DEAR DR ROACH: My brother-in-law is a lovely man, but for years, he’s suffered from obesity. He also gambles and drinks alcohol too much. I hesitate to get too involved, but I recently read that the new weight-loss drugs based on GLP-1 agonists are also helpful in reducing alcohol and gambling addictions. This sounds too good to be true. Is it?

• D.N.A.

ANSWER: The evidence is very strong that GLP-1 agonists like tirzepatide (Zepbound) and semaglutide (Wegovy) help people lose weight. About 80% to 90% of people will experience a weight loss of more than 5% of their initial body weight. For people who are severely obese, people with obesity and metabolic complications (diabetes, prediabetes or metabolic syndrome), and people with other weight-related complications (sleep apnea and arthritis), the benefits of these medicines probably outweigh the risks just for the weight loss.

The evidence for GLP-1 agonists helping with alcohol use disorder is now quite strong, with studies showing significant reductions in alcohol-related hospitalizations and a reduction in problem drinking.

The evidence for gambling disorders is preliminary based on the understanding of how these drugs work in the brain. There are no strong clinical data at this time supporting the use of GLP-1 agonists for a gambling disorder.

Still, given the clear benefits in weight reduction and problem drinking, these drugs might be a good choice for your brother-in-law — if both he and his physician agree. It might also help his gambling problem, which I’ve seen take a terrible toll on a person’s social and financial life.

Finally, I was supervising a medical resident yesterday when we discussed the effect of these drugs on heart health. The evidence is also strong that these medications decrease the risk of heart disease — both in people with and without diabetes. Multiple mechanisms have been proposed for this heart protection, but it isn’t exactly clear which ones are the most important.

For those of us who lived through the approval of previous weight-loss drugs, which were later found to cause heart damage, the news about heart protection is welcome.

Still, we’ve been using these drugs for less than 10 years, and it’s wise to use them only when there is a clear benefit in doing so.

Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column when possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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