People have been searching for a magic weight loss pill for a long time. In the modern era, the story begins with doctors’ prescribing thyroid medication to their overweight patients in the 1920’s. Once it became apparent that HRT resulted in hyperthyroidism in many patients without a diagnosis of hypothyroidism, however, hormonal supplements were replaced by a new weight loss medication called DNP (2,4-dinitrophenol) in 1933. Due to adverse effects including fatal hypothermia and cataracts, DNP would also fail, with the FDA prohibiting the human consumption of DNP in any form just 5 years after its introduction (it was later repurposed as a pesticide but would ultimately be banned even for agricultural usage in 1998).

As DNP was being taken off the market for serious safety concerns, another class of medications was already becoming popular for weight loss. Amphetamines, and the many adverse effects and addictive qualities associated with these potent stimulants, would become synonymous with the term “diet pill” for decades. In the late 1960’s, Congress finally passed stricter laws restricting access to these notorious weight loss drugs. Today, amphetamines are much less likely to be used by adults hoping to drop some weight than they are to be taken by children with trouble concentrating.

While stories of weight loss medications from the early through the middle part of the 20th century may strike us as anachronistic and quaint today, the cautionary tale of fen-phen is disturbingly recent. By combining phentermine, originally approved by the FDA back in 1959, and fenfluramine, FDA approved in 1973, a new weight loss aid was born. Two separate studies demonstrated that fen-phen effectively assisted participants in shedding pounds, leading many to demand the drug from healthcare providers. By 1996, more than 18 million prescriptions were being written. Unfortunately, like all of the weight loss pills approved by the FDA in the 20th century, the evidence of adverse effects—in this case, valvular heart disease in up to 30% of patients—would eventually outweigh proof of benefits, and fen-phen, too, was banned in 1997.

GLP-1 Analogs — The Next Generation

Recently celebrities and influencers have shone the spotlight on the latest and greatest development in pharmaceutical weight loss, the GLP-1 analogs. Originally approved for the treatment of diabetes, these medications activate receptors found on the pancreas and in the brain that control blood sugar by stimulating insulin secretion. Not only is blood glucose lowered, food intake also decreases, allowing patients to painlessly and, in a relatively short time, lose weight.

With benefits which include better blood sugar, less cardiovascular illness, improved mood in patients with depression, and reversal of non-alcoholic fatty liver disease, this novel class of medications is becoming popular, and, like fen-phen, the number of patients using these drugs has soared. Cost can be prohibitive, since a pen with enough doses for a month runs $935 (despite a production cost of $4-$8 for the 1.5 ml contained within). Safety is another serious consideration with these drugs, with preliminary data suggesting adverse effects ranging from hair loss to thyroid cancer. Like all of the other weight loss drugs of the last century, will we discover that the pros of GLP-1 analogs come with severe, even potentially fatal, cons?

The Real Risks of Chemical Weight Loss

Only time will tell if GLP-1 analogs are sufficiently effective and safe, and, for some patients, these injections may be their best options. It is, however, undeniable that for many overweight people, any form of chemical weight loss is dangerous. By offering weight loss without exercise or diet modification—a body “hack” of sorts—healthcare providers are enabling an unhealthy lifestyle. A patient loses 15, 20, even 30 pounds, but without improvements in their core strength or better nutrition, resulting in a thinner, but weak and malnourished, body. Can this be considered “healthcare”? Even as treatment for diabetes, GLP-1 analog injections are little more than a substitute for the real diabetic cure of healthy diet and exercise. We seem to have simply given up on good life choices in favor of a medicated America where the future of health for many of us, and even our very survival, may ultimately depend on a daily cocktail of drugs.