The changing face of weight management: Sioux Falls patients flock to new medications

Like a lot of people, Lindsey West had tried most everything she could think of to try to lose weight.

The Sioux Falls woman, who struggles with multiple health conditions such as a blood clotting disorder, did the “keto diet.” She tried working on a calorie deficit, and she even considered surgery as the scale climbed over 300 pounds.

Then, she started watching videos on TikTok touting the benefits of GLP-1 agonists – a class of medications sold under names such as Ozempic and Wegovy – and the dual GLP-1/GIP receptor agonist sold under the name Mounjaro. They were designed to help with Type 2 diabetes, and more recently are being used for weight management.

“I was like, OK, I want to try this,” West said, asking her doctor who “didn’t know a ton about it yet for weight loss. He said some people don’t lose any and some people lose a little, and that’s how I got started.”

That was in September 2022. Recently, West saw a number on the scale that brought her to tears: 199.

“I haven’t seen that number in over 20 years,” she said. “It’s almost freaky that I’m down this much. It’s hard to believe. It’s not all about the scale but just the way I feel. I have no knee pain. I have no ankle pain. It’s insane.”

West has a lot of company in her weight-loss journey. Just how much is tough to quantify, but anecdotally Lewis Drug CEO Mark Griffin has noticed a significant uptick at the pharmacy.

GLP-1 purchases have “created a huge impact in the pharmacy business,” he said. “I know quite a few people in town that have used the drug quite successfully. It’s really, really popular.”

Weight-management professionals are saying the same.

“We are seeing a high level of interest … for both diabetic care and weight-loss management,” said Dr. Zoilo Lansang of Avera Medical Group Comprehensive Weight Management. “This is due to its weight-loss benefits, data behind use, social media influence, advertising and national news.”

But, while the interest is there, “the overall knowledge about GLP-1 agonist, including cost, effectiveness, side effects and how this drug works in the body is not,” he said.

Quieting ‘food noise’

A love of food spans the generations of Patti Lindstrom’s family.

“My mom, my sister, myself, we’ve all struggled with weight. It’s just a thing, a hormonal thing, and we love food,” the Brandon woman said. “I’ve been overweight forever, and on top of that, Type 2 diabetes kicks in, so it was like, let’s do this.”

After starting on Mounjaro, which made her constantly nauseous, she switched to Ozempic, and it “has been amazing,” she said. “Once my body gets used to a new dose, I’m fine, and now I’m at the top dose I can be.”

She has dropped 50 pounds from a top weight of 313, “and the last time I was at the doctor, she said if I can lose 20 pounds, she’ll take me off all my meds. I have a long way to go – I need to lose at least another 100 pounds – but at least I can see that now as a possibility.”

Her daughter, Acacia Dede, soon joined her.

“I had been on my own weight-loss journey for a long time, trying different things – WeightWatchers, Noom – and all of those just left me extremely ‘hangry.’ I could never get full,” she said.

After talking with her doctor in late 2022, she was prescribed Mounjaro before changing to Wegovy.

She has dropped from a high of 200 pounds down to ranging from 125 to 135 pounds, and her underlying health conditions – including multiple sclerosis and herniated discs in her back and neck – are eased considerably, she said.

“It’s just easier to be able to get up and move,” Dede said. “With MS, they say the best thing to do is exercise, but when you’re overweight, it’s hard to exercise.”

She has given up her daily Starbucks stops, has lost her cravings for sweets and “fast food in general doesn’t really settle well,” she said. “Instead of two helpings of spaghetti, I’ll have a small helping, and I’m good to go. Being on this medication is probably the first time in my life I’ve actually felt full.”

Sanford Health physician Dr. Jennifer Schriever, who specializes in weight management, explained that’s how the drugs work.

“These medicines are replacing the fullness hormone that decreases as we gain weight,” she said. “They help you feel full sooner and faster, but they also affect how your brain thinks about food. Some people think about food all the time. Even though they’re eating, they’re thinking about their next meal.”

The medications shut off or help quiet that “food noise,” she added.

“They definitely are some of the most successful medicines out there for weight management.”

But they’re not for everyone and don’t work for everyone. Schriever said a patient must have a body mass index of 30 or above, or 27 and above with a weight-related disease such as diabetes, high cholesterol or high blood pressure, to be a candidate.

Those with chronic constipation or slow stomach emptying also aren’t a fit as the medications can delay gastric emptying, and “my consideration is these will cause potentially significant nausea,” she said. “It’s very important to eat and drink slower so you feel that full feeling.”

For those patients, other more traditional and older appetite suppressants still could be a fit, she added.

Other potential side effects of GLP-1 medications include vomiting, constipation, diarrhea, abdominal pain, pancreatitis, gallbladder disease, dehydration and kidney diseases. In some rare cases, medullary thyroid cancer has occurred.

“I don’t think we know enough about how long people will need to be on this,” Schriever said. “It depends on their life experiences and how much stress and anxiety and food thoughts have been part of their life, or trauma. Over 90 percent of people with elevated weight have had some sort of trauma.”

Controlling costs

Without what she calls “great insurance,” Carrie Sanow would be paying more than $1,500 per month for Wegovy, which she began taking in early 2023 after even weight-loss surgery failed to solve her weight gain, driven by hormone issues and insulin resistance. Instead, her share of the bill is $25 per month.

After losing almost 90 pounds, “I’m 8 to 10 pounds from target,” she said. “Right now, my doctor wants to keep me on a dose that’s working for me … and just do maintenance, and then we’re going to check back in six months.”

Here’s a look at her before and after the medication:

She has noticed a significant difference in appetite.

“I used to be able to sit down and eat two cream-filled doughnuts, and now I don’t even crave the sweets or cakes or cookies,” she said.

“I probably eat three small meals a day, and obviously if I do more walking, I’ll see a 1- to 3-pound drop. I’ve gone from eating a full meal when I would go out to now I share a meal and some things can’t even eat half.”

It’s a different financial situation for West, whose insurance doesn’t cover her medication and who has used savings cards to get the cost down to $432 per month.

She drives for Lyft as a side job to help afford the prescription.

Insurance “will not cover anything for weight loss,” she said. “They told me it hasn’t been shown to be effective. Are you kidding me?”

Still, the difference it has made in her life is “worth it,” she continued. “It’s how I feel and my energy level. I eat like I used to, but smaller portions, but I also make better choices.”

All indicators are that the wave of patients using GLP-1 medications has just started. For now, they’re available only in an injectable form, but the consensus seems to be it’s only a matter of time before equivalent pills are available. As cost comes down and coverage increases, usage growth is all but certain to follow.

Keeping up with demand might be the bigger issue. Shortages already have affected patients, including those who used the drugs to treat diabetes before they expanded to weight management.

“We’ve had patients call and drive to Mitchell or somewhere like that because they finally found a dose of the medicine they needed, but not as much recently,” Schriever said. “It was worse a few months ago. But obesity is a disease that deserves recognition and treatment, just like high blood pressure. We should be treating it like those other conditions.”

A word of warning, though: Patients should consult a doctor before starting any medications and should purchase only from a state-licensed pharmacy or outsourcing facility registered with the FDA. The FDA has warned against turning to a compounding pharmacy for generic versions of semaglutide, the active ingredient in Ozempic and Wegovy, because of unanticipated side effects. There also are possible injection risks tied to counterfeit versions of the medications.

“The bottom line is these medications and even surgery are simply tools to aid a patient’s overall lifestyle changes,” Lansang said. “It is important to remember that these medications can’t be used (for) every patient wanting to lose weight, and these are not a cure-all for overweight and obesity treatment. These medications are one tool in the toolbox, along with diet, exercise and a healthy lifestyle.”

Still, for the success stories, these injections have been nothing short of life-changing. The one missing link, said Lindstrom, who is still hoping for additional triple-digit weight loss, is a local support group.

“It would be good for people to share their experience. I’d be totally willing to go,” she said. “It would be good to have that support because it’s a hard road. It encompasses everything.”