Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
Doctors have powerful new tools in their quest to help their patients struggling with the health consequences of obesity. Ozempic and its related medications (i.e., Wegovy) have been nothing less than game-changers for the field of obesity medicine. But are these drugs right for you?
The more we learn about obesity, the less sense it makes to lecture people about their weak willpower. We now know that a key aspect of this disease is dysregulation of the communication between the digestive tract and the brain, conducted via the exchange of hormones. When the stomach is empty, it releases hormones that travel to the brain, prompting a signal that creates a feeling of hunger. After we’ve gotten enough to eat, the digestive system sends other hormones to the brain to indicate that it’s time to stop eating. Brain imaging shows that for people with obesity, these signals have stopped working.
For about 15 years, doctors have prescribed a generic medication called semaglutide for the treatment of type 2 diabetes. Semaglutide, branded as Ozempic, is a class of drug known as a GLP-1 receptor agonist, meaning that it mimics one of those metabolism-related hormones, one called glucagon-like peptide 1 (GLP-1).
Semaglutide, which is injected subcutaneously, is effective for diabetes because, just like GLP-1, it stimulates insulin production, which brings down blood glucose. But it also has another effect…it travels to the brain to signal fullness after eating.
When doctors observed significant weight loss among their patients taking Ozempic, some began prescribing it off-label for their patients who suffered from obesity but did not have diabetes. Then in 2020, the FDA approved another semaglutide formulation, Wegovy, specifically for obesity.
“Ozempic” has become the popular shorthand for semaglutide and other GLP-1 agonists, but it’s worth pointing out that only Wegovy, not Ozempic, is approved for weight loss. However, many doctors continue to prescribe Ozempic off-label to help patients without diabetes lose weight.
Over the past few years, in addition to Ozempic and Wegovy, three other related drugs have been approved, and others are in development.
Ozempic. This is the original semaglutide drug originally created as a diabetes medication. It’s taken by injection weekly.
Rybelsus. Semaglutide in a tablet form. Rybelsus is only approved for diabetes management but does typically cause weight loss, although slightly less than Ozempic. It’s taken daily as a 7 milligram (mg) or 14 mg tablet.
Wegovy. This is the first version of semaglutide approved for weight loss. Like Ozempic, Wegovy is taken as an injection, at a dose of 2.4 mg once per week. In a 2021 study of 2,000 patients with obesity, taking the standard dose of a weekly 2.4 mg injection, plus changes to diet and exercise, resulted in a loss of 15% to 20% body fat. A control group of people who underwent the same lifestyle changes but did not take the drug achieved weight loss of less than 2.5%. Wegovy is recommended for patients with a body mass index (BMI) of 27 or higher with one or more weight-related conditions, or a BMI of 30 or greater.
Mounjaro. After the success of semaglutide, researchers began looking for even more powerful ways of modifying digestive hormones to control insulin. They developed tirzepatide, which, like semaglutide, triggers GLP-1 receptors, but also triggers receptors for another hormone called glucose-dependent insulinotropic polypeptide (GIP). Approved under the brand name Mounjaro in 2022, tirzepatide is taken as a once-weekly subcutaneous injection. In its phase III clinical trial, patients taking the 15 mg dose experienced nearly 20% weight loss, on average.
Zepbound. As Wegovy is to Ozempic, Zepbound is to Mounjaro. In other words, Zepbound is the weight-loss version of Mounjaro (tirzepatide), which is only approved as a diabetes drug. Mounjaro and Zepbound are taken similarly. Zepbound is intended for people with a body mass index (BMI) of 30 and above, or those with a BMI of 27 or higher with at least one additional weight-related health problem.
Adverse events….Although they’re generally well tolerated, like all drugs, both semaglutide and tirzepatide carry risks. Bear in mind that these drugs have only been around for a few years, so we don’t yet know what their long-term effects will be. The most common short-term Ozempic side effects are digestive…diarrhea, cramps, nausea, vomiting, constipation, and loss of appetite. Both semaglutide and tirzepatide have been found to cause C-cell thyroid tumors in rats, though to date there is no evidence that they cause any cancer in humans. However, people with a history of thyroid cancer should not take these medications.
“Ozempic face”. This term got a lot of press right around the time semaglutide was taking the world by storm. It refers to the gaunt facial appearance of some people after losing considerable weight taking semaglutide. While some critics of these drugs suggest that it indicates malnutrition, other experts say these are the same changes in appearance experienced by people after weight-loss surgery and after losing large amounts of weight naturally.
Weight regain. Unfortunately, for most patients, the weight loss achieved through these medications is not sustainable. Once they stop taking the drug, the weight returns. The drugs are, therefore, a lifelong commitment.
Contraindications. You shouldn’t take these drugs if you’ve ever had gallbladder disease, medullary thyroid cancer, pancreatitis, or a rare condition called multiple endocrine neoplasia syndrome (MENS).
Cost. These medications typically cost $1,000 per month or more, and they aren’t covered by most insurance companies. That’s a considerable lifetime expense.
Shortages and misuse. These blockbuster drugs are in short supply. Unfortunately, much of that demand comes from people who shouldn’t be taking them in the first place. These medications are intended for people with diabetes or people with serious, life-threatening obesity, not someone with a generally healthy BMI who’s seeking a “hack” to lose that last stubborn 10 pounds.
This is a discussion you should have with your doctor, but here are some questions to ask yourself:
