DEAR DR. ROACH: In a recent column, you answered a question regarding weight loss. You stated that you do not recommend weight-loss drugs unless the person is very overweight or has medical complications. I’m curious to know your reasoning behind this. Can you please elaborate on your answer? — J.S.

ANSWER: In my opinion, being overweight is not a medical diagnosis and does not have a large effect on a person’s quality or length of life. So, I do not recommend weight-loss medications for people who are overweight.

Being obese puts a person at a much higher risk of medical complications such as sleep apnea, arthritis, high blood pressure, and diabetes. When a person does have a medical complication associated with being obese, then a weight-loss drug can be considered.

I still don’t rush to prescribe them as many people can make a big difference in their health by changing their diet and exercise. When these aren’t enough to control whatever medical complication is associated with their weight, then it’s time to consider medications.

Although the data so far suggest that these are pretty safe drugs, there are possible side effects. People tend to not only lose fat but lean body mass. There are rare reports of serious kidney and pancreas complications with GLP-1 drugs. A rare eye disease (non-arteritic ischemic optic neuropathy) is associated with GLP-1 use, so vision changes should be promptly evaluated.

Since these drugs have the potential for harm, they should only be used when the benefit outweighs the risks. This means that they should only be used in people where losing weight is very important, such as those who are very obese or people who already have medical complications.

I see patients who ask about this medication for cosmetic use to lose a few pounds, and I do not recommend it due to the potential for side effects and the fact that the medication only works when it is continued long-term.

DEAR DR. ROACH: I am someone who opted for a minimally invasive knee replacement surgery. It was a botched, failed operation. A revision orthopedic surgeon said that my knee could be fixed with another surgery, but at my age (I’m an 88-year-old woman), he doesn’t advise it. He suggested that if I can live with it the way it is, I should do so. So, I can never walk again without a walker, which I use even around the house.

Your recent column mentioned that sometimes the “easier” surgery can leave nerve damage, which is also what happened to me. I have nerve damage in my left leg and foot, and I never had nerve problems like neuropathy before the surgery.

My regular orthopedic surgeon had tried to keep me from having the knee surgery. I sure wish I had listened to him. This is being written to support the people who fall for the marketing scam of no pain, walking and dancing and golfing the next day, and no therapy. — Anon.

ANSWER: I appreciate your writing. I’ve heard from people who have done extremely well with the minimally invasive procedure, but your letter points out what the data show, which is that not everybody does well with it. I recommend getting two different opinions and finding a surgeon who is very experienced and can make the best recommendation for you.

As always, procedures that seem too good to be true might just be exactly that.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved