The popularity of glucagon-like peptide-1 (GLP-1) agonists like Ozempic, Wegovy and Mounjaro has exploded in recent years. Initially approved to treat Type 2 diabetes, the drugs have become the tool of choice for millions of Americans, including influential celebrities, who wish to slim down. A recent survey even suggests that 1 in 8 Americans have received a prescription for them. 

But David B. Sarwer and Leah M. Schumacher, Temple faculty with extensive research on improving weight loss outcomes and the treatment of obesity, are concerned with how some plastic surgeons are promoting GLP-1s and using them to treat patients. 

Together they authored “Considerations for the Use of Glucagon-like Peptide-1 Medications for Obesity in a Plastic Surgery Setting,” published on September 10 in Plastic and Reconstructive Surgery—Global Open. 

In the paper, Sarwer and Schumacher make a series of recommendations to plastic surgeons prescribing GLP-1s. These include treating obesity as a chronic disease rather than a cosmetic issue, pursuing additional training on evidence-based approaches to obesity management and providing more comprehensive support to patients on the medications.  

“There are a number of concerns with how plastic surgeons are promoting GLP-1s online. One is that these medications are really designed for people who have significant health problems related to their weight. They’re not designed for people who are looking to lose 10 or 20 pounds to improve the way that they look,” said Sarwer, senior associate dean for research and strategic partnerships at the College of Public Health and director of the school’s Center for Obesity Research and Education (CORE).  

“Second of all, obesity is a significant disease that has a number of comorbidities associated with it. Plastic surgeons may not have been trained to assess and manage these in their day-to-day practice,” he continued. 

Despite their cautionary words, Sarwer and Schumacher note that GLP-1s have shown great promise and may be appropriate treatment options for many patients. 

The researchers explained that GLP-1s produce weight losses much larger than previously approved medications. GLP-1s are also associated with significant improvements in weight-related health issues like high blood pressure.   

“Evidence-based approaches to treating obesity—including lifestyle modification, obesity management medications like the GLP-1s, and metabolic and bariatric surgery—have, historically, only been used by 1–2% of Americans. These medications have great potential to be used by a much larger percentage of the 42% of Americans currently diagnosed with obesity,” Sarwer said. 

GLP-1s have also caught the interest of plastic surgeons, and a number of surgeons are prescribing them on the promise that they can help patients lose weight. Some have started to market them in the same way that they promote cosmetic procedures, such as how Botox smooths facial wrinkling.  

The popular belief, historically, was that obesity is the result of failures in personal responsibility—that if people simply ate less, moved more and made different choices, they wouldn’t be struggling with their weight. There’s also been a prevailing oversimplification that obesity is a cosmetic issue, which can minimize the health concerns that often accompany obesity.  

According to Schumacher, these inaccurate beliefs can fuel weight bias and stigma, and it is important for people to appreciate the complexities of obesity. 

Things started to shift in 2013 when the American Medical Association (AMA) classified obesity as a disease. 

“Now, we’re really thinking of obesity more as a chronic disease, much like Type 2 diabetes or cardiovascular disease,” said Schumacher, assistant professor of social and behavioral sciences and a researcher at CORE. “Rather than putting the blame or full responsibility on the person, the science has evolved to where we now know there is a lot more at play physiologically, genetically and on a systems level.” 

But the researchers worry that some plastic surgeons continue to perpetuate the outdated view that obesity is a cosmetic issue, both in how they talk about GLP-1s and how they are using them with patients. 

Some plastic surgeons, Sarwer noticed, were talking about their approach to GLP-1s the same way they would Botox, “where you get an injection, you come back three or six months later, and there’s really nothing that you need to do between those visits.” 

But GLP-1s, he continued, are entirely different than Botox, and patients losing weight need different kinds of support.  

Conditions like hypertension or Type 2 diabetes can improve or even go into remission as someone loses weight, which may require a patient to change their medication. Studies have also shown that some patients lose significant muscle mass as they lose weight, and so they may require additional strength training. Nutritional and behavioral counseling also can help patients make changes to help them lose weight and maintain it over time.  

The researchers are also concerned that plastic surgeons are offering only GLP-1s as an intervention for weight loss, and ignoring other effective options like lifestyle changes focused on diet and exercise, or metabolic and bariatric surgery. 

“Comprehensive care would dictate that a physician be prepared to talk about all three of these treatment options, and not saying ‘I only offer one,’” Sarwer said. “So, it may be great that plastic surgeons are willing to offer these medications, but Dr. Schumacher and I would argue that to do so responsibly, they should get some additional training in obesity management and also prepare themselves and their staff to manage patients beyond just writing a new prescription for them every month.” 

In 2023, Sarwer and Schumacher authored a piece reflecting on the decade that passed since the AMA classified obesity as a disease. While they applauded advancements that had been made, they acknowledged the need for a true paradigm shift in the way we view and treat obesity. With their newest paper, they continue that advocacy. 

“Many medical providers don’t get a lot of training on obesity and its management, which is a little bit surprising considering how prevalent it is. And so a lot of providers may then feel hesitant to address it with patients,” Schumacher said. “I think there are huge training gaps that we can work to fill. We still have a lot of work to do to fully embed obesity management training, so that your standard, practicing clinician feels confident to address obesity sensitively and with good evidence-based treatment options.”