It seems like no day goes by without discussing weight loss medications, including Wegovy® and diabetes medications, like Ozempic® and MounjaroTM (prescribed off-label for weight loss purposes). And, frankly, the hype is very much deserved. While just a few short years ago, diet and exercise or weight loss surgery were the only long-term effective treatments for excess weight and obesity, today, that paradigm has shifted, and weight loss medications seem to be another good option in the fight. Before we get into the details of weight loss medications and their effectiveness, we must discuss what they are and how they rose to fame.
What are these weight loss medications?
The origins of what we are seeing today started with a class of type-2 diabetes medications known as GLP-1 receptor agonists way back in 2005. GLP-1RAs stimulate the production of GLP-1, an intestinal hormone produced when eating, improving insulin secretion, and slowing food movement from the stomach into the small intestine—all of this with a low risk of hypoglycemia or low blood sugar. Various forms of GLP-1RAs have been developed over the years. Yet, Ozempic (semaglutide) developed by Danish pharma giant Novo Nordisk, and Mounjaro (tirzepatide), created by Eli Lily, rose to the top for blood sugar management.
Both drugs have been very successful in controlling type-2 diabetes, and as is the case with some medicines, a previously unknown positive side effect was observed. In this case, the drugs showed exceptional weight loss results in many patients. These results were so significant that the same drug manufacturers then applied for FDA approval of a higher dosage version specifically for treating obesity in qualifying patients. Wegovy was ultimately approved at the end of 2022, and a weight loss-specific version of Mounjaro is expected to be approved soon. With a big push from social media influencers, these drugs became household names early in 2023. They have become so popular that until recently, there was a severe shortage (even with diabetes drugs being prescribed off-label)
What are the results?
Wegovy is showing impressive weight loss results, with many patients reporting up to 15% body weight loss, in line with clinical trials.1 This roughly translates to a loss of 30 pounds in a typical 200-pound person. A 300-pound patient may see between up to 45 pounds of weight loss, though not everyone will experience these results. Also, these weight loss figures are specific to Wegovy, the only one of these medications studied specifically for obesity. However, many patients receive off-label prescriptions for Ozempic, which, at its highest dose, almost matches Wegovy’s.
What if I hate injections?
Because these drugs are injected into the abdomen once a week, it can be difficult for some patients to continue using them. Ultimately, every patient needs to decide whether their fear or dislike of injections outweighs the benefit of the medication. Rybelsus, a semaglutide tablet made by Novo Nordisk, is currently on the market but only approved for diabetes management. With that said drug makers are seeking approval for daily pill-based options that may not offer quite the benefit of the injections but still allow for exceptional, long-term weight loss. Once these drugs are approved, patients will have a more accessible, albeit likely less effective, weight loss medication option.
What are the risks of these weight loss drugs?
As with any medication, their use has risks and side effects. Clinical trials showed a relatively low side effect profile, with patients most commonly experiencing nausea, vomiting, and other minor symptoms. Some patients, however, have experienced more significant issues, including pancreatitis. These concerns should be discussed with your weight loss specialist, and you should be on the lookout for any unusual symptoms while taking these medications.
Since the worldwide rollout of these medications, some “new” though not necessarily unusual symptoms have been observed, including:
- Hair loss (common during periods of rapid weight loss)
- Vivid dreams (sometimes of celebrities)
- Ideations of self-harm (currently being investigated in Europe)
- “Ozempic face” (loss of facial fullness)
- Muscle wasting and skeletal bone density loss
- Weight regain after discontinuation
Any side effects and risks should be discussed with your weight loss specialist to ensure we can identify and address issues early on.
Are they right for weight loss?
Treating obesity is much like treating any other disease, which includes a stepwise approach to the continuum of care. Consult with Dr. Burton to determine if diabetes meds are right for you.REQUEST APPOINTMENT
A recent study on cardiovascular benefits
A recent study2 was completed on Wegovy, showing that the weight loss drug may significantly reduce the risk of heart disease. One of the primary risk factors for heart attack and other cardiovascular issues is excess weight and the metabolic disorders that often accompany it. It stands to reason, therefore, that weight loss would equal cardiovascular improvement. While this study was sponsored and funded by the drug maker, there’s no reason to believe the results aren’t accurate.
Are weight loss medications the future of obesity treatment?
This is a meaningful discussion that patients with morbid obesity should have with their doctor. Treating obesity is much like treating any other disease in that there should be a stepwise approach to the continuum of care. When patients first notice they’ve gained significant weight, they may try diet and exercise, which is the safest way to lose. Unfortunately, especially for patients suffering from severe obesity, this weight loss is often short-lived as they return to their former habits within several weeks to a few months. It’s not necessarily a sign of failure as much as it is a product of the mind-body connection, which tries to maintain homeostasis or the status quo.
Some patients who qualify for weight loss medications may benefit tremendously from them. This is true for those obese patients with relatively lower BMIs. As mentioned above, a patient with less to lose may do well with a 10 or 15% body weight loss. However, this may not be enough for patients with higher BMIs (over 40 or so). These patients may benefit from weight loss medications as a first-line option to drop some weight but ultimately may not lose enough to get healthy again.
For these higher BMI patients, weight loss surgery, amongst other interventions, may be an effective and long-term solution to their obesity problem.
What about the costs?
Patients who qualify for Ozempic and Mounjaro for type 2 diabetes are often covered by their commercial or government health insurance plan. As such, they may receive the dual benefit of diabetes management and weight loss. Longer-term, each insurance company has different policies regarding continued coverage of these medications.
Some plans may cover Wegovy, so you must speak to your insurance company or plan administrator to understand if you have coverage. If you don’t have coverage, the self-pay cost of Wegovy can exceed $1,300 per month. Even if your insurance covers Wegovy, understand your financial obligations, including deductible and co-pay.
Insurance will likely not cover off-label prescriptions of Mounjaro and Ozempic. Speak to your doctor and pharmacist about the cost of these medications to determine if they make financial sense.
To save money, some patients attempt to get these medications from compounding pharmacies, where a pharmacy mixes or compounds its version of the drug. There have been reports of quality issues, and patients should be cautious. It has also been reported that these weight loss drugs are significantly cheaper when sourced from outside the US. While this may be true, patients must exercise caution and good judgment to ensure appropriate quality and safety.
With the new data mentioned above regarding cardiovascular risk, there is some hope that more plans will cover these medications for a broader set of patients. We also expect the cost to drop significantly as weight loss pills are approved.
Natural alternatives to Wegovy
As with any drug, finding a natural alternative that achieves the same result is always preferable. Patients may also be enticed by natural supplements pushed by biohackers and influencers on the web. Unfortunately, because supplements have no FDA oversight, their purity, quality, and effectiveness may be questionable. There is no substitute for visiting a qualified weight loss specialist to understand more about these prescription medications and other lifestyle changes that can contribute to significant and sustained weight loss.
Should I explore weight loss surgery drugs?
If you qualify for these weight loss medications, we encourage you to speak to our weight loss specialists to learn more about whether they may be right for you, either as a definitive treatment or to start losing weight in preparation for other surgical and non-surgical care. Of course, please be aware that many patients cannot secure weight loss medications due to nationwide shortages. If you are considering an off-label prescription, be mindful of those who may need it more for diabetes management. Most importantly, don’t forget that any weight loss medication regimen must be combined with appropriate diet and exercise to be effective over the long term.
Meet Dr. Allison Burton
Dr. Allison Burton completed her medical school at Ross University School of Medicine in Dominica, West Indies. She completed her residency in Family Medicine at Virginia Commonwealth University and Riverside Regional Medical Center in Newport News, Virginia
Dr. Burton was born in Idaho and moved to Maine, but most of her childhood and adult years were spent in Tampa, FL. She attended the University of Florida in Gainesville for pre-med. In her spare time, she enjoys being a mom and sharing quality time with her family.
1Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. doi: 10.1056/NEJMoa2032183. Epub 2021 Feb 10. PMID: 33567185.
2Lingvay I, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, Hardt-Lindberg S, Hovingh GK, Kahn SE, Kushner RF, Lincoff AM, Marso SP, Fries TM, Plutzky J, Ryan DH; SELECT Study Group. Semaglutide for cardiovascular event reduction in people with overweight or obesity: SELECT study baseline characteristics. Obesity (Silver Spring). 2023 Jan;31(1):111-122. doi: 10.1002/oby.23621. Epub 2022 Dec 10. PMID: 36502289; PMCID: PMC10107832.