the potential for developing permanent deterioration in your ability to see is worth it.
Taking semaglutide as part of a comprehensive lifestyle treatment to put your diabetes into remission, lower your 10-year ASCVD risk, and/or increase your life expectancy may warrant the risk of compromising your vision.
Taking that same medication because that extra twenty pounds makes you feel bad about yourself and you want to get back into the clothes you wore before you had kids is a different story. Those are valid reasons to embark on a weight loss journey – but, in that case, the risk of the treatment versus the risk of doing nothing is radically different.
My Obesity Medicine colleagues and I are thrilled to have GLP-1 medications in our toolbox. My team at Heartland Weight Loss uses them when appropriate – responsibly and cautiously. But they aren’t the only tools we wield. Every month, we get a handful of patients who just want us to write a prescription and don’t want to do “all the other stuff” (like monitoring labs, watching body composition, and engaging in a prescriptive nutritional intervention). We refer them out. Thankfully, we are blessed to have a much bigger group of patients who want to treat their excess weight – responsibly and cautiously. And we love taking care of those patients!
