As an obesity and lipid specialist, I’ve seen how drugs like Ozempic, Wegovy and their predecessors have completely changed the landscape for people struggling with type 2 diabetes and obesity. Meanwhile, people still don’t really understand how they work and there are huge misconceptions about them, especially on social media. What I know is that the current drugs on the market are just the beginning – more options are coming soon and they may be even more effective.
One that’s already being prescribed is Mounjaro, though at this stage it’s only technically FDA-approved to treat type 2 diabetes, like Ozempic. In the summer of 2023, it is likely that Mounjaro (known generically as tirzepatide) will also receive official FDA approval for weight loss (it appears to be another major safety and efficacy study).
Mounjaro, like Ozempic, is currently prescribed off-label for the treatment of obesity, especially given the recent shortages of Wegovy, which is FDA-approved for obesity. Wegovy and Ozempic are the same drug, semaglutide – they are just different doses. Wegovy has been shown to help people lose 15 percent of their body weight. At certain doses, Mounjaro can potentially cause a loss of 21 percent of body weight. These results are fast approaching what bariatric surgery can do.
More from women’s health
The reason Mounjaro is more powerful may be because it uses more weight loss mechanisms than Wegovy. Ozempic and Wegovy belong to a class of drugs called glucagon-like peptide-1 (GLP-1) agonists. GLP-1 is naturally produced in the gut and sends satiety signals to the brain. These drugs lead to weight loss because they act like GLP-1 in the body and can suppress appetite (“agonist” refers to a drug that binds to a receptor in a cell or on the cell surface and causes the same action as the substance normally binds to the receptor). These drugs also help spur the pancreas to produce insulin, which can help lower blood sugar levels for people with diabetes.
Mounjaro, on the other hand, is a GLP-1/GIP agonist, meaning that it not only acts like GLP-1 in the body, but also mimics the gastric inhibitory polypeptide (GIP) which, like GLP-1, triggers insulin secretion. . While there is debate about how it works, the addition of GIP in this case may increase the effectiveness of GLP-1, creating an additional weight loss effect.
The future of obesity medicine is all about developing compounds or combining compounds that hit multiple receptors in the body related to appetite and possibly even metabolism, nutrient distribution (how your body selects which fuels it stores) and maintenance of lean muscle mass. There are many new compounds in the pipeline that are currently being researched, with the goal that each new compound can produce a greater percentage of weight loss with fewer side effects. Therapies that don’t need to be taken as often are also in the works.
CagriSema (a combination of cagrilintide and semaglutide) looks promising. Cagrilintide emulates amylin, a pancreatic hormone that also has an effect on satiety.
Another is retatutride, a GLP-1/GIP/glucagon agonist. This compound is similar to tirzepatide but takes it a step further by adding glucagon agonism. It’s possible that the added glucagon agonism aids in energy expenditure, allowing people to burn more calories, on top of appetite suppression.
In addition to the new compounds under investigation, there are ongoing studies on how higher doses of current GLP-1 agonists are tolerated. And while most of these compounds are first tested and approved for type 2 diabetes, and later tested and approved specifically for obesity, that order may change. A compound called AMG-133, a GLP-1 agonist with an antibody that, unlike tirzepatide, inhibits rather than increases GIP, appears to be being studied first for obesity.
It may seem like it, but these drugs didn’t come out of nowhere. Ozempic, Wegovy and Mounjaro are the result of decades of research and development. Since the first GLP-1 agonist was approved in 2005, a series of new compounds have entered the market every few years. First there was exenatide (Byetta), then liraglutide (Saxenda and Victoza), then dulaglutide (Trulicity), then semaglutide (Ozempic and Wegovy), and then tirzepatide (Mounjaro).
Before the next generation of drugs arrive, it’s critical to get the facts straight: This isn’t just an out-of-control drug-fueled fad for weight loss. Let me debunk some of the many myths surrounding these new-in-the-zeitgeist-but-not-new drugs.
Myth 1: People shouldn’t use drugs like Ozempic and Mounjaro just to lose weight.
Obesity is a chronic disease. It has been classified as such since the 1990s, due to the fact that the body fights back when people try to lose weight, and because being overweight is associated with an increased risk of a host of health problems, including type 2 diabetes, cardiovascular disease . events, Covid-19 complications and more.
Yet our society has shamed obese people for decades. They are told that their weight is simply a reflection of their inability to eat healthy food and exercise. This is largely due to the weight stigma that permeates every aspect of our culture, from TV shows to healthcare.
Weight stigma hurts people with larger bodies in many ways. Research shows that people classified as obese are more likely to be discriminated against at work and fired from health care facilities. But another way that weight stigma harms those with bigger bodies is that there’s also judgment involved in getting medical treatment for obesity — whether that’s bariatric surgery or now, using an FDA-approved weight-loss drug. It’s seen as a “crutch” or “the easy way out,” when that couldn’t be further from the truth. Just as you wouldn’t tell a person with type 2 diabetes that they should feel bad if they inject insulin, you shouldn’t tell obese people that they should feel bad if they take drugs to treat their obesity.
It’s true that most of the GLP-1 agonists on the market have been approved as type 2 diabetes drugs, and not all of them have been approved for obesity yet, but it’s a big misconception that people shouldn’t just use them for weight loss . . Since semaglutide has been approved by the FDA in 2021 specifically for the treatment of obesity (in the Wegovy form), we know that Ozempic (the same compound) is safe and works for weight loss.
In the face of Wegovy shortages, people can work with their doctors to see if an off-label prescription is right for them. Obesity should be taken as seriously as any other disease, and people struggling with it have just as much of a right as anyone else to medicines that can help them cope.
Myth 2: You can use these drugs to lose weight and then get rid of it.
Another big misconception about these drugs is that they are a “quick fix”, that you can use them for weight loss and then stop taking them. In reality, they only work if you use them consistently, similar to a blood pressure medication or other chronic disease medications. They are meant to be taken indefinitely, and switching these drugs on and off can cause a yo-yo effect on appetite and weight. There may be people who can come off these drugs, but many will have to stay on at least a low dose.
By affecting one of the keys to long-term weight loss — regulating appetite — these drugs enable people to live the lifestyle they already know they need to lose weight. Most people know that eating an apple instead of chips is probably a good idea if they are trying to lose weight. But why can’t they do it despite the knowledge? It’s because the brain can forcefully push people to eat bigger portions and high-calorie foods, especially for people with a genetic predisposition to obesity. Some people are able to handle these foods in moderation. Some people can remember. Many cannot, despite their best efforts.
When people struggling with obesity – despite the best coaching and advice available – try these drugs, they describe what it must be like not to struggle with appetite and weight. They say they feel ‘normal’. They still have to make healthy lifestyle choices and work hard to lose weight. But they can do it without starting at a disadvantage.
Obesity medication can greatly improve the lives of people with health problems related to obesity, but only if we allow it. Currently, only 30 percent of insurers cover these drugs, another way weight stigma and the misconception that obesity is purely a lifestyle issue continues to harm people.
Myth 3: These drugs are great whether you’re trying to lose 15 pounds or 100 pounds.
People without type 2 diabetes or obesity should not seek out these drugs. Not only does that exacerbate supply problems for people with real medical conditions who depend on these drugs, there are also risks. A person looking to lose a few pounds may become underweight and lose bone and muscle mass instead of excess fat when taking them. Although the drugs are relatively safe, there is a potential for uncomfortable side effects, mainly nausea.
The use of these drugs requires the supervision of a qualified physician. I wouldn’t trust a doctor helping you access a drug you don’t really need, especially if they prescribe a version of a compounding pharmacy (one that not only distributes drugs but also makes them, which carries the risk of contamination ).
This content was imported from a poll. You may be able to find the same content in a different format, or you can find more information on their website.
The fact is that diet and exercise only work for a minority of obese people who want to lose weight because they are incredibly difficult to maintain. With these new tools, there is now another option – a relatively safe, non-invasive, effective one – to help people lose weight and keep it off without a constant battle.
Ultimately, everyone should have complete autonomy over their own body. Someone who is classified as obese but is otherwise healthy and happy should never feel pressured to lose weight or be discriminated against because of their height. At the same time, those who are suffering and in need of change should not feel embarrassed or experience barriers to accessing tools that can help.
Spencer Nadolsky, DO, is a board-certified obesity and lipid physician. He is the medical director of JoinSequence.com, where he helps deliver accessible, comprehensive online obesity treatments. You can follow him on Instagram at @drnadolsky.