Expert Diet and Weight Loss Solutions

Wegovy vs. Ozempic? Should you consider new diabetes drugs for weight loss or skip medications and stay fit? Photo: Getty Images.

If youre interested in losing weight, perhaps your ears perked up when Jimmy Kimmel cracked a joke during his opening monologue at this years Academy Awards.

Everybody looks so great, Kimmel said. When I look around this room, I cant help but wonder Is Ozempic right for me?

Or maybe you took note when Elon Musk tweeted about Wegovy as his magical weight loss method.

What are Ozempic and Wegovy, and if theyre working so well for Hollywood stars and social media influencers, should I think about trying these weight loss drugs?

Before you race to your doctor to get a prescription, its vital to consider the fine print for the medications.

While there are reasons to be cautious about the newest drugs, Ozempic and Wegovy are helping many people lose considerable weight about 12% of body mass, on average which can dramatically improve a persons health.

And for decades, leading medical experts blamed people who were overweight or obese for the extra pounds they were carrying without giving them much help or considering the physiological causes for weight gain. Some blamed obesity on simple math: Overweight people simply needed to eat less and move more.

While sedentary lifestyles and consumption of high-calorie, processed foods most certainly have boosted obesity rates in the U.S. and around the world, experts have learned much more in recent years about genetic causes for weight gain. Some peoples bodies may, in fact, want them to pack on fat. So, drugs that dramatically reduce appetite and help people lose significant pounds, may be a game changer.

To get answers to your questions, we consulted with Dr. Cecilia Low Wang, a UCHealth expert in endocrinology, diabetes and metabolism.

Low Wang is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus. And she chairs the committee that advises the U.S. Food and Drug Administration (FDA) on drugs related to endocrinology and metabolism.

The FDA approved Wegovy in June of 2021, marking the first time since 2014 that federal health authorities had given the green light to a new weight loss drug.

(Low Wongs views do not represent those of the FDA or the FDA EndocrinFologic and Metabolic Drugs Advisory Committee.)

Its correct that Wegovy and Ozempic are two names for the same drug: semaglutide. Ozempic is the name of the drug as prescribed for people with diabetes. The FDA approved Ozempic for people with diabetes in 2017 and approved Wegovy for people who have obesity or are overweight and have additional health problems in 2021.

They are just prescribed under different names with slightly different doses and different indications, Low Wang said. The drug product itself is the same.

The drugs decrease appetite and slow down emptying of the stomach so people feel less hungry and eat less. They can cause some unpleasant gastrointestinal side effects.

Under the FDA authorization, Wegovy is supposed to be used for people who are obese or overweight. Those who have a body mass index (or BMI) of 30 or greater are eligible along with those who have a BMI of 27 or greater who also have other health problems such as high blood pressure, diabetes or high cholesterol that make weight loss important.

In reality, some people who do not have obesity or weight-related health conditions have been saying that theyre using Wegovy or Ozempic to drop 10 pounds and get skinny.

Yes. The FDA has approved Wegovy for some children and teens ages 12 and older who are dealing with obesity.

FDA officials approved Ozempic for people with Type 2 diabetes.

Wegovy and Ozempic mimic a hormone called glucagon-like peptide-1, which targets areas of the brain that regulate appetite, according to the FDA authorization.

In the U.S., about 70% of adults are obese or overweight, and many have serious health problems that put them at greater risk for heart disease, stroke, diabetes and some types of cancer.

Losing 5% to 10% of body weight through diet and exercise has been associated with a reduced risk of cardiovascular disease in adults, Dr. John Sharretts of the FDAs Center for Drug Evaluation and Research said when the FDA approved Wegovy.

Gastrointestinal problems are the most common side effects since Wegovy can slow down peoples digestive systems. During clinical trials, some participants experienced nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion, dizziness, bloating and gas.

In Low Wangs opinion, yes, it was wise for the FDA to authorize Wegovy for people who truly need to lose weight.

Along with persuasive data about weight loss, Low Wang said there is evidence that people with Type 2 diabetes who take Ozempic can improve their cardiovascular health.

A 5-to-7% weight loss, for example, can significantly lower blood pressure, Low Wang said.

Cardiovascular risk factors improve in people with obesity or overweight who take Wegovy, but evidence for cardiovascular risk will have to wait until later in 2023 when the SELECT trial is completed. (Learn more about the clinical trial.)

Yes. As with many chronic conditions, most people who use the drugs for diabetes or weight loss will need to keep taking them to keep benefiting from them.

Sometimes people can decrease or eliminate the need for chronic medications through significant lifestyle changes, Low Wang said.

Of course, that takes work and commitment.

Depending on your individual situation, and without sustained lifestyle changes, it is likely you would need to be on these medications indefinitely to maintain weight loss, Low Wang said.

Using Ozempic or Wegovy without insurance coverage can cost more than $15,000 a year.

Thats causing some challenges for doctors and patients.

So far, many of the people who are publicly discussing using the medications are wealthy individuals for whom cost is not a problem.

And my sense is that many people posting on social media are using these drugs but dont meet the medical criteria for using them, Low Wang said.

The cost really affects access. Thats a huge issue related to health equity, she said.

Here are the criteria for use of Wegovy (meaning its meant for you, and health insurance plans might pay for the prescription).

If your body mass index, or BMI, is 30 or above, then you are eligible. If your BMI is 27 or higher and you have additional health risks, then youre eligible to get a prescription for Wegovy, Low Wang said.

If you dont meet those criteria, Low Wang said you would be using the medications off-label, or not as the FDA has approved them. This is OK if your health care provider feels the drug is necessary for you, but not if Wegovy is being prescribed by someone who is not one of your providers.

She said insurance plans do tend to cover these drugs for people with Type 2 diabetes.

Yes. Its true that the medications come as injectables, although there is one pill form. (See more information about that below.)

Wegovy and Ozempic are injected once a week, Low Wang said. So that can be a challenge for anyone who is absolutely against all injections. But because you only need to do the injection once a week, I think its doable for many people.

There is a tablet form of semaglutide. Its called Rybelsus and is for people with Type 2 diabetes. Patients need to take one tablet every day.

People who have uncontrolled diabetes can get retinopathy, a complication that involves damage to blood vessels in the eyes, and can result in vision loss or blindness.

During the clinical trials for Ozempic, a small percentage of study volunteers developed new or worsening retinopathy.

There was an almost three-fold increase in the rate of people getting retinopathy when they were placed on Ozempic (semaglutide) as compared to those who were not receiving Ozempic, Low Wang said. This was the relative risk, not absolute risk, but it is still concerning. However, it occurred in a small percentage of people.

People who have retinopathy should talk with their health care providers before starting Ozempic or Wegovy. And patients also should have a thorough eye exam and regular follow-up eye exams.

People may be at increased risk for pancreatitis, which is inflammation of the pancreas often caused by gall stones, alcohol use or high triglycerides.

We generally do not use this class of medicines if someone has a history of pancreatitis, Low Wang said.

If you have a history of MEN2 (multiple endocrine neoplasia 2) or medullary thyroid cancer, you should not take Ozempic or Wegovy.

As with any drug, you always have to weigh the benefits and risks, Low Wang said. Even though this can be an amazing drug for many people, each person is unique and you need to make an informed decision.

We know that if you start out with very uncontrolled diabetes and you have underlying retinopathy, if you lower the A1C (estimated blood sugar levels) too quickly, you have a higher risk of worsening retinopathy, Low Wang said.

Thats one reason that its really important to discuss weight loss drugs with your primary care provider and specialists who focus on both eye care and common conditions like diabetes so you can make good decisions.

Many people skip annual eye exams and some who are at risk of kidney disease like those with diabetes and high blood pressure dont get essential blood and urine tests. Having a full health picture is vital for safe use of weight loss drugs.

Yes, these are potentially awesome medications that can lead to dramatic weight loss, but people need to be committed to following up with their ophthalmologist (eye doctor) regularly, Low Wang said.

No, they dont need to be tapered before stopping, Low Wang said.

You can always choose to stop the medications, but its important to know that you will have a very high risk of regaining lost weight and worsening diabetes control, she said. These medications are like others. Whatever you were treating is likely to recur.

Yes. Low Wang said the medical community has learned a great deal in recent years about genetic causes for obesity.

As with many medical conditions, especially chronic conditions, theres a genetic component and an environmental component. In the past, many people mistakenly thought that weight gain was all environmental, and its not, Low Wang said.

What were trying to do now is to address the end goal: decreased weight that can lead to better health, she said.

Were acknowledging the physiology that is dysregulated and contributes to excess weight for people with obesity or who are overweight. And the newer weight loss medications are able to address this.

Finding the exact genetic causes for weight gain has proven to be challenging, Low Wang said.

For most people, its not a single-gene disorder. There are multiple genes that affect appetite, hunger, fullness and metabolism, Low Wang said.

In addition, individuals have different microbiomes and different metabolic set points, all of which affect weight and weight gain. Furthermore, researchers dont yet fully understand the connection between the brain and the gut.

Its extremely complex. Were learning a lot, but there is a lot more to learn, and the causes for obesity are definitely multifactorial, including social determinants of health and the built environment, Low Wang said.

I do, Low Wang said. Shed like to see insurance coverage that fosters long-term good health for patients.

These drugs could prevent health problems down the line, she said.

For example, if a person with diabetes reduces their weight by 15% or so, that can be enough to cause diabetes remission. Thats huge because we know that Type 2 diabetes is associated with increased risk of heart attacks and strokes, Low Wang said.

Reduced weight can also help with lower blood pressure, reduced cholesterol levels and a reduction in fatty liver disease.

Right now, fatty liver is the leading cause of cirrhosis, Low Wang said.

Many people mistakenly think alcohol consumption is the leading case of cirrhosis. In fact, fatty liver disease is a bigger driver of cirrhosis.

And weight loss treats that, Low Wang said.

Yes, there are other medications called Jardiance, Farxiga, and Invokana that are used to treat diabetes, but can also cause weight loss. They are what are known as SGLT2 inhibitors.

Patients who qualify also can consider bariatric surgery.

Or if people dont want to take drugs indefinitely, there are other options.

We have non-medication weight loss strategies. The specialists at the Anschutz Health and Wellness Center are terrific and can discuss other options with you, Low Wang said.

To minimize gastrointestinal side effects, Low Wang said patients need to start with the lowest level dose and stay on that dose for about four weeks before moving to a higher dose.

That minimizes side effects like nausea, bloating, diarrhea and overall gastrointestinal upset, Low Wang said.

Dose titration means that a person starts with a less powerful dose, then builds up to the goal dose, which is a higher dose.

Yes. Low Wang said its common for patients to stop taking the medications because they dont like the adverse effects.

About one in five people might stop because they are experiencing bad side effects, she said.

I encourage some patients to stay at the lower dose level for a longer period of time to see if they can tolerate it better and still get some benefit from the medication. Or if they dont tolerate this medication, we might try a different one, Low Wang said.

Low Wang said shes not hearing that concern from her patients. But she understands why some people could feel that way.

Its probably because of the degree of weight loss. It can be pretty quick and dramatic, she said.

Most people are pleased. Some arent used to the decreased appetite. But of those who are able to tolerate the medications, most have been happy with the effects, Low Wang said.

See your health care provider. Be aware of the side effects. And the costs may be an issue. Its not just for one year. The cost is a long term issue unless insurance plans start covering these medications for everyone who needs them, Low Wang said.

She is eager to help her patients with diabetes learn about ways to manage the condition and consider the new medications if appropriate.

It doesnt have to be Ozempic, but this class of diabetes medications controls your blood sugar and causes weight loss without putting people at risk for hypoglycemia, Low Wang said. That affects quality of life. Repeated hypoglycemia puts people at risk for car crashes and falls.

Many of the medications in this class also prevent heart attacks and strokes, Low Wang said.

For people with diabetes, the medications make a lot of sense.

For people who are healthy but want to lose weight, Low Wang would not recommend Wegovy.

Its not even worth discussing because its not indicated, she said.

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Wegovy vs. Ozempic: The truth about new 'weight-loss' drugs - UCHealth Today