Ozempic and Similar Drugs for Weight Loss- Should You, or Shouldn’t You?

WHAT IS OZEMPIC?  IS IT THE SAME AS WEGOVY?

Ozempic is a brand name of the injectable drug semaglutide, approved by the FDA for the treatment of Diabetes Type II in 2017.  Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 ra), a class of drugs that mimic an intestinal hormone which decreases appetite, slows stomach emptying, increases insulin production and makes the body more sensitive to the effects of insulin.  Studies have shown that semaglutide works for weight loss even in people who do not have diabetes, so it is now also marketed as the brand name Wegovy for weight loss. 

The weight loss version of the medication goes up to a higher dose and has a more user-friendly hidden needle system.  Providers (doctors, nurse practitioners and physician assistants) can prescribe either Ozempic ("off label") or Wegovy for weight loss, but insurance companies will usually only cover these medications for their FDA-approved uses (Ozempic for only diabetes and Wegovy for only medical obesity treatment).  These medications cost many hundreds of dollars, so most people need insurance coverage to access them…. fortunately, more insurance companies are covering weight loss medications these days.

IS IT OK TO USE SEMAGLUTIDE FROM THE INTERNET?

Unscrupulous providers and pharmacists, sometimes from outside of the US, have been known to access semaglutide or other similar medications packaged for research labs or other uses.  They then re-formulate this product (or simply pretend to use semaglutide) to make injections, drops, pills, and creams of unknown safety, purity, and efficacy.  Semaglutide is available as a specially formulated oral pill for diabetes (called Rybelsus), but the injectable formulation simply does not work orally.  These “bootleg” formulations are not recommended and are illegal in the US.

HOW GOOD ARE OZEMPIC AND WEGOVY FOR WEIGHT LOSS?

In a recent real-world study* at a weight loss center, the average weight loss on the maximum tolerable dose of Wegovy (up to the maximum of 2.4mg weekly), was about 6% of body weight (about 15 lbs.) at 3 months and 11% (about 27 lbs.) at 6months.  Most people lost at least 5% of body weight and about half lost over 10% by 6 months.  Some studies in more controlled settings showed similar or better results.  My patients often lose more than this because they have a full program to go with the medication, but in contrast I often see patients started on this class of medication for diabetes (without a weight loss program) who didn’t lose much weight at all, although the diabetes is usually better controlled.  Semaglutide also decreases the risk of heart attack, stroke and death in adults with diabetes.

WHAT ARE THE SIDE EFFECTS OF SEMAGLUTIDE?

All GLP-1 ra drugs cause nausea, vomiting, abdominal pain, diarrhea, constipation and fatigue, but although at least a third of patients have complaints like these, in the recent real world study* only 3% felt bad enough that they had to stop the medication.  These medications also increase the risk of gallstones and pancreatitis, and cause thyroid tumors in rats.  Semaglutide also slightly increases the risk of diabetic retinopathy in diabetics.  Many of these side effects are minimized by the very slow titration schedule for semaglutide, but the trade-off is that it takes 16 weeks to get all the way up to the full dose of Wegovy.

WHAT ABOUT MOUNJARO (TIRZEPATIDE)?

Mounjaro in a new drug which is similar to Ozempic but is active against 2 types of intestinal receptors instead of just one.  Currently tirzepatide is only FDA-approved for diabetes, but studies showed it to be superior to the medium dose of Ozempic for both diabetes and weight loss, so the FDA is evaluating tirzepatide as a weight loss drug also.  It is a little more expensive that Ozempic as a diabetes drug, so the weight loss version is likely to also be a little more expensive.  Mounjaro has similar side effects to the GLP-1 ra drugs, but because it is so new, we may see other side effects emerge over the next few years.

WHAT HAPPENS TO MY WEIGHT LOSS WHEN I STOP SEMAGLUTIDE?

Unfortunately, it looks like about 2/3 of the weight loss is usually regained fairly rapidly after cessation of the medication.  These drugs are meant to be taken long term, but with significant lifestyle change some people can successfully stop the medication and still maintain their weight loss.

* https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796491

Author

Rachel Chastanet MD Dr. Chastanet is Board Certified in Internal Medicine and Obesity Medicine. She practices at Chesapeake Weight Loss & Aesthetics in Chesapeake, VA.