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Researchers say some anti-obesity medications may help people with knee or hip osteoarthritis. Liza Vlasenko/Stocksy
  • Researchers report that medications that promote slow to moderate weight loss may improve survival rates for people with weight issues who also have knee or hip osteoarthritis.
  • They added that medications that produce rapid weight loss may actually increase the chances of premature death for people with these conditions.
  • Experts note that newer anti-obesity medications work differently than older drugs.
  • They add that lifestyle habits such as diet and exercise should always accompany the use of weight loss drugs.

You might be in a hurry to lose weight, but your body may have other ideas.

Rapid weight loss prompted by anti-obesity drugs may increase the chance of premature death among people with weight issues who also have knee or hip osteoarthritis, according to new study published in the journal Arthritis & Rheumatology.

The study authors suggest people with weight issues and knee and/or hip osteoarthritis have a better chance of living longer by taking anti-obesity medications that promote slow-to-moderate weight loss instead of ones that work more quickly.

The researchers used data from 6,524 participants in the IQVIA Medical Research Database with knee or hip osteoarthritis who were taking weight loss drugs orlistat, sibutramine, or rimonabant.

The research team said the five-year death rate was 5.3% for the “weight gain/stable” group, 4% for the “slow-to-moderate weight loss” group and 5.4% for the “fast weight loss” group.

The study said the risk of death was 28% lower for the “slow-to-moderate weight loss” group compared with the “weight gain/stable” group while only 1% lower for the “fast weight loss” group.

“A slow-to-moderate rate of weight loss induced by anti-obesity medications may lower the risk of death in overweight/obese people with knee/hip osteoarthritis,” said Jie Wei, a doctor of public health at Xiangya Hospital at Central South University in China and a study first author, in a statement.

Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California who was not involved in the study, told Medical News Today that weight loss specialists typically don’t classify weight loss medications based on how fast a person loses weight.

“Unfortunately, there is a great deal of variability when it comes to how a patient responds to medications,” Ali said. “The most effective medications currently available for weight loss mimic some of the hormones that induce satiety and slow the emptying of the stomach (such as Wegovy and Mounjaro).”

“This can result in more rapid weight loss. Older medications that are less effective typically have slower weight loss,” he added.

Ali noted it’s not just the drugs that determine how fast someone loses weight.

“The body adjusts to medication differently in each patient. There are many reasons why someone may lose weight slower; age, sex, activity, underlying medical conditions, and most importantly the foods being eaten all affect weight loss,” he said.

Ali added that there is a difference in newer medications that affects how fast they work.

“The medical difference between drugs is the mechanism of action of the drugs. Earlier medications did not target hormones as directly, so weight loss was slower,” he said.

Dr. Avantika Waring, chief medical officer of online weight loss, diabetes and heart health clinic 9amHealth who wasn’t involved in the research, said most weight loss medications can be “dosed and titrated to promote weight loss more slowly.”

“Depending on the method being used, slower weight loss can be more sustainable,” Waring told Medical News Today. “If a person is focusing on diet and exercise, a more moderate approach to lifestyle change may cause slower weight loss, but is more likely a change they can maintain in the long term. With medications, rapid titration or increase of the drug might result in faster weight loss, but more side effects and potential risks.”

Waring said the study demonstrates an association between mortality and rate of weight loss, but it doesn’t necessarily extrapolate the reasons why.

“It may be related to the type of medications used and potential side effects, for example, if the medication that causes a person to lose weight more quickly also carries other significant health risks,” Waring said. “Another hypothesis could be that rapid weight loss results in more severe metabolic or nutritional complications.”

Waring explained that various weight loss drugs have different methods of doing their job.

“Some drugs suppress the appetite very strongly or increase metabolism and result in faster weight loss, while others impact cravings and the reward sensations people experience when they eat certain foods,” Waring said. “Depending on the root cause of a person’s struggle with weight, a certain medication might have a greater, faster or lesser, slower, effect on weight loss. Any person looking to use medications to lose weight should talk with their doctor to find the best medication for them and understand the potential side effects.”

Weight loss drugs are known to work on the brain’s pleasure center, which helps people with addiction problems.

Some weight loss drugs, such as Ozempic and Wegovy – both of which use the active ingredient semaglutide – have been found to possibly affect a person’s desire to drink alcohol by cutting down how much dopamine the body releases in response to addictive behavior.

Dopamine is the human body’s “pleasure hormone” that’s released in response to some addictive behavior, which can include eating.

Lenny Powell is an osteopathic physician and an associate professor of medicine at the departments of geriatrics and gerontology at Rowan-Virtua School of Osteopathic Medicine in New Jersey who was not involved in the latest research.

Powell told Medical News Today the study results show why, even with weight loss medications, therapeutic lifestyle changes such as eating better, calorie restriction from healthier food choices, and regular exercise are often prescribed by physicians.

However, he said, compliance tends to be low. Slower and more lasting measures seem to be all-around healthier.

“Lifestyle changes are often the underlying mechanism by which weight loss is initiated and becomes most successful,” Powell said. “A new behavior can take up to two months to become habitual. Fast weight loss is typically unsuccessful, and your weight can rebound quickly with even more added weight as a result.”

“The results are certainly promising, and more research is needed but the underlying premise makes sense,” he added.