I've been wondering about this recently: Say you have someone who is really dangerously obese. Is it less risky to have them take one of these drugs, lose a ton of weight along with all the side effects like muscle and bone density, and then try to get them on an appropriate diet plan once the weight is off - or - try to get them to go on a diet and lose weight the natural way?
The drugs are going to make the weight loss happen. Sure, there are downsides, but there's a high degree of success at reducing their bodyfat by huge amounts. Telling obese people to just eat right and lose the weight slowly over years has a very low success rate. Sure there are some people who manage to do it, and we've all seen the inspirational videos, but we also know the vast majority of them don't stick to the diet and lose the weight.
I just wonder if you took two groups of 1000 people and did this experiment, what would the rate of All Cause Mortality be 20 years out? My instinct tells me the people who used the drugs to get their weight down would have a higher survival rate than the people who just tried to diet their way to a healthy weight, even with the negative effects of the drugs. But maybe that's also dependent on age?