A new wave of medications, including Ozempic, Wegovy, Mounjaro, and Zepbound, has revolutionized weight management. Ozempic, in particular, has garnered significant attention, being labeled everything from a "miracle drug" to a "public health concern." For the millions of Americans struggling with obesity or overweight, the question remains: does it live up to the hype?
It's crucial to understand that Ozempic is primarily designed for individuals with type 2 diabetes. As bariatric surgeon Armando Castro-Tie, MD, points out, many are surprised to learn this. While Ozempic isn't explicitly approved for weight loss, related medications like Wegovy and Zepbound are. Understanding who should use these medications, under what circumstances, and the necessary support during treatment is essential.
Understanding Ozempic
Ozempic, with the active ingredient semaglutide, received FDA approval in 2017 for treating type 2 diabetes in adults. Semaglutide is a synthetic version of GLP-1 (glucagon-like peptide-1), a hormone found in the pancreas, stomach, and brain. As a GLP-1 agonist, semaglutide aids the body in producing insulin, a hormone vital for converting blood sugar into energy, a process often impaired in type 2 diabetes patients.
When insulin levels drop, blood sugar rises, potentially leading to long-term complications such as eye, kidney, and nerve diseases. Ozempic reduces the amount of sugar released by the liver, resulting in more stable blood glucose levels. It also slows down stomach emptying, leading to slower digestion and reduced glucose release into the bloodstream, and influences the brain to reduce hunger and increase satiety.
Weight loss itself can significantly improve glucose levels and other risk factors, with even a 5% to 10% reduction in body weight making a substantial difference.
Read also: Comprehensive guide: Tirzepatide and Semaglutide for weight management
Ozempic vs. Wegovy
Ozempic and Wegovy share the same active ingredient: semaglutide. Recognizing Ozempic's weight-loss benefits, the pharmaceutical company developed Wegovy specifically for weight management, gaining FDA approval in 2021 for adults and children aged 12 and up. The primary distinction lies in the dosage, with Wegovy offering a higher dose.
Wegovy is intended for individuals with a body mass index (BMI) of 30 (obese) or 27 (overweight) with at least one weight-related condition, such as high blood pressure. Both Ozempic and Wegovy are administered via a once-weekly injection, starting with a low dosage that gradually increases every four weeks until an effective and tolerable level is reached.
Dosage Tailoring
Ozempic is typically prescribed at a low dose of 0.25 milligrams (mg) for the first four weeks to allow the body to adjust, followed by potential increases of 0.5mg per week.
Wegovy, also starting at 0.25 mg weekly, has a higher maximum dose of 2.4mg per week, with a more gradual dose escalation over several months. This slow progression allows the body to adapt and maximize its effectiveness in supporting weight loss. A typical Wegovy dose schedule looks like this:
- Week one (starting dose) - 0.25mg/week
- Week four - 0.5 mg/week
- Week eight - 1mg/week
- Week 12 - 1.7mg/week
- Week 16 (maintenance dose) - 2.4mg/week
This higher dose supports substantial weight loss, with one study showing participants experiencing an average weight loss of about 15-18% of their initial body weight over 68 weeks, compared to about 6-10% with Ozempic.
Read also: Semaglutide Without Diet Changes
Other Medications for Diabetes and Weight Management
Other medications for type 2 diabetes treatment, including a pill form of semaglutide with the brand name Rybelsus are available. All others are injections and have the added benefit of weight loss, like Trulicity (dulaglutide) and Victoza (liraglutide).
Additionally, several drugs are FDA-approved for chronic weight management:
- Xenical (orlistat) - FDA-approved in 1999
- Alli (orlistat) - FDA-approved in 2007
- Qsymia (phentermine-topiramate) - approved 2012
- Contrave (naltrexone-bupropion) - approved 2014
- Saxenda (Liraglutide) - approved 2014
- Wegovy (semaglutide) - approved in 2021
- Zepbound (Tirzepatide) - approved in 2023
Older medications like orlistat affect what happens after eating, while newer medications like semaglutide and tirzepatide target the body's need or desire to eat.
Tirzepatide: A Dual-Hormone Approach
Like semaglutide, tirzepatide is the generic name for two brand-name drugs. Mounjaro was FDA-approved in 2022 to treat type 2 diabetes, followed by Zepbound in 2023 for chronic weight management.
While Ozempic and Wegovy mimic only GLP-1, tirzepatide medications mimic both GLP-1 and GIP (glucose-dependent insulinotropic polypeptide). In addition to curbing appetite, GIP plays a role in breaking down sugar and fat. By targeting GIP receptors, these drugs increase insulin, slow down food breakdown in the stomach, and help patients feel fuller longer.
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Mounjaro vs. Ozempic: A Comparative Look
Both Mounjaro and Ozempic are FDA-approved for type 2 diabetes and aid in weight loss. A July 2024 observational cohort study compared their effectiveness, examining the average weight loss achieved over one year in 18,386 people taking either Mounjaro or Ozempic between May 1, 2022, and September 30, 2023. The results, estimating weight loss for a 150-pound person, were as follows:
Three months
- Mounjaro: 5.9% - 9 pounds
- Ozempic: 3.6% - 5.5 pounds
Six months
- Mounjaro: 10.1% - 15 pounds
- Ozempic: 5.8% - 9 pounds
12 months
- Mounjaro: 15.3% - 23 pounds
- Ozempic: 8.3% - 12.5 pounds
The majority of patients lost at least 5% of their body weight, with Mounjaro patients experiencing greater and faster weight loss. The study also examined adherence and potential side effects, finding no significant differences between the two, with over half of patients stopping their medication during the study (55.9% of those taking tirzepatide and 52.5% of those taking semaglutide).
Additional Benefits and Considerations
- Heart Benefits: Wegovy has been shown to reduce the risk of cardiovascular events like heart attack and stroke in those with heart disease, overweight, or obesity, and was approved in 2024 for that use. A similar study is underway to determine if Zepbound could have a similar effect.
- Age Qualifications: Zepbound is approved for those 18 and older, while Wegovy is approved for use in adolescents 12 and older.
- Long-Term Use: Both semaglutide and tirzepatide drugs are intended for long-term use, with effects lasting only as long as they are taken. Studies have shown that weight can creep back up after discontinuing these medications, highlighting the "yo-yo effect" and potential metabolic impacts.
- Insurance Coverage: A 2024 survey revealed that offer health insurance plans that cover weight-loss drugs like Wegovy. Without insurance, semaglutide can be expensive, with a month’s supply costing around $900 for Ozempic and $1,300 for Wegovy.
Potential Side Effects
Ozempic/Wegovy and Mounjaro/Zepbound share similar side effects due to their similar functions in weight loss and diabetes management. However, some differences in frequency and intensity may occur due to the dual-action mechanism and higher dosage levels of Mounjaro/Zepbound.
Common side effects include nausea, vomiting, diarrhea, constipation, and abdominal pain. Many patients experience these effects, either individually or in combination, particularly when starting treatment. These effects typically appear within the first one to two days of taking the injection and lessen over the course of the week.
Other potential side effects include:
- Injection Site Reactions: Reactions like itching, redness, swelling, or a small lump at the injection site may occur. Rotating injection sites and ensuring proper injection technique can help.
- Pancreatitis: Inflammation of the pancreas is a rare but serious side effect.
- Kidney Problems: Some have reported kidney-related issues due to severe dehydration from prolonged vomiting or diarrhea. Symptoms may include reduced urine output, swelling in the legs, ankles, or feet, fatigue, and shortness of breath.
- Hypoglycemia: Low blood sugar risk may increase when these drugs are used with other diabetes medications like insulin or sulfonylureas. Regular monitoring of blood sugar levels is crucial, and carrying glucose tablets or a fast-acting carbohydrate source can help manage symptoms.
- Allergic Reactions: Although rare, allergic reactions can occur, including rash or hives, itching, swelling of the face, lips, or throat, or difficulty breathing.
- Hair Loss: Rapid weight loss can stress the body and lead to telogen effluvium, causing increased hair shedding. Adequate nutrition, particularly protein and essential vitamins like biotin, is crucial.
- Mood Changes: Some users report experiencing mood swings, anxiety, depression, or suicidal thoughts, potentially related to rapid weight changes, the psychological impact of chronic conditions, or neurochemical effects of the medication.
- Eating Disorders: The appetite-suppressing effects of Ozempic can potentially trigger or exacerbate disordered eating behaviors in some individuals. Patients with a history of eating disorders should approach treatment with caution and under close medical supervision.
"Ozempic Face" and "Ozempic Butt"
These terms describe the appearance of facial aging or gauntness and the loss of volume and shape in the buttocks, respectively, due to fat loss while on semaglutide medications. These are not medical terms and can occur with any weight-loss method. Gradual weight loss, a healthy diet, and strength training exercises can help minimize these effects.
Personal Experiences and Testimonials
Many individuals have shared their experiences with Ozempic and Wegovy, showcasing the potential for significant weight loss and improved health.
- Gina Schweppe: She started semaglutide on February 13. After around three months, she came off semaglutide because she had reached a healthy weight. She had lost 35lbs while taking semaglutide in conjunction with healthy diet and exercise.
- Pepper Schwartz: Lost about 30 pounds using Ozempic off-label. She notes the main effect of Ozempic is she’s not hungry as much: “It makes food less important".
- Jamel Corona: Started taking Wegovy in December 2021. She lost about 60 pounds and discovered an unexpected side effect: She used to enjoy drinking socially, but lost interest in alcohol after starting the medication.
- Jeannine DellaVecchia: She was prescribed Ozempic to treat symptoms related to insulin resistance caused by congenital adrenal hyperplasia and polycystic ovary syndrome. She lost 30 pounds between August 2022 and February 2023. She stopped taking the drug because she couldn’t tolerate the side effects.
- Holly Figueroa O’Reilly: Lost 105 pounds with Ozempic after trying various diets and bariatric surgeries.
- Barbie Jackson-Williams: Lost 180 pounds thanks to Ozempic and working out.
These experiences highlight that while semaglutide medications can be effective, they are not a "magic bullet" and require lifestyle changes like diet and exercise to achieve and maintain weight loss.
Dosage and Weight Loss Expectations
Ozempic dosing starts at 0.25 mg weekly to allow your body to adjust. After four weeks, the dose typically increases to 0.5 mg. One study found people who received weekly semaglutide injections lost an average of about 15 pounds after three months and about 27 pounds after six months, which translates into about a 5-pound weight loss per month.
Four years after starting semaglutide, patients maintained an average weight loss of 10% of their body weight, a peer-reviewed 2024 study funded by Novo Nordisk found.
Dietary Considerations
To reduce nausea while on semaglutide, registered dietitian Emily Rubin recommends skipping hot, fried, or greasy food and avoiding eating or cooking strong-smelling food. Other foods to avoid on Ozempic include fruits and vegetables that contain significant roughage, such as pineapple, and gas-forming vegetables like broccoli. It’s also important not to eat too quickly and avoid having large drinks with meals.
Ozempic as a Weight Loss Kickstart
Semaglutide "works by making people not hungry,” according to Dr. Leigh Perreault, an endocrinologist at UCHealth in Denver, Colorado. It mimics GLP-1, reducing appetite and promoting a feeling of fullness. The medication also slows down stomach emptying, which slows down the absorption of calories and may contribute to the feeling of fullness.
The FDA emphasizes that semaglutide for weight loss should be used in addition to a reduced-calorie diet and increased physical activity.
Changing Perspectives on Obesity Treatment
Ozempic and similar drugs now yield an average weight loss of 15 to 20 percent, significantly higher than previous options. However, there are still many misconceptions about medical obesity. It is often not seen as a disease, which can make it harder for patients to seek treatment.
Effective medication has opened people's eyes to obesity as a disease, as the vast majority of obese patients never got effective treatment before.
Considerations for Bariatric Surgery
Bariatric surgery was only available to about 2 percent of the population that was eligible for it. If you have bariatric surgery and your obesity is in remission, does that mean you don't have the disease? The same thing applies to the drug.
Previously, semaglutide medications have been mostly prescribed for patients who either need significant weight loss before surgery or those who are post-surgery and struggling, either not having lost enough or gaining back weight. However, we're seeing easily 25 percent of patients who are coming in for surgery have tried and failed or don't want to stay on these medications, either due to bad side effects or lack of significant weight loss.
The Importance of Maintenance
It's not just about the weight loss, it's about the maintenance. The majority of patients stop taking semaglutide medications. There's often a mindset of, "Once I get this under control, I'll be able to keep it under control," because it's not really viewed as a disease. However, this might be a little bit easier to exercise, but you won't like it more, and feeling better doesn't automatically make you eat less. The hunger response to that weight loss is really what makes the weight come back.
Side Effects Compared to Bariatric Surgery
While Ozempic can be effective, it's important to consider the potential side effects. They also cause reflux, nausea, and abdominal cramping. A very small percentage of patients get pancreatitis, one of the major side effects. Nausea, delayed gastric emptying.
Bariatric surgery doesn't typically have nausea. Gastric bypass doesn't have reflux. Some patients have sleeve gastrectomy, where they get bad reflux. With Ozempic, nausea is the biggest thing for patients. It's the most common reason for stopping.
The Future of Obesity Treatment
Basically, these drugs were discovered from some of the research we did on how gastric bypass works. In gastric bypass or sleeve, you get a blast of GLP-1 once you start eating. It's there in a balanced way, so you don't have the nausea because it's not there all the time.
There is a future where you may be taking multiple drugs or combination drugs, either injection or pill, that hit up on these multiple hormones. And in the short term, the bariatric surgery practice is expanding.
Eligibility and Cost
A BMI of 27 is overweight, BMI over 30 is obese. Usually, the insurance company would want you to have a BMI and a comorbid illness, whether it is high cholesterol, diabetes, sleep apnea, or hypertension.
Ozempic costs about $1,200 a month, depending on the dose. There are some of these compounding pharmacies that do a generic version of it for a lot less money. However, people are generally not good about taking medications, and as soon as you lose some weight and see you’re not losing weight anymore, a large percentage stop taking it.
Addiction and Societal Pressure
There is a percentage of patients who are addicted. They don't just have the disease of hunger but have the disease of addiction. Usually, those are carb abusers. Some people say that surgery turns that around for them. Some people with these meds say the cravings for sweets and stuff have gone away, but not for everybody.
It's hard to fight what society has told you, which is that this is your fault. It's in your control. Just shut up and stop eating. They just don't understand this as a disease.
Potential Risks
Some patients get gallstones from the medication, but that's a common thing with weight loss in general. A few patients have had pancreatitis as a result of medication. However, it's not known what percentage of patients taking the drug are obese versus not obese. It could be called a drug of abuse, as everybody wants to be 10 pounds lighter. However, we just don't know enough about these drugs and the benefits versus the potential risks long-term.