Weight-Loss Injections: New Approaches to Weight Loss—Opportunities and Risks: An Expert Interview with Dr. Markus von der Groeben, M.D.

Dr. Markus von der Groeben, M.D., is a recognized specialist in surgery with a focus on visceral surgery and is considered a proven expert in the field of obesity treatment. Since 2018, he has headed the Obesity Center at Muri Hospital in the canton of Aargau, where he serves as a senior physician in visceral surgery and bariatric medicine. With extensive clinical experience and in-depth expertise, Dr. von der Groeben has specialized in the treatment of severely obese patients and is now one of Switzerland’s leading specialists in this field. In his work, Dr. von der Groeben combines surgical expertise with a holistic understanding of the complex causes of obesity.

As a member of several renowned professional associations, including the Federation of Swiss Physicians (FMH), the Swiss Society of Surgery (SGC), and the German Society for General and Visceral Surgery (DGAV), he is actively committed to the further development and quality assurance of obesity treatment. He takes a modern, patient-centered approach that includes conservative treatment options in addition to surgical procedures.

The Obesity Center at Muri Hospital has an interdisciplinary structure and offers a comprehensive range of therapies—from nutritional therapy and behavioral counseling to surgical procedures such as sleeve gastrectomy or gastric bypass. This range is complemented by innovative medication options such as the so-called “weight-loss injection.” Together with his specialized team, Dr. von der Groeben develops customized treatment strategies aimed at sustainable weight loss and an improved quality of life.

With its modern infrastructure, wide range of medical specialties, and strong interprofessional collaboration, Spital Muri itself provides the ideal setting for high-quality medical care. His dedicated work plays a key role in raising awareness of obesity as a chronic disease and in showing those affected effective paths to a healthier life.

The so-called weight-loss injection—such as one containing the active ingredient semaglutide (Wegovy)—opens up new possibilities in the treatment of overweight and obesity. For many patients, it can be a useful supplement to diet, exercise, and behavioral therapy—especially when traditional measures alone are not sufficient. But what can the injection really achieve, for whom is it suitable, and what are its limitations? The editorial team of the Leading Medicine Guide spoke with Dr. von der Groeben to learn more about this.

Overweight is no longer just an aesthetic issue—it affects health, quality of life, and often self-esteem as well. Many people struggle for years with diets, exercise programs, and lifestyle changes, yet the desired success often fails to materialize. In recent years, however, a new option has emerged in the field of obesity treatment: the so-called weight-loss injection. Medications such as Ozempic or Wegovy promise to make weight loss significantly easier—by curbing appetite and increasing feelings of fullness. What sounds like a simple solution also raises many questions.

Before starting treatment with the so-called weight-loss injection (Wegovy), a detailed medical consultation is essential. 

Pre-existing conditions such as diabetes, cardiovascular issues, or hormonal disorders are just as important as previous diet attempts, current weight, and mental health. Together, the individual goals of the treatment are discussed, and realistic expectations are established. The patient is informed about how the medication works—namely, by regulating appetite, slowing gastric emptying, and improving blood sugar control. It is also important to note that this is not a miracle cure, but rather a medical aid within the framework of a comprehensive treatment plan. 

“Right now, we’re seeing a very high demand for Wegovy therapy. We’re literally being overwhelmed because we’re authorized to prescribe the medication, and it’s covered by health insurance when appropriately indicated. The reality is that perhaps one in twenty patients is a candidate for bariatric surgery. The vast majority want to try Wegovy first—even if they have a high body mass index. To many, this seems easier: one injection, eating a little less, and you start losing weight. It works well, but especially for those with a very high BMI, surgery remains the more effective long-term solution. As far as I know, in Germany the body mass index must be significantly higher for surgery to be approved and covered at all. In Switzerland, the threshold for surgery is a BMI of 35 kg/m², or as low as 30 kg/m² if the patient also has type 2 diabetes mellitus that is difficult to control,” says Dr. von der Groeben, adding:

“If someone comes to me with, say, a BMI of 28 kg/m², I first explain exactly what options are available. In Switzerland, clear criteria also apply to Wegovy therapy: either a BMI of 35 kg/m² or higher, or a BMI between 28 and 35 kg/m² if there are additional conditions such as high blood pressure, prediabetes, diabetes, or a lipid metabolism disorder. We then perform a comprehensive lab workup on all patients. This means we check vitamin levels, thyroid function, cholesterol, triglycerides, and a number of other parameters. If the results indicate the presence of one of these comorbidities—such as hypertension—I can apply to the health insurance provider for coverage of the Wegovy treatment. At the same time, I also inform patients about possible side effects. I have an information sheet that explains typical symptoms such as nausea, vomiting, abdominal pain, or diarrhea. I also make it clear that pregnancy must not occur during therapy. And, of course, we also discuss rarer but more serious side effects, such as pancreatitis. Once coverage has been arranged, patients receive an introduction to the therapy. They are instructed on what to watch for—including side effects—and they attend nutritional counseling sessions. This is mandatory. From the start of therapy with Wegovy, clear goals are set: Patients must lose seven percent of their body weight within four months. And another five percent after an additional six months. These are requirements that must be met for the therapy to continue. Health insurance covers the costs for a total of three years. Whether patients actually continue for that long or perhaps stop sooner depends on how things progress. For example, if someone reaches a BMI of 25, health insurance will no longer cover the treatment. This raises the question of whether they might be able to try continuing without the injections for a while.”

Medication can be particularly helpful when conventional measures such as diet, exercise, and behavioral therapy alone have not produced the desired results. Ozempic and Wegovy both contain the active ingredient semaglutide, belong to the group of GLP-1 receptor agonists, and work in a similar way in the body: They promote a feeling of fullness, delay gastric emptying, and have a beneficial effect on blood sugar levels. The main difference, however, lies in the dosage and, consequently, in their intended uses.

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Ozempic was originally developed for the treatment of type 2 diabetes and is approved in correspondingly lower doses. It improves blood sugar control and, as a positive side effect, can also lead to weight loss. Wegovy, on the other hand, was specifically developed for the treatment of obesity. It contains a higher dose of semaglutide and is approved exclusively for weight loss in overweight or obese individuals—even if they do not have diabetes.

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“In recent years, the field of weight loss and obesity treatment has advanced significantly. There is hope that, through successful therapy, patients can achieve a lasting change in their lifestyle and maintain their weight in the long term. However, as has been the case with many weight-loss therapies in the past, maintaining the achieved weight after treatment ends remains a challenge. Once therapy is completed, there is a risk that patients will regain weight. Whether patients permanently change their eating and physical activity habits depends on their mindset. Change cannot be achieved by an injection alone; it also requires a conscious decision to adopt a healthier overall diet and to remain active. In this context, nutritional counseling is an essential component of the therapy. When patients combine the therapy with appropriate counseling, the results are quite positive. In some cases, however, patients must discontinue treatment due to side effects such as nausea, vomiting, abdominal pain, or diarrhea. “These side effects are relatively rare,” explains Dr. von der Groeben.

The obesity specialist emphasizes, however: “For patients with a higher BMI, surgical treatment is often recommended. A combination of medication and surgery can be a sensible option, especially if medication does not produce the desired results. In cases of extreme obesity, the use of Wegovy prior to surgery could be considered to reduce the patient’s weight and make the surgical procedure easier. In practice, however, this approach is not yet fully approved, although it would seem sensible in many cases. Patients who have achieved weight loss with Wegovy could benefit from being lighter before surgery, as their liver size would decrease and the surgical procedure would be simplified. However, it remains a matter of cost and approval by health insurance providers, which is why this combination has not yet become widespread or been approved.”

Successful and sustainable weight loss requires an interdisciplinary approach that includes not only medication but also a tailored diet, regular exercise, and psychological support. 

“At our facility, we collaborate with a psychosomatic specialist who serves as an internist and provides comprehensive care for patients. In addition, we offer psychological nutrition counseling, which I sometimes refer patients to. Ideally, we would have another psychologist on staff here at our facility, which is something we are currently considering. The practice we collaborate with is a private practice specializing in psychiatry and psychosomatics and is located across the street from our facility. It would be helpful to have another psychologist on site to better assist patients, especially after they have undergone surgery. This is because when patients fall back into their old behavioral patterns, it is often psychological—rather than psychiatric—support that is needed to develop new coping strategies. “We are currently working on integrating this option into our care, as we believe it is very important for our patients,” explains Dr. von der Groeben.

The use of GLP-1 receptor agonists for weight loss is a promising option, but it is associated with certain risks and side effects, particularly with long-term use. 

“There are certain risk factors where I am cautious and tend to be more reluctant to prescribe this therapy. One example is thyroid cancer, but patients with a history of abdominal adhesions or pancreatitis also present challenges. Such patients should be carefully evaluated before starting treatment. The most common side effects include nausea, vomiting, and diarrhea. There are also some specific considerations for patients with kidney disease. In these patients, kidney function must be monitored regularly, especially if treatment with Wegovy leads to severe gastrointestinal side effects. “If chronic kidney disease is present, I would tend to refrain from treatment. Caution is also advised in hemodialysis patients, as treatment with Wegovy is not ideal in such cases,” he adds, commenting on the dreaded yo-yo effect:

“I can’t say much at this point, since we’ve only been using this therapy for about a year. We don’t yet have enough long-term experience from this period. In general, however, I assume that a yo-yo effect is possible. A period of three to four months, during which about 7% of body weight is lost, is still relatively short to truly establish a sustainable lifestyle. In such a short period, it’s difficult to make enough changes that will lead to a more active lifestyle in the long term. It’s important for patients to understand that, in addition to weight loss, a long-term change in diet and exercise habits is necessary to ensure success.”

The increasing prevalence of weight-loss injections such as Ozempic and Wegovy raises a variety of ethical and societal questions concerning both medical care and broader social and cultural implications. 

In a culture heavily influenced by beauty ideals, the availability of such medications could lead to an increased focus on weight loss as a means of enhancing personal worth. There is a risk that society will view people’s weight even more strongly as an indicator of their health, success, or worth, which could affect the mental health and self-image of many people. The pressure to be “perfect” and to optimize one’s body could be intensified by the widespread use of these medications, especially at a time when body culture plays a dominant role on social media and in other public forums.

Dr. von der Groeben comments on this: “We are indeed receiving requests from very young people who are heavily influenced by social media and feel they are a few kilograms overweight. In these cases, they often express a desire to use a weight-loss injection like Wegovy. We also receive referrals from primary care physicians who do not adhere to the official guidelines but nevertheless send patients with this concern to us. For us, however, it is clear that we do not offer Wegovy therapy to patients with a BMI below 28 kg/m2, I oppose the use of medication solely for weight loss for aesthetic reasons, since a weight loss of just 5 to 6 kilograms can usually be achieved without medication by adjusting one’s diet and avoiding sugary drinks. “The intense pressure to look a certain way is indeed a major issue among young people today, and it’s amplified by social media,” he adds,

“In Switzerland, general practitioners sometimes start patients on Wegovy and allow them to purchase the medication at their own expense. After one to two months of use, they then refer the patients to us. However, this presents us with administrative challenges, as we require verifiable weight loss after 16 weeks for health insurance coverage. There have been cases where a patient came to us after 14 weeks and was denied coverage because she had not waited the required 16 weeks. Health insurance companies require that weight loss be monitored regularly, which creates a significant administrative burden. For this reason, I am not in favor of prescribing the medication at the patient’s request without a medical necessity, as this leads to additional bureaucratic hurdles.”

Treatment with Wegovy offers a means of weight loss, but it requires more than just administering the medication via injection. It is only successful when accompanied by nutritional counseling and lifestyle changes. Dr. von der Groeben emphasizes that, for severely obese patients, bariatric surgery remains the better long-term solution. He also criticizes the misleading labeling of food products and advocates for more education in schools on nutrition and physical activity.

“The monthly cost of treatment with Wegovy is 183 francs, which is no small amount. It is important that patients understand that the therapy does not consist solely of injecting the medication, but that accompanying nutritional counseling and lifestyle changes are crucial for success. This has also been demonstrated among patients who have been undergoing treatment at Muri Hospital for a year. While many are losing weight effectively, there are also patients who wish to discontinue treatment due to side effects or an inability to continue giving themselves injections. In my professional capacity as a surgeon, I do not view weight-loss injections as a long-term solution for severely obese patients. For these patients, bariatric surgery remains the only long-term option for achieving significant weight loss and improving health. Patients who are not extremely obese can achieve good weight loss with medications like Wegovy, but for truly severe cases, I consider surgery to be the more sustainable solution. There are patients who, after a thorough consultation, consciously decide to undergo surgery because they find the prospect of taking medication for the rest of their lives too burdensome. They prefer a one-time surgical procedure and do not want to deal with medication indefinitely. The patients I operate on are generally people who have been overweight since childhood and have already tried many diets. These patients view surgery as a long-term solution. Bariatric surgery has proven to be very safe. Patients are usually hospitalized for only three days after surgery and can then go home. We have a very low complication rate. Follow-up care includes regular checkups to ensure that patients are getting enough vitamins and nutrients, as there is an increased risk of deficiencies, particularly after a gastric bypass. “Patients are then given high-dose multivitamins to prevent deficiency symptoms, since certain vitamins and nutrients can no longer be properly absorbed after surgery,” states Dr. von der Groeben, who also criticizes the food industry and the lack of education regarding eating habits:

“There should be less sugar in food, as many products advertised as ‘low-fat’ or ‘sugar-free’ actually still contain too much sugar. Food labeling is often misleading, giving consumers the impression that they are consuming healthy products, even though they are actually taking in a lot of sugar. This is particularly true of products marketed to children, such as candy that is advertised as containing health-promoting additives like milk. Finally, we must also place greater emphasis on nutrition and physical activity in schools. Cooking classes and more physical education could help children learn to eat healthily and stay active. Healthy eating is often more expensive and time-consuming, and quick, unhealthy meals are a practical solution, especially for working parents. Therefore, it is important for society to find the right balance between promoting healthy eating and taking families’ everyday lives into account.”

Dear Dr. von der Groeben, thank you very much for your comprehensive and clear explanation of weight-loss injections!