How are results maintained after weight loss injections? Dr. Diana Morea-Lambrinoc, endocrinologist: “If you have strengthened some healthy habits, it is possible to maintain the effect for longer”

Weight loss injections are a new class of drugs whose use has expanded from type 2 diabetes patients to people who have weight problems. There is a lot of incorrect information circulating about weight loss injections, it attracts attention Dr. Diana Morea–Lambrinoc, specialist endocrinologist in the Queen Maria Health Network. This explains the differences between older and newer drugs on the Romanian market, how they work and the criteria by which a patient qualifies for such treatment, which must be prescribed and monitored throughout its duration.

Made wildly popular among Hollywood stars after a 20-year history of being prescribed for type 2 diabetes patients, the weight-loss injections are essentially synthetic hormones that suppress appetite and induce satiety.

It acts at the brain level by inhibiting neurons, at the stomach level – by slowing down its emptying, which, again, increases satiety – and at the pancreatic level – by increasing the secretion of insulin after a meal. Basically, these drugs reduce the body's food and energy intake and this is how weight loss is achieved. The name under which these hormones are marketed is different: Ozempic – for people with type 2 diabetes – Mounjaro, Wegovy and Saxenda, for overweight and obese people.

The criteria by which patients qualify for treatment

One thing that should be understood from the beginning is that weight loss injections are not a solution for those who want to get rid of unwanted extra pounds quickly.

The criteria by which patients are selected for treatment are written in the drug leaflets themselves and are quite clearly established, he points out Dr. Diana Morea-Lambrinocone of the specialists who recommend this type of treatment. “That is, the body mass index – BMI – over 30 kg/m2 is taken into account, which means a person with obesity. There are also indications for overweight people, i.e. those who have a BMI between 27 and 30 kg/m2 and who also associate a comorbidity related to excess weight. This can mean hypertension, cardiovascular diseases, prediabetes or even type 2 diabetes, dyslipidemia – that is, a high level of cholesterol or triglycerides in the blood. And, I would also add here, sleep apnea syndrome, another comorbidity that would indicate treatment”, emphasizes the endocrinologist.

Medical assessment and its importance

Within the Regina Maria Health Network, patients receive treatment through the general practitioner who evaluates them, recommends basic analyzes and various specialist consultations. But, before starting the therapy, an endocrinological evaluation is definitely needed, especially for the thyroid part, emphasizes Dr. Diana Morea-Lambrinoc.

“Before starting the treatment, we need to know the patient's history, what other pathologies he has and if he has contraindications for such treatments,” explains the endocrinologist.

Contraindications are not absolute unless the patient is known to be allergic to the medicine, respectively to its excipients, to pregnant and lactating women. Also, the treatment is not indicated in a patient with a personal or family history of thyroid cancer – of the medullary thyroid carcinoma type.

However, it is important to know if the patient had a history of acute pancreatitis, serious digestive diseases – such as gastroparesis, or currently has gallstones. “In these cases, caution and strict monitoring of the treatment is needed,” the specialist emphasizes.

The anamnesis begins with a clinical examination that measures weight, height, abdominal circumference, blood pressure and continues with blood tests and ultrasounds. “Blood tests include a complete assessment with blood glucose, glycosylated hemoglobin – to see if the patient has diabetes – we also measure the HOMA (Homeostatic Model Assessment) index to test for insulin resistance. We also measure the lipid profile: cholesterol, triglycerides, creatinine for kidney function, liver function tests – transaminases, bilirubin. And we can also measure pancreatic enzymes – amylase and lipase – to see if the patient is at risk for pancreas”, lists the endocrinologist.

The endocrinological evaluation includes analyzes to identify the level of thyroid hormones – TSH, FT4 – to rule out hypothyroidism that could be associated with a degree of obesity, or weight gain, of cortisol – which, in excess, can indicate Cushing's syndrome, a pathology that can also be associated with obesity, as well as calcitonin – the marker for medullary thyroid carcinoma, says Dr. Morea-Lambrinoc. And, in women, ovarian hormones are also tested to see if there is polycystic ovary syndrome, a pathology which, again, can be associated with obesity and which has a specific treatment.

To which ultrasounds are added: of the thyroid – to identify any suspicious nodules – and of the abdomen – to see how the organs look, if there are gallstones or fatty liver – a common situation in people with obesity, adds the doctor.

What are weight loss injections and how do they work?

According to Dr. Morea-Lambrinoc, weight loss injections are hormonal medical treatments. The therapeutic class to which weight loss injections belong is that of GLP-1 receptor agonists, a natural hormone released in the gut after each meal.

The most well-known drug is Ozempic, prescribed to patients with type 2 diabetes. The active substance is semaglutide, identical to that of the drug Wegovy, the latter being strictly indicated for weight control. GLP-1 agonists are synthetic hormones that mimic the natural hormone by acting on receptors in the brain that control appetite.

More recently, Mounjaro is a dual agonist – for both GLP-1 (glucagon-like peptide) and GIP (glucose-dependent insulinotropic polypeptide). By activating the receptors of these two hormones, practically imitating the natural intestinal hormones, the drug helps to control blood sugar, slow down the emptying of the stomach and increase the feeling of satiety.

“Strictly with the indication for weight loss, these drugs are newer on the market, but the therapeutic class is not really new. This type of drug based on GLP-1 agonists has been used in people with diabetes for about 20 years. Not necessarily the same substances, but different ones. And it was noticed that in addition to the good effect on the diabetes side, on glycemic control, they also have the effect of weight loss. And then he came up with this idea of being strictly approved for weight loss as well,” emphasizes Dr. Diana Morea-Lambrinoc.

Saxenda – with the active substance liraglutide – belongs to the same class of drugs, which in Europe has been used as a weight loss drug for about 10 years. The downside to Saxenda would be that an injection is needed every day – compared to once a week with the others – and the weight loss effect is on average 8% over a year, compared to 15-23% with the others.
For those with a fear of needles, there is the medicine Rybelsus, the pill version – but this too is only approved for diabetic patients. An important difference between Ozempic and weight loss injections prescribed strictly for weight loss is that the latter are in higher doses for a stronger effect. “Wegovy and Mounjaro appeared with us last year, in 2025. Saxenda has been around for longer,” says the endocrinologist.

Treatment and lifestyle changes

The duration of an injectable weight loss treatment varies from patient to patient. “Taking into account that obesity is a chronic disease, we must consider that these treatments are also long-term. There may be periods when they stop, only to be resumed. When we stop the treatment, there is the possibility of weight gain because all the mechanisms that these drugs control resume. But, in practice, most patients stop the treatments after a year,” points out the endocrinologist.

And that's because financial considerations also come into play here. These treatments are not covered by the public insurance system and have prohibitive costs. That is, somewhere from 770 lei per month, depending on the drug and dose, and up to 2,200 lei per month.
In order to be more effective, the injectable treatment, says Dr. Diana Morea-Lambrinoc, must also be accompanied by lifestyle changes. That is, with a hypocaloric diet, with regular physical activity: “The moment you stop the treatment and go back to your old eating habits, the effect will be a rapid weight rebound. It must be understood that the treatment helps to lose weight, but it does not replace a healthy lifestyle”, the doctor draws attention.

And one more important clarification: the injections are made in the skin layer in the abdomen, thigh or upper arm – the needle is small and a medical professional is not needed to do them.

Monitoring, month by month

Injectable weight loss treatments require a prescription to be dispensed and more than that, they require monthly medical monitoring. Why? Because, in addition to appreciating the effectiveness of the treatment, adverse effects may occur. “The most common side effects are gastrointestinal, that is, nausea, even accompanied by vomiting, diarrhea, constipation, abdominal pain. In general, they are not serious side effects, most of them are mild, very rarely, moderate. In terms of severity, I mean. And they usually appear when you increase the dose. A lot of people are scared and in the media there are still reports of serious side effects. In fact, it is not like that. Pancreatitis – because it is still circulating news about this side effect – it is a very rare complication. In Mounjaro, for example, it is 0.39%, compared to placebo. Many people also ask me about the side effects on the eyes – the aggravation of diabetic retinopathy – which has been reported only in people who also have diabetes, and for this reason, caution is recommended for diabetics with this complication.”

According to the endocrinologist, injectable treatments reduce the risk of cardiovascular disease, myocardial infarction and cerebrovascular accident, prevent chronic kidney disease, reduce blood fat levels, so it is even a plus that the treatment is prescribed to patients who already have such complications.

As for the age category of patients who use this type of treatment, it is heterogeneous. “Most people are 40-50 years old, but we also have young people over 20 years old. But I think that young people call less because they want to first exhaust all other options to lose weight related to lifestyle changes. In fact, this treatment is always indicated together with lifestyle changes. This is also the best option. Let's try lifestyle changes first and then come with medication to help control weight.” says the doctor.

Another thing to keep in mind is that every patient is different, and the treatment and dose that works for one may work less well for another.

“There are also patients who lose weight more slowly or who need a higher dose. So it doesn't work the same for everyone. The result is different, depending on the patient. And the patient has to understand that it's not okay to take treatment after the ear. Because with us there are many who “make sense”. Medical supervision is needed, a very important thing, I repeat. I want to add something about regaining weight after stopping the treatment. It is possible to regain weight if you stop the treatment, but if you have consolidated some healthy habits, it is possible to maintain the effect for a longer time”, concludes the specialist doctor.

Article endorsed by Queen Mary