The landscape of obesity treatment is undergoing a significant transformation. Once limited to modest weight loss options, medical interventions now include drugs like Ozempic, initially designed for diabetes management, that are being used by a growing number of individuals for weight loss. This article aims to provide a comprehensive overview of Ozempic, its mechanisms, potential benefits, side effects, and the broader context of medical weight management.
The Changing Landscape of Obesity Treatment
Effective medical treatments for obesity were once limited, offering only modest weight loss. However, drugs like Ozempic and similar medications now offer an average weight loss of 15 to 20 percent, significantly higher than previous options. This has opened people's eyes to obesity as a disease, especially now that there's effective medication for it. The vast majority of obese patients never got effective treatment because there wasn't effective treatment, or the treatment had more significant side effects.
What is Ozempic?
Ozempic is the brand name for semaglutide, a prescription drug approved by the Food and Drug Administration (FDA) for treating type 2 diabetes. It works by reducing glucose (sugar) production in the liver and increasing insulin production in the pancreas. Ozempic stimulates the production of a hormone called GLP-1 that causes the body to produce more insulin. At the same time, GLP-1 limits glucose production in the liver. It also slows the digestive process, decreasing the risk of blood sugar spikes after a meal. It is administered as a liquid solution via under-the-skin injection.
How Ozempic Works for Weight Loss
Ozempic and other GLP-1 receptor agonists have gained attention for their role in promoting weight loss. GLP-1 receptor agonists are a class of medications that work by mimicking the natural GLP-1 hormone. This hormone is released by the gut in response to eating and has several effects that help regulate blood sugar levels, hunger, and slow digestion.
The active drug in Ozempic, glucagon-like peptide-1 (GLP-1), is a natural compound released from your gastrointestinal tract after you consume a meal. It acts to stimulate insulin secretion, which is why it helps for type 2 diabetes, but it also acts in the brain to terminate food intake or to signal satiety. These drugs take that natural form of GLP-1 and they make it much more stable and active. This clinical form is called semaglutide. GLP-1s are typically prescribed at a higher dose for obesity than for diabetes. In some studies, participants using GLP-1s have lost an average of 10% to 15% of their body weight over a year. The most effective GLP-1 medications can lead to weight loss of over 20% of body weight.
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Ozempic vs. Wegovy vs. Mounjaro
While Ozempic is approved for type 2 diabetes, another drug called Wegovy, also made by the same company, is approved by the FDA for chronic weight management. Both Ozempic and Wegovy contain the same active ingredient, semaglutide. However, Wegovy contains higher doses of it and is designed for weight loss.
Mounjaro, on the other hand, is a different drug from a different company that not only has GLP-1 agonist effects but also GIP gastrointestinal polypeptide, which delays stomach emptying a little bit and has been shown to be more effective for weight loss.
Potential Benefits Beyond Weight Loss
Beyond diabetes and weight loss, researchers are exploring other potential benefits of GLP-1 drugs. Heart health remains a major area of interest, as GLP-1 receptor agonists also reduce the likelihood of developing heart-related problems such as heart attacks or strokes. Research is ongoing to determine whether these drugs could help protect against neurodegenerative diseases like Alzheimer's, aid in addiction treatment, and address liver disease, specifically metabolic associated steatotic liver disease (MASLD) and metabolic-associated steatohepatitis (MASH).
Side Effects and Risks
Like other drugs, Ozempic can have a range of side effects, some common and relatively minor, others less common but potentially more serious. The most common long-term side effects of Ozempic are stomach-related, including nausea, vomiting, and associated symptoms. Nausea is the biggest thing for patients and the most common reason for stopping. Some have a lot of discomfort from reflux. They also cause reflux and abdominal cramping. A very small percentage of patients get pancreatitis, that's one of the major side effects. Persistent nausea or vomiting can lead to dehydration, kidney problems, or malnutrition in some cases.
Long-term usage may also be implicated in more serious medical issues, including the development of pancreatitis, thyroid tumors, or gallstones. Some people develop gallstones or gallbladder inflammation while taking GLP-1s. Some reports suggest that rapid weight loss from GLP-1s may lead to a decrease in muscle mass.
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Taking Ozempic can also lead to low blood sugar in persons with type 2 diabetes. It is also possible to have an allergic reaction to Ozempic. Symptoms would include rapid heartbeat, disorientation, hives, labored breathing, and facial swelling.
Important Considerations
Not a Quick Fix
It's important to note that if you start taking either of these drugs for weight loss, your body may get used to it, establishing a new normal. This can cause your weight to plateau. Also, as soon as people stop the medication, they often will regain the weight. This is true not just for drugs, but also for dieting or bariatric surgery.
Lifestyle Changes are Still Important
While reducing daily calorie intake and increasing daily calorie output are important for weight reduction, they do not go far enough in managing obesity. They fall short of influencing the pathways near the hypothalamus that regulate weight and appetite. When patients are properly monitored, guided and supported from a lifestyle modification standpoint (nutrition, physical activity and behavior), they tolerate the medication better.
Cost and Insurance Coverage
Ozempic costs about $1,200 a month, depending on the dose. Wegovy may cost out of pocket about $1,200 a month retail, and Zepbound about $550 a month retail. It’s an expensive medication. A lot of progress has been made in terms of employers covering these drugs compared to a decade ago, but still not all employers include them as part of the insurance benefits they offer employees. This is also true with some insurance plans like Medicare that do not cover weight loss medications.
Compounded Versions
Lack of coverage and high demand for these medications have led to a national shortage of Wegovy and Zepbound. Unfortunately, we have seen clinics, pharmacies and online weight loss programs offering compound Semaglutide and Tirzepatide. It is important for patients to know that these compounded versions are not the same as the actual drugs offered by Lilly and Novo Nordisk.
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The FDA has issued warnings about compounded GLP-1 drugs because of reports of harmful side effects. The agency has identified some areas of concern for compounded GLP-1 drugs, including improper storage during shipping, supply chain issues, and products that contain false information on the product label.
Off-Label Use and Ethical Considerations
Some doctors prescribe Ozempic for weight loss, though it isn’t approved by the FDA for that purpose. Some doctors may prescribe Ozempic for persons with prediabetes, especially if they have been diagnosed as obese (meaning a body-mass index of 30 or more). However, experts still recommend that people avoid using Ozempic unless they have type 2 diabetes.
Alternatives to Ozempic
There are medications approved for weight loss and weight management (such as Wegovy). Semaglutide treatments can also be used as an alternative to bariatric surgery for some patients who are obese. Bariatric surgery touches on the distension of the stomach and signaling fullness much sooner when you eat from nerve impulses to the brain, not just hormonal impulses to the brain.
The Future of Obesity Treatment
Looking down the road, there are more drugs in the later phase of clinical trials that mirror the results of bariatric surgery. It is believed that in the future, multiple drugs or combination drugs, either injection or pill, that hit up on these multiple hormones may be used.
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