Many patients are interested in medications like Ozempic, Wegovy, and Mounjaro. These medications are used to help manage type 2 diabetes and have also found success as weight loss medications. They have gained attention as celebrities and social media influencers have described taking them to lose weight.
The active ingredients in these medications by mimicking the role of glucagon like peptide-1. These work by inducing satiety. This gives a patient the feeling of being satisfied or “full”, which in turn suppresses appetite and helps with weight loss. They work by affecting the hunger centers in the brain (specifically, in the hypothalamus) to reduce hunger, appetite, and cravings. They also slow the rate of stomach emptying, which prolongs fullness and satiety after meals.
These medications also help the pancreas to produce insulin, which helps treat type 2 diabetes. This in turn lowers blood sugar levels. They also help to reduce the body’s release of glucagon, which in turn helps control high blood sugar levels. These medications are not insulin.
These medications are designed to be injected once a week in the stomach, thigh or arm.
The FDA has approved these medications for treating Type 2 Diabetes, and for adults with obesity or excess weight with at least one weight-related condition, or comorbidity. These conditions can include high blood pressure, Type 2 diabetes, or high cholesterol. Obesity is defined using a patient’s Body Mass Index. The medications may also reduce a patient’s chance of having a heart attack or stroke.
Side effects can include nausea and dehydration, fatigue and malaise. A patient may develop GI symptoms such as diarrhea or constipation. Pancreatitis or gallstones can result. Hypoglycemia or vision changes may result. Facial aging, kidney problems, and thyroid and other cancers can result. Discontinuing the medications may cause a patient to gain back the weight that she has lost while taking the medication.
GLP-1 medications are not for everyone. People who should avoid using these medications include those who have a history of: pancreatitis; type 1 diabetes; under 18 years of age; pregnant or breastfeeding; diabetic retinopathy; problems with the pancreas or kidneys; family history of medullary thyroid carcinoma (MTC); multiple endocrine neoplasia syndrome type 2 (MEN 2), an endocrine system condition.
Many insurance companies will not cover these medications. We do not treat patients under the age of 18 with these medications.
Overview
Incretin mimetics:
- Class of drugs that emulate or mimic the effects of naturally occurring GI hormones:
- Glucagon like peptide-1 (GLP-1)
- Gastric Inhibitory Polypeptide (GIP)
- Help in type 2 diabetes by enhancing secretion of insulin from a “burned out” pancreas
- Suppress appetite after a meal
Byetta first to market in 2005
Weight loss results:
After 4 weeks
- Average weight loss of 7.5 lbs on lowest dose of semaglutide
- Maximum one-month weight loss of 22.8 pounds After 8 weeks
- Average weight loss of 13 lbs on lowest dose of Semaglutide
Semaglutide 0.25 Mg Or 0.5 (2 Mg/1.5 Ml) Subcutaneous Pen Injector
Brands:
Ozempic
- Approved in 2017 for type 2 diabetes
- Glucagon like peptide-1 (GLP-1) receptor agonist
- Active ingredient is semaglutide
- Once per week injection
- Weight loss MOA:
- Appetite suppression, possibly in hypothalamus
- Delayed gastric emptying
- Insulin increase leading to satiety
Wegovy
- FDA approved for obesity in 2021 (same as Ozempic but max does up to 4mg)
- Average weight loss of 15.1% of body weight (~35 lbs)
- 83% of adults taking Wegovy lost >5%, compared to 31% taking placebo
- 30% of people taking Wegovy lost >20%, compared to 2% of people taking placebo
Mounjaro
- GLP-1 receptor agonist
- Glucose dependent insulinotropic polypeptide (GIP)
- Even greater appetite suppression
- Compounding pharmacies ramping up to duplicate this commercially available drug
- But must do so before it’s removed from the shortage list (time sensitive, expensive)
Cost:
- Initial consult of $100
- 6-month weight management program ($1199-$100 consultation fee = $1099) includes
- Bluetooth enabled scale
- Journal
- Baseline labs
- Coaching with NP on diet and exercise, dosage adjustment, monitoring of side effects
- $420 automatic charge every 28 days for 4 pre-filled syringes of semaglutide from compounding pharmacy; shipped to patient (goes up to $520/m after 6 months)
Patients can purchase a consult online here:
And they can start their semaglutide monthly recurring subscription here:
