This post was adapted from episode 33 of the Nourished & Free™ podcast: “Dietitian Review of GLP-1 Drugs for Weight Loss and what NO ONE is telling you!” Listen to the full episode.
Special thanks to Dr. Idz for discussing this topic with me!
If you haven’t heard about Ozempic, Wegovy, or Mounjaro by now – you probably live under a rock. These drugs are in high demand as people are snatching them up as the latest weight loss solution. But do they deliver on helping people lose weight? What about side effects, long-term effects, and cost? I’m breaking it all down (and more) in this dietitian review of GLP-1 drugs for weight loss.
What are GLP-1 Drugs?
GLP-1 drugs were initially designed for diabetes management but have since grown in popularity for weight loss.
GLP-1 (glucagon-like peptide 1) is a hormone naturally produced in the intestines. GLP-1 drugs are GLP-1 receptor agonists, meaning they bind to and activate the receptors for GLP-1, which leads to several physiological effects:
- Increase in insulin secretion by stimulating the release of insulin from pancreatic beta cells, which helps to lower blood sugar levels.
- Inhibits the release of glucagon, which is a hormone that raises blood sugar. This further helps to lower blood sugar levels.
- Slows down gastric emptying by relaxing stomach muscles and inhibiting movement in the duodenum (meaning, food stays in the stomach longer)
- GLP-1 agonists also act on the brain’s appetite centers, helping to reduce hunger and promote fullness.
GLP-1 Drug Names
There are several drugs that fall under the GLP-1 drug class:
- Semaglutide, sold as:
- Ozempic (FDA approved for Diabetes)
- Wegovy (same drug, but sold under a different name after it was FDA approved for weight loss)
- Liraglutide, sold as:
- Victoza (FDA approved for Diabetes)
- Saxenda (same drug, but sold under a different name after it was FDA approved for weight loss)
- Dulaglutide, sold as:
- Trulicity (FDA approved for Diabetes only)
- Tirzepatide sold as:
- Mounjaro (FDA approved for Diabetes only)
Let’s walk through each of these drugs real quick and talk about some basic info, then dig into what the research says about using GLP-1 drugs for weight loss.
Ozempic and Weight Loss / Wegovy Weight Loss
Ozempic is one of the GLP-1 drugs that you hear of the most these days. Ozempic is used for diabetes due to the positive effects it has on blood sugar management, however now many are doing Ozempic shots for weight loss. With the emergence of Wegovy, many are now using that instead of Ozempic. But what is Wegovy, and what is the difference between Ozempic and Wegovy?
Ozempic is the FDA approved semaglutide for diabetes. After semaglutide became FDA approved for weight loss in obese individuals, it started being sold as Wegovy. They are the same drug, just separate names for different FDA-approved intended purposes.
But do semaglutides really work? Will Ozempic really work for weight loss?
To see more about the research on whether semaglutides work for weight loss, jump here. Or, keep reading to learn the difference between the various GLP-1 drugs, the side effects, and the costs involved.
Difference Between Wegovy, Ozempic, and Mounjaro
Wegovy and Ozempic are both semaglutides. Mounjaro is a tirzepatide. Let’s dive into the differences between semaglutide vs tirzepatide.
Semaglutides (Wegovy and Ozempic) act only by activating glucagon-like peptide 1 (GLP-1) receptors, whereas tirzepatide (Mounjaro) activates both the GLP-1 receptors and glucose-dependent insulinotropic polypeptide (GIP). GIP stimulates insulin to release after a meal, which insulin is of course key in regulating blood glucose.
Therefore, the difference is Mounjaro (tizepatide) activates two agents working to secrete insulin while Ozempic or Wegovy (semaglutide) only activate one agent to secrete insulin.
Ozempic dosage, Wegovy dosing, and Mounjaro dosage
Ozempic, Wegovy, and Mounjaro are all injectibles that are inserted subcutaneously (under the skin). The dosages vary by brand, and typically look like the following according to GoodRx:
- Starts at 0.25mg injected once a week for 4 weeks
- Increased to 0.5mg for another 4 weeks
- Can be increased to up to 2.0 (moving along in 4 week increments) depending on how the patient is responding.
- Wegovy 0.25 once a week for a month, which then titrates up to
- Wegovy 0.5 once a week for a month.
- Wegovy 1.0 for month 3
- Wegovy 1.7 in month 4,
- Wegovy 2.5 in the final month and is sustained as a maintenance dose.
Mounjaro shots for weight loss follow a similar titration schedule as Ozempic and Wegovy do.
- 2.5mg once a week for a month
- 5mg for the following month
- Up to 7.5mg if needed
GLP-1 Drug Costs: Cost of Ozempic, Wegovy, and Mounjaro
With insurance, Ozempic’s price is next to nothing. Without insurance, the cost of 1 monthly dose Ozempic pen is a shocking $935.
But it doesn’t stop there. The out-of-pocket rates for 1 monthly dosage of Wegovy might bring you to tears: Wegovy’s cost is a cool $1,349.
There are some ways to get bring down the out-of-pocket cost with Wegovy coupons and Ozempic coupons from sites like GoodRx.
Mounjaro is no exception. Mounjaro’s cost sits at around $1,000 according to GoodRx (without a Mounjaro coupon)
Does insurance cover Ozempic?
Does insurance cover Wegovy and other GLP-1 drugs? Depends on your insurance plan. Additionally, the only FDA approved GLP-1 drugs for weight loss are Wegovy and Saxenda. Ozempic, Mounjaro, Victoza, and Trulicity are technically for diabetes. Because the FDA approved Wegovy and Saxenda for weight loss but only in obese individuals, insurance will likely not cover if someone’s BMI is below 30.
For a refresher on the difference between all these drugs with their crazy names, go here.
Ozempic Side Effects & Wegovy Side Effects
It’s important to consider the potential side effects of any new drug that you’re considering. Let’s look at the side effect of semaglutide. One study showed that 84% of people taking semaglutide experienced gastrointestinal issues such as diarrhea. Part of its interaction is to reduce glucose absorption from the gut therefore there is more sugar and water in the intestines, potentially causing the diarrhea.
What about Ozempic and throwing up? More than 10% of people may experience nausea and hypoglycemia as a side effect of Ozempic or as a Wegovy side effect.
Rarer side effects affecting <10% of people include constipation, vomiting, indigestion, bloating, abdominal pain, tiredness, decreased appetite (obviously), and increased heart rate. Also noted is worsening diabetic visual disturbances and feeling dizzy.
Does Ozempic Work for Weight Loss?
Let’s get to the brass tacks of Ozempic, Wegovy, and Mounjaro for weight loss (I’m focusing on these 3 drugs specifically out of all the GLP-1 drugs as they are the most popular).
In a groundbreaking study published in the New England Journal of Medicine, researchers examined nearly 2,000 obese participants from 129 places across 16 countries (no one had diabetes, some had prediabetes) and randomly assigned them to 68 weeks of weekly semaglutide injections (sold as Ozempic and Wegovy) with lifestyle interventions.
They found that the semaglutide group lost more than 33 lbs on average whereas the placebo group lost just 5 lbs. Additionally, almost double the number of people normalized their HgA1C in the prediabetic subgroup than those who did in the placebo group. More than 69% of people in the semaglutide group lost more than 10% of their weight compared to just 12% of the people from placebo over the course of 68 weeks.
Other trials using tirzepatide (sold as Mounjaro) showed similar results over the course of 72 weeks.
So according to these reports alone, yes… semaglutides and tirzepatides aka Ozempic, Wegovy, and Mounjaro do work for weight loss. But keep reading for the most important part – the part that no one will tell you.
What Happens When You Stop Taking Semaglutide for Weight Loss?
The same researchers from the New England Journal of Medicine study mentioned above performed a follow up study 1 year after the participants quit taking the injections.
The study showed that after 1 year of stopping the semaglutides, participants regained 2/3 of the weight they had lost as seen in the figure below. Most of the cardiometabolic improvements initially seen reverted towards baseline as well.
(Wilding et al., 2022)
Interestingly, the people in the placebo group (no semaglutide, just lifestyle interventions) also gained back the weight. Although, that’s not saying much as they only lost an average of 5 lbs.
If this is within 1 year of quitting the semaglutide, what would happen after 2 years? Would all the weight have been regained? Would we see even more weight regained than was lost?
What We Can Learn About Using Semaglutides for Weight Loss
What these studies are showing us is that weight loss is likely while taking semaglutides (specifically in obese individuals). However, the benefits are only seen as long as you are taking the drugs.
So now this raises the question of longevity. If taking the drug is required in order to keep the weight off, can the average person take these drugs for the rest of their life?
With gastrointestinal side effect rates of up to 84%, out-of-pocket costs between $900-$1,300 (depending on the drug), and a growing concern for a shortage, – what do you think? Are these drugs sustainable?
If the answer is no and we know that as soon as the drugs are stopped the weight comes back, then do they really work for weight loss?
What would a “Mounjaro weight loss before and after” story look like if we didn’t just hear about Mounjaro reviews while someone was taking the drug, but instead we heard about what has happened long after their last Mounjaro injection?
Insurance may cover the cost of GLP-1 drugs, but for how long? Wegovy is only approved by the FDA for weight loss in obese individuals. In other words, if you don’t have a BMI over 30, insurance likely won’t cover the cost. So what happens when someone loses weight and their BMI falls below 30? Will insurance continue to cover the cost of maintaining the weight loss, or stop covering because they are no longer obese? Are individuals going to have to pay $16,188 per year for Wegovy to maintain their weight loss?
These are the questions that we need to be asking before beginning a new drug like this.
Are GLP-1 Drugs Ethical?
Whether someone is getting a Mounjaro prescription online or visiting their provider in person, I have to wonder how thoughtful these providers really are. If they are prescribing GLP-1 drugs for weight loss to their patients knowing full well that the weight will come back as soon as the drug is stopped, then this raises an ethical concern. Why are providers prescribing GLP-1 drugs in the first place when they know the weight will return? Shouldn’t we have the patient’s best interest at heart? Wouldn’t helping them find a long-term solution be in their best interest?
Alternatives to Ozempic
If you have gotten this far and have decided taking Ozempic, Wegovy, and/or Mounjaro is not the right step for you, then you might be wondering what the alternatives to Wegovy and other GLP-1 drugs are.
As we are seeing in the literature above, anything you do to lose weight must be sustained. Even the placebo group was doing the classic 500 calorie/day deficit and 150 minutes/week of exercise, but they didn’t sustain the weight loss after the study was over (most likely because they didn’t keep up with the lifestyle changes).
One of the most helpful things we can do for our health is to see weight as a symptom, not as a problem. Then we can ask, “what is the problem at the root of my symptom?”
From there, that’s where the magic starts to happen.
For many women, battling binge eating and emotional eating is a big source of the issues they are experiencing with their health and happiness. They may even feel powerless over food. This is why they turn to GLP-1 drugs – they genuinely feel like they have no other choice.
However, it is 100% possible to overcome binge eating and emotional eating and get your power back over food, especially with the help of a binge eating dietitian.