Are Prescription Weight Loss Medications Right for You?
You can’t scroll through social media or watch TV without hearing ads for “miracle” weight loss programs. But a new group of drugs is offering realistic hope for people struggling to manage weight or diabetes: Ozempic®, Wegovy®, Zepbound™ and Mounjaro®.
What should you know about the benefits and risks? Is one of them right for you? Here are insights from Karen Earle, M.D., an endocrinologist with Sutter Health.
How These Weight Loss Drugs Work
The drugs generally work in the same way, whether you have Type 2 diabetes or you’re overweight.
Ozempic and Wegovy are brand names for semaglutide, which is a peptide that mimics a natural hormone (GLP-1) that tells your brain your body is full. Semaglutide also slows digestion, which increases the time it takes for food to leave the body. Ozempic and Wegovy are the same drug, made by Novo Nordisk, but have slightly different doses and are marketed under different names. Ozempic is used for diabetes and Wegovy for weight loss. You inject the drugs under the skin once a week. Studies show people have lost about 15% of their weight, although the weight often returns when people stop using the drug.
Mounjaro and Zepbound are brands of tirzepatide, a peptide that mimics two hormones in the body (GLP-1 and GIP). As a result, people tend to lose more weight — about 20%. The drugs are made by Eli Lilly and, again, are the same drug with slightly different doses marketed for diabetes or weight loss. Like the semaglutides, they are injected weekly under the skin.
Some pharmacies also make a compounded version of semaglutide, but the FDA warns these are not approved and there’s no guarantee they are safe and effective.
Finally Feeling Full
“A lot of my patients tell me they feel ‘full’ for the first time in years,” Dr. Earle says. “Before, they would continue to eat because they never felt the sensation of satiety. They never felt full.”
Dr. Earle only prescribes the weight loss drugs to people who meet the clinical criteria: People with diabetes or who are obese or overweight (BMI 27+) with a related health problems such as high blood pressure or high cholesterol.
Her office gets “tons of inappropriate requests” from people who just want to lose a bit of weight, she says. While she’s sympathetic, she worries that the overwhelming demand for weight loss treatment alone could create national shortages.
Benefits vs. Risks
These drugs are meant to be taken long-term or even lifelong, Dr. Earle says. When stopped, most people regain weight. Some regain all the weight they lost; others about half the weight they lost, Dr. Earle says.
“But my patients who have really made changes to their diet and lifestyle don’t regain all the weight they lost,” she says. “Sometimes these drugs can give people the nudge they needed to exercise and change how they eat. They’re the most likely to keep some of the weight off.”
Both types of these drugs commonly cause nausea, bloating, diarrhea and constipation when a person first starts taking the medication. Sometimes the drugs cause repeat vomiting, and the patient needs to stop the treatment. Generally, the side effects fade within a week of starting the drug or increasing the dose.
(Note: The FDA warns that in rare cases Zepbound and Mounjaro can cause thyroid tumors in rats, but it isn’t known if they would also cause tumors in people.)
Cost and Access
“The biggest issue currently is access. They’re expensive and not everyone can afford them,” Dr. Earle says.
The drugs can cost $1,000 to $1,500 a month. Health insurers will usually cover the cost for people with Type 2 diabetes, but often won’t pay for people who are overweight — even if they meet the criteria of BMI 27+ with high cholesterol or blood pressure.
“The number of patients who might qualify to be on these medications is huge,” she acknowledges. “They’re amazing drugs, but at their current prices they could really drain healthcare dollars.”
She hopes research continues and more similar drugs become available, eventually lowering the prices.