> Everyone I know that are using these looks gaunt and sickly.

This is a statistical fallacy where you're only identifying the extreme cases. The average obese person loses 14-20% of body weight. (Remember that the "obese" category is already defined as 20%+ above the high end of the "normal" range.) So the vast majority of people on these drugs just look normal, not skinny or gaunt.

> They also complain of constant nausea and eat like a bird because eating makes them sick

This is a high dose phenomenon. They can and should reduce their dose if it is preventing them from eating enough or being comfortable.

> I worry about ... medical professionals not using it as a brief intervention then steering towards lifestyle changes.

They absolutely do, of course.