Weight Loss Medications (Ozempic, Wegovy, Mounjaro, Zepbound) – What You Need to Know.

Dr. Jacobs’ 5 Key Points

1. I encourage patients to lose weight. How it’s done doesn’t matter, as long as it’s safe. If you don’t want surgery, these medications can help you lose significant body weight and can improve cardiovascular and metabolic disease risk as a result. That’s great!! Be aware, high BMI (very obese) patients, may not lose enough weight on these meds.
2. If you’ve had bariatric surgery and have regained weight, these medications may reboot your surgery and help you lose what you have gained. Weight loss medications and bariatric surgery can work hand-in-hand.
3. When you stop taking these medications, studies show you regain the weight. It’s a long term commitment. This is why, if you don’t want to take lifelong meds (especially adolescents and young adults who need to be on meds for many many years), will benefit more from surgery. Some people may want to take these meds intermittently, we don’t know enough about that yet.
4. If these medications don’t work for you, consider bariatric surgery (still the gold standard). Being obese or overweight is not good. Surgery is very safe and effective.
5. These drugs are generally well tolerated but look out for pancreatitis, gastroparesis (paralysis of your stomach), severe constipation, nausea and vomiting, and unusual behaviors, including ideations of self-harm.

If you’ve been looking for weight loss options over the past several months, you’ve undoubtedly come across the new generation of weight loss medications showing great promise in helping people lose up to 10 or even 15-20% of their body weight. Let’s discuss where these medications came from and if they have a place in the weight loss continuum of care.

Ozempic – The One We Are All Hearing About

Ozempic is a weight loss drug developed by Novo Nordisk that is injected directly into the abdomen once a week. Ozempic was FDA-approved in 2017 to treat patients with type 2 diabetes. Over time, as happens from time to time with some drugs, a very welcomed side effect was noticed – in this case, weight loss. The weight loss was significant enough that the FDA approved a new higher-dose formulation, specifically for certain obese patients. This drug, known as Wegovy, is simply a higher-dose version of Ozempic.

These medications we just discussed are known as semaglutides or GLP-1 receptor agonists. In other words, these medications trigger the secretion of GLP-1 and a consequent hormonal response that reduces hunger and makes patients feel full with less to eat. Because of the results achieved with these new drugs, they have become so popular that we are seeing shortages worldwide.

Mounjaro is yet another diabetes drug that, much like Ozempic, has shown promise for weight loss. Indeed, Eli Lilly, the maker of Mounjaro, received approval for a weight loss application. This drug is now known as Zepbound. Mounjaro/Zepbound triggers very similar reactions in the body but does so using a different compound. Much like Ozempic and Wegovy, Mounjaro and Zepbound are in short supply, mainly due to off-label prescriptions.

The Side Effects of These Drugs

As with any medication, there can be side effects with these weight loss drugs. In contrast to some weight loss drugs in the past, approval data has shown the side effects of this new generation of drugs to be relatively mild with better results. This has further driven the popularity of the drugs. Side effects include nausea, vomiting, constipation, reflux, and gastroparesis. It’s also important to note that weight loss drugs are being investigated in the UK and Europe for possible ideations of suicide or self-harm. While we don’t have any concrete data on this as of the writing of this article (October 2023), it is essential to tell your doctor about any unusual side effects or symptoms while on these drugs.

Even if you are successful with weight loss medications, you need to be aware of potential complications, including nutritional deficiencies and muscle and skeletal mass loss due to the rapid weight loss. Also, it’s important to remember that medications are only helpful if you take them. If you stop using the drug and have not implemented significant lifestyle changes, the benefit will be curtailed.

How This Affects Bariatric Surgery

These medications should be considered part of a larger conversation about weight loss and patient care. Weight loss is critical for reducing (even curing) the effects of metabolic diseases that can lead to heart conditions, high cholesterol, high blood pressure, type two diabetes, fatty liver, and sleep apnea. Weight loss can also improve the symptoms of osteoarthritis and reflux, and greatly improve your quality of life.

The question is whether weight loss medications are an alternative to bariatric surgery – and for most, the answer depends on the patients themselves. While these medications can offer significant weight loss, it’s unlikely that their effect will be substantial enough for severely obese patients who need to lose large amounts of weight- as bariatric surgery can achieve. However, for lower BMI patients, these medications should work. Of course, their suitability should be discussed with your medical team.

Will I Regain Weight After Stopping Weight Loss Medications?

Multiple studies have shown weight regain when patients stop taking these medications. In this sense, they behave like our experience with the gastric balloon (a non-surgical temporary procedure), where patients regain their weight after the balloon is no longer present in the stomach: after their balloon is removed, they no longer feel full.

What’s the Correct Answer?

These medications for weight loss are fairly new, and we still don’t know enough about long term use. Although we assume today, they will be safe.

For many, weight loss medication is a good option.  They may not work as well if you are very heavy and need to lose large amounts of weight (BMI of 40 and above).  I also worry about placing young people who are in their teens or early adulthood on these medications, theoretically, for 50 plus years.  They may also be appropriate for maintaining or enhancing weight loss after a bariatric procedure and avoiding a second surgery. Don’t hesitate to contact us if you’ve already had surgery or if you are considering your weight loss options.

Most importantly, weight loss is difficult no matter your method, and there’s no easy way to drop the pounds. Patients should speak to their primary care physician, bariatric surgeon, or weight loss specialist to understand their options.

Whatever works for you is what you should do. As long as it’s safe.