HERSHEY, Pa. — Hardly a day goes by without another headline touting the benefits of new Food and Drug Administration (FDA)-approved, injectable weight-loss medications.
“Weight-loss drugs are among the most sought-after products sold in the U.S.,” said Dr. Taraneh Soleymani, director of Obesity Medicine at Penn State Health Medical Group. “Semaglutide and Tirzepatide have been game-changers in treatment of obesity. It is no surprise that neither of the pharmaceutical companies making them, Novo Nordisk and Lilly, can keep up with the demand.
“Obesity is an epidemic. Seven out of 10 Americans are struggling with overweight or obesity. And this is not a disease that only affects Americans. It is a worldwide struggle,” Soleymani said. “People don’t have to hear about the new weight-loss drugs from their doctor. They see their effectiveness in delivering significant weight-loss in their neighbors, co-workers and family members.”
Here, Soleymani discusses these medications and provides context and clarity around how they work, how they’re used and prescribed, and what the potential side effects might be.
How is Ozempic used?
"Ozempic, which has become synonymous with weight-loss medication, is FDA-approved only for treatment of Type 2 Diabetes Mellitus (T2DM). It’s important for us to communicate this to our patients as there has been a great deal of misinformation on what is an FDA-approved drug for obesity," Soleymani said. "We have seen patients requesting their provider to start them on Ozempic, and it gets rejected by their insurance plan for coverage because the patient did not have T2DM.
"Popular culture has contributed to this kind of misunderstanding that Ozempic is a weight-loss medication. Both Wegovy and Ozempic are Semaglutide but at a different dose, with Wegovy being approved by the FDA for treatment of obesity. The same is true for Mounjaro and Zepbound. Both are the antidiabetic medication Tirzepatide, but only Zepbound is approved for obesity treatment."
Who should consider taking Wegovy and other weight-loss drugs?
"People who struggle with an overweight body mass index (BMI) of 27 to 29.9 with one comorbid condition related to their excess weight, like hypertension, or people who have obesity ― a BMI of 30 or greater ― would qualify for FDA-approved weight-oss medications including Wegovy, Zepbound, Saxenda, Contrave and Qsymia," Soleymani said.
In addition to weight loss, what other benefits does Wegovy provide?
"More than half of the participants in Wegovy research trials achieved 15% weight loss and one third achieved 20% or greater," Soleymani said. "This is an impressive amount of weight loss ― something we have not seen with previous weight-loss drugs. This is important because a greater amount of weight loss means we are able to more effectively treat obesity and its related co-morbid conditions.
"We’re now treating Type 2 Diabetes Mellitus much more effectively ― reversing it in some cases ― helping patients come off their CPAP machines for obstructive sleep apnea or significantly reduce knee pain," Soleymani added. "Wegovy can also have a positive impact on cardiovascular health and kidney health outcomes."
How do these medications work in regulating appetite and offering other health benefits?
"The new class of weight-loss drugs that includes Wegovy and Zepbound work like the gastrointestinal hormones that naturally exist in our body. These medications act on several areas of brain involved in weight regulation," said Soleymani.
"While reducing daily calorie intake and increasing daily calorie output are important for weight reduction, they do not go far enough in managing obesity. They fall short of influencing the pathways near the hypothalamus that regulate weight and appetite," Soleymani added. "Therefore, when weight-loss medications are added to lifestyle modification, we are able to achieve and sustain a greater amount of weight loss because we are treating the disease much more effectively.
"These medications have also shown promise in managing binge-eating disorder, depression and addiction. We need more studies to better understand the mechanism and how to best use these drugs for our patients," said Soleymani.
Are there any negative side effects?
"As with all medications, potential side effects exist with weight-loss medications," said Soleymani.
"In Wegovy trials, participants most commonly reported gastrointestinal side effects along with headache and fatigue. Zepbound also causes gastrointestinal side effects," said Soleymani. "When patients are properly monitored, guided and supported from a lifestyle modification standpoint (nutrition, physical activity and behavior), they tolerate the medication better. This is what we aim for with Penn State Health’s lifestyle program for obesity, Digital Weight Management. This six-month, structured lifestyle program allows us to partner with our patient in their weight-loss journey to ensure it’s safe and effective."
Must people remain on weight-loss medication for life?
"I get this question a lot from patients and providers. Not many people may know obesity was recognized as a disease by the American Medical Association in 2013. It is a chronic and relapsing disease much like hypothyroidism or cancer. Once you treat the disease, the patient should stay on the treatment that works long term," Soleymani said. "If treatment is stopped, the disease will relapse. Weight-loss drug trials have shown discontinuation of medication leads to weight regain. That’s because the brain pathways that regulate the weight are no longer treated by the medication. Feelings of discomfort with taking a medication for life are understandable. I would encourage patients to communicate their concerns with their health care provider."
What’s the cost of Wegovy and similar drugs?
"It’s an expensive medication," said Soleymani. "Without coverage, the patient may pay out of pocket about $1,200 a month retail for Wegovy and $550 a month retail for Zepbound. A lot of progress has been made in terms of employers covering these drugs compared to a decade ago, but still not all employers include them as part of the insurance benefits they offer employees. This is also true with some insurance plans like Medicare that do not cover weight-loss medications. Lack of coverage and high demand for these medications have led to a national shortage of Wegovy and Zepbound. Unfortunately, we have seen clinics, pharmacies and online weight-loss programs offering compound Semaglutide and Tirzepatide. It is important for patients to know that these compounded versions are not the same as the actual drugs offered by Lilly and Novo Nordisk. Also, they have not been shown to be safe or effective, and are therefore not FDA-approved."
Are you hopeful that there will be even better drugs in the not-too-distant future?
"No question about it," said Soleymani. "This is a very hopeful time in the field of obesity medicine. For the longest time, all we could offer our patients was lifestyle modifications ― cut down your calories, be physically active ― which are important. But we were not really treating the physiology of the disease. We were not optimizing the effect of lifestyle change. With the introduction of the first FDA-approved weight-loss medication in 2012, we began to address the underlying physiology of obesity. And with the introduction of the new class of medications like Wegovy and Zepbound, we are doing a far more effective job.
"Looking down the road, there are more drugs in the later phase of clinical trials that mirror the results of bariatric surgery. It is an exciting time, as we have more treatment options than ever to offer our patients who struggle with obesity," Soleymani said.
Related content:
- The Medical Minute: Three tips to lose your pandemic pounds safely
- The Medical Minute: Weight loss and exercise can help prevent knee problem
The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.