Health & nutrition insights.

A trending topic in our culture at the moment are diabetes medications being utilized for weight loss. The most popular medications include Ozempic, Wegovy and Mounjaro. It’s hard to know what each medication provides, the differences, what they are being used for, side effects and more. Let’s dive in!

 

Click the link to listen to our Practical Nutrition podcast episode titled: Is Ozempic Safe for Weight Loss

 

Ozempic is a once-weekly injectable medication formulated to help adults with type 2 diabetes manage their blood sugar. Although not officially a weight loss drug, research suggests that people who take Ozempic may lose modest amounts of weight while on the medication. In fact, the active ingredient in Ozempic, known as semaglutide, is FDA-approved at higher doses for treating individuals living with obesity and other weight related medical problems under the name Wegovy. Ozempic is only FDA approved for use with type II diabetics. 

Due to a Wegovy shortage coupled with Ozempic’s weight loss effects going viral on social media, people without type 2 diabetes have begun using Ozempic off-label for weight loss.

Wegovy is approved by the FDA for weight loss. It is designed to assist in weight loss for those who have weight related comorbidities. Those that are eligible include:

• a BMI of 27 or higher with at least 1 weight related comorbidity (HTN, DM, high cholesterol) 
•  a BMI of 30 or higher, regardless of weight-related conditions 

 

What do Wegovy and Ozempic have in common? Semaglutide. 

Semaglutide is a GLP-1 (Glucagon-like peptide-1 ) agonist and mimics its effects in the body. It works by increasing insulin release, lowering the amount of glucagon released, delaying gastric emptying and reducing appetites when food is in the body.   GLP-1 receptor agonists have been shown to be an effective treatment option for patients with uncontrolled type 2DM with a once-weekly injection.  Pharmaceutical companies have taken this hormone that is naturally occurring and restructured it into a drug for diabetics, and now for weight loss.

 

There is a third medication on the market that is a distant cousin of Ozempic and Wegovy. It is called Mounjaro. The major difference is this medication is a tirzepatide instead of semaglutid. Mounjaro is a combination drug  that acts on the GLP-1 receptor along with another receptor in the brain called glucose-dependent insulinotropic polypeptide (GIP).   

GLP1 and GIP are both peptides that are released in the gut in response to consuming food and work synergistically for balancing glucose and regulating post meal metabolism. They support weight loss by stimulating insulin release, reducing glucagon release, which also reduces appetite and slows gastric emptying (aka more full). People often have fewer cravings and feel fuller longer, resulting in lower calorie intake followed by weight loss. 

Tirzepatide is proving to be slightly more effective for weight loss and glucose control than semaglutide 

 

What are the results with these different medications?

• Semaglutide (aka Ozemic and Wegovy)- studies show participants lost an average of 7% BW in 1 year WHEN COMBINED WITH DIET AND EXERCISE with 1mg per weekly dosage. A weekly dose of 2.4 mg of semaglutide has been shown up to 15% BW loss. 
• Tirzpatide (aka Mounjaro)- more than ½ participants in one study lost over 20% BW WHEN COMBINED WITH DIET AND EXERCISE.  

 

Point being….DIET AND EXERCISE CHANGE IS MOST OFTEN THE FIRST STEP AND NEEDS TO BE CONTINUED. 

Weight loss medications and drugs are not a new thing.

-Amphetamines (1950s):  

• stimulants given to soldiers during World War II to keep them alert.
• side effects were appetite suppression. 
• led to the pills being prescribed in the US to help people with weight loss. The risk of abuse/adverse neurological and psychological effects proved to be more significant than the value the meds  

-Ephedrine (1970s): 

• A physician used ephedrine + caffeine to treat asthma. Eventually this treatment was prescribed for weight loss. 
• Adverse reactions to the medication in the form of cardiovascular and neurological problems forced the FDA to declare ephedra as an unsafe substance. 

-Orlistat (2000s) 

• taken to reduce the amount of dietary fat that is absorbed by the digestive tract. Orlistat is used in conjunction with a reduced-calorie diet. Major GI upset due to “fat blocking”. 

 

There are some concerns to think about with using these medications. 

• First being potential side effects. Some include nausea, vomiting, diarrhea, constipation, abdominal pain, thyroid tumors, etc. 

• The longevity of drug use: considered “long term” medications if tolerated well  
• The cost: $1000-1200 per month if insurance does not cover it (roughly $18000 per year) 
• Needing to make lifestyle changes outside of the drugs. If you stop the drug, it’s important to still have healthy habits in place with nutrition and exercise 
• Beauty standards: the pressure to be thin 
• Metabolic effects: Decreasing metabolism with a major prolonged decrease in calorie intake  
• Rebound: stop taking meds and influx of hunger. A recent study shows that 1 year after withdrawal of once-weekly semaglutide dosage of 2.4 mg and lifestyle intervention, participants regained two-thirds of their weight lost.  

 

In conclusion, the medication can be helpful for certain populations and we agree with the research for its helpfulness in promoting healthier blood sugar levels in diabetics and decreasing adverse events from comorbidities. However, we encourage you to explore an approach that is most realistic and sustainable for you!