The increasing popularity of injectable medications for weight loss has sparked interest and questions about their effectiveness, safety, and alternatives. Achieving and maintaining a healthy weight offers numerous health benefits, reducing the risk of diabetes, heart disease, certain cancers, sleep apnea, and other conditions. While diet and exercise remain fundamental, weight loss drugs can provide a significant advantage for individuals with diabetes or obesity. This article explores several Wegovy alternatives, comparing their mechanisms, dosages, side effects, and other crucial factors to help you make an informed decision in consultation with your doctor.
Understanding GLP-1 Agonists and Their Role in Weight Loss
Many weight loss medications, including Mounjaro, Ozempic, Wegovy, and Zepbound, contain a class of drugs called GLP-1 agonists. GLP-1, or glucagon-like peptide 1, is a hormone produced by the small intestine. It stimulates insulin production to lower blood sugar levels when blood sugar rises. GLP-1 agonists mimic this action, aiding in blood sugar control and promoting weight loss through several mechanisms:
- Slowing Gastric Emptying: These drugs prolong the time food remains in the gastrointestinal tract, leading to a prolonged feeling of fullness and reduced appetite.
- Signaling to the Brain: GLP-1 agonists send signals to the brain, reinforcing the sensation of satiety and making it easier to consume fewer calories.
Comparing Weight Loss Medications: Mounjaro, Ozempic, Wegovy, and Zepbound
These medications share similarities but also have distinct differences. Semaglutide is the active ingredient in Ozempic and Wegovy, while tirzepatide is the active ingredient in Mounjaro and Zepbound.
Here's a detailed comparison:
| Medication | Generic Name | Minimum Age | Drug Class | Approved Usage(s) | Prescribed Usage(s) |
|---|---|---|---|---|---|
| Mounjaro | Tirzepatide | 18 | GLP-1 and GIP receptor agonist | Type 2 diabetes | Type 2 diabetes/overweight/obesity |
| Ozempic | Semaglutide | 18 | GLP-1 receptor agonist | Type 2 diabetes/heart disease prevention* | Type 2 diabetes/heart disease prevention*/overweight/obesity |
| Wegovy | Semaglutide | 12 | GLP-1 receptor agonist | Overweight/obesity/heart disease prevention** | Overweight/obesity/heart disease prevention** |
| Zepbound | Tirzepatide | 18 | GLP-1 and GIP receptor agonist | Overweight/obesity** | Overweight/obesity** |
*For adults with type 2 diabetes and known heart disease
Read also: Learn how spa therapy can enhance your overall health.
**For adults with overweight or obesity and at least one other weight-related condition
Ozempic vs. Wegovy
Ozempic and Wegovy both contain semaglutide but are approved for different primary uses and dosages. Wegovy is specifically approved for weight management in adults and children aged 12 and older with obesity, or in adults with excess weight (BMI ≥27) who also have weight-related medical problems, while Ozempic is approved to lower blood sugar in individuals with type 2 diabetes and to reduce the risk of cardiovascular events in those with both diabetes and heart disease.
Dosage: Wegovy is administered via injection in the belly, thigh, or upper arm once weekly, starting with a lower dose and gradually increasing to 2.4 mg. Ozempic also starts at a lower dose, increasing to 0.5 mg weekly. The dosage may be increased to 1 mg per week for diabetes management if needed.
Side Effects: Common side effects for both drugs include nausea, diarrhea, vomiting, constipation, abdominal pain, and indigestion. Wegovy, at higher doses, may also cause dizziness, bloating, burping/gas, low blood sugar, gastroenteritis, GERD, headache, and fatigue.
Effectiveness for Weight Loss: Wegovy is approved for weight loss in individuals with a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition. Ozempic is sometimes used off-label for weight loss.
Read also: Facial oil: Benefits and how to use
Other Differences: Health insurance coverage may vary between Ozempic and Wegovy depending on the intended use. The cost for either drug can be around $1,000 per month without insurance.
Mounjaro vs. Ozempic
Mounjaro (tirzepatide) and Ozempic (semaglutide) are both approved to lower blood sugar in people with type 2 diabetes, but they act on different receptors. Mounjaro is a GLP-1 and GIP receptor agonist, while Ozempic is solely a GLP-1 receptor agonist.
Side Effects: Both drugs share common side effects like nausea, vomiting, diarrhea, abdominal pain, and constipation. Mounjaro may also cause reduced appetite and indigestion.
Other Differences: Mounjaro is typically prescribed at a higher dose, starting at 2.5 mg and increasing to 5 mg once weekly. Both are administered via injection once a week. They are not recommended for individuals with a history of pancreatitis or who are pregnant.
Effectiveness for Weight Loss: While both drugs promote weight loss, studies suggest Mounjaro may be more effective. One study showed that a 15 mg dose of Mounjaro led to a 20% body weight loss, while Ozempic typically results in a 15%-20% weight loss, with many people experiencing closer to 10%.
Read also: The role of alpha-keto acids in metabolism.
Mounjaro vs. Zepbound
Mounjaro and Zepbound share the same active ingredient, tirzepatide, but are approved for different primary uses. Mounjaro is approved for type 2 diabetes, while Zepbound is approved for weight management in adults with a BMI of 30 or higher, or in overweight adults with at least one health condition like high blood pressure, high cholesterol, type 2 diabetes, obstructive sleep apnea, or heart disease.
Dosage: Both drugs are administered in similar doses, with a maximum dose of 15 mg per week. The starting dose is 2.5 mg, adjusted based on effectiveness and side effects.
Side Effects: Common side effects for both include nausea, diarrhea, vomiting, constipation, abdominal pain, and indigestion. Zepbound may also cause injection site reactions, fatigue, hypersensitivity reactions, burping, hair loss, and GERD.
Other Differences: Insurance coverage may vary depending on the specific plan and whether the drug is being used for its approved indication. Both drugs are costly without insurance, at around $1,000 per month.
Wegovy vs. Zepbound
Both Wegovy and Zepbound are approved for weight loss, but they work in slightly different ways. Wegovy (semaglutide) acts like one hormone, while Zepbound (tirzepatide) acts like two.
Side Effects: Both drugs have similar side effects, including nausea, diarrhea, vomiting, constipation, abdominal pain, indigestion, and fatigue. Wegovy may also cause dizziness, bloating, low blood sugar, gas, gastroenteritis, and nasopharyngitis, while Zepbound may cause injection site reactions, hypersensitivity reactions, burping, hair loss, and GERD.
Other Differences: Some evidence suggests Zepbound may lead to more weight loss than Wegovy. Insurance coverage and availability may also vary.
Other FDA-Approved Weight Loss Medications
Besides the GLP-1 agonists, other medications are approved for weight loss, each with its mechanism of action, side effects, and suitability for different individuals.
Liraglutide (Saxenda, Victoza)
Liraglutide is a daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals. Doses start at 0.6 mg to 3 mg a day. Some patients may lose 5-10% of body weight, especially with the higher dose of liraglutide. Liraglutide is also approved for Type 2 Diabetes, under the brand name Victoza. Side effects include nausea, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, fatigue, dizziness, abdominal pain, increased lipase, and renal insufficiency.
Phentermine (Adipex-P, Lomaira)
Phentermine is the oldest and most widely used weight loss medication. It was originally used as a short-term medication to jump-start weight loss, but now newer medical guidelines have added it to long-term therapy. Side effects include headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor.
Phentermine-Topiramate (Qsymia)
Topiramate can be combined with phentermine to decrease appetite and cravings. Adults with migraines and obesity are good candidates for this weight-loss medication. Some patients may lose an average of 5-10% of body weight. Daily doses with four strengths start at 3.75 mg/23 mg to 15 mg/92 mg. Side effects include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth.
Naltrexone-Bupropion (Contrave)
Naltrexone-bupropion combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day. The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea.
Orlistat (Xenical, Alli)
Orlistat is a lipase inhibitor that comes in a capsule. Undigested fat is then passed through the body. Some patients may lose about 5% of their body weight. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal.
Setmelanotide
Setmelanotide is a melanocortin-4 receptor agonist indicated for chronic weight management in adult and pediatric patients six years and older, with obesity due to certain rare genetic disorders.
Plenity
A medical device rather than a medication, Plenity was FDA-cleared in 2019 for people with a BMI of 25 to 40. It consists of a capsule that releases a biodegradable, super-absorbent hydrogel into the stomach. The gel helps to increase satiety, enabling the person to eat less.
Considerations When Choosing a Wegovy Alternative
Selecting the right weight loss medication requires careful consideration of several factors:
- BMI and Health Conditions: Guidelines for medications like tirzepatide (Zepbound) and semaglutide (Wegovy) typically require a BMI of 30 or a BMI of 27 with weight-related health problems.
- Insurance Coverage: Insurance coverage varies and will affect many patients’ choices about going on weight loss medications.
- Side Effects: All weight loss medications have potential side effects, and it's crucial to discuss these with your doctor to determine which medication is safest for you.
- Cost: GLP-1s are notoriously costly. The Kaiser Family Foundation estimates the annual net price of Wegovy at $13,600.
- Personal Preferences: Some patients may prefer oral medications over injections, while others may have specific health conditions that make certain medications unsuitable.
The Importance of Lifestyle Changes
All weight loss medications work best when combined with a healthy eating plan and regular exercise. These lifestyle changes are crucial for long-term weight management and overall health.
The Future of Weight Loss Medications
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026. Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. The other, retatrutide, targets GLP-1, GIP, and glucagon. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication, including peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK).