It’s hard to avoid the buzz about Ozempic, Wegovy, and Mounjaro. Ozempic (technically semaglutide) is a drug for adults with type-2 diabetes that has weight loss as a side effect. Wegovy is a larger dose of semaglutide, approved specifically for weight loss. In one study, about two-thirds of participants lost 10 percent of their weight, although seven percent dropped out because of unpleasant side effects. Mounjaro (tirzepatide) is a similar diabetes drug that also has weight loss as a side effect. All of these once-a-week injectable medications have been described as miracle drugs for failed dieters. Along with dramatic weight loss, there are reports of users losing their continual thoughts about eating (“food noise”).
Gossip magazines are filled with stories about celebrities using these drugs. At the Oscars, Jimmy Kimmel joked about Ozempic use in Hollywood. Charles Barkley said he lost 62 pounds on Mounjaro. Amy Schumer and former British Prime Minister Boris Johnson report that they tried Ozempic but didn’t like some of the side effects. Even billionaire Elon Musk has used it, So, should you?
These drugs work by curbing appetite and making the stomach empty more slowly. They lower blood-sugar levels and act like glucagon-like peptide-1 (GLP-1), a hormone produced in the intestines that signals fullness and allows the stomach to empty more slowly. As a result, your appetite will decrease, you’ll eat less, and lose weight.
In addition to weight loss, there may be fringe benefits from these drugs. In a study of people with obesity but without diabetes, Wegovy was shown to reduce the overall risk of heart attacks, strokes, and cardiovascular deaths by 20 percent. Another recent study found that after three months on semaglutide, 69 participants with obesity showed significant reductions in emotional eating, food cravings, and external eating, as well as a significant increase in physical activity. Also, there are clinical reports that, in addition to decreased food cravings, alcohol cravings decline.
So, if Wegovy produces significant weight loss, reduces the risk of heart attack, and curtails emotional eating, what’s not to love? About 20 percent of people taking these drugs experience possible side effects including nausea, dehydration, fatigue, constipation, and muscle loss. But even if you were in the lucky 80 percent who didn’t have side effects, you’d need to pay attention to your food choices. There have been reports of malnourishment resulting from extreme loss of appetite. One patient said she’d lost interest in eating and had to “force herself” to just have cheese and crackers for dinner.
Then there’s the cost. A month’s supply of Wegovy costs $1,300. Unfortunately, weight is rapidly regained after going off the drug, so to maintain your weight loss you’d have to keep spending until there’s a generic version on the market. One questionable solution is to try “knock-off” versions offered by compounding pharmacies. Typically, they mix semaglutide from scratch. Unfortunately, these injections may be made from ingredients obtained from unregistered manufacturers that haven’t undergone the rigorous FDA approval process.
Final cautions: Weight loss with these medications will plateau, so, despite losing pounds you might not reach your target weight. Also, curbing appetite and eating less are not sufficient for long-lasting weight loss. Increasing energy expenditure (exercise) is necessary to preserve the lean muscle mass needed to maintain weight loss.
So, should you try semaglutide or tirzepatide? A few questions to help you decide:
- Is your weight a significant health risk or is your motivation just to improve your appearance?
- If your insurance doesn’t cover it, can you afford the cost?
- Are you willing to inject yourself weekly?
- Can you tolerate the possible side effects?
- With reduced appetite, will your food choices provide sufficient nutrition?
- Will you be frustrated if you lose pounds but don’t reach your goal weight?
- Are you willing to exercise to preserve muscle mass?
Despite the proven effectiveness and all the buzz, these drugs aren’t magic. Give it some serious thought before you decide to try one.
Nicolau, J, Pujol, A, Santiago, T, et. al. (2022). Short term effects of semaglutide on emotional eating and other abnormal eating patterns among subjects living with obesity. Physiology & Behavior, 257, 113967.
Christoffersen, B. O., Sanchez-Delgado, G, et al. (2022). Beyond appetite regulation: Targeting energy expenditure, fat oxidation, and lean mass preservation for sustainable weight loss. Obesity, 30, 841-857.