Ozempic…What’s all the fuss about?
Weight management is a complex field and we are still learning about all the factors and hormones at play when it comes to weight gain. Diet and exercise, specifically calories in/calories out, has been the focus of weight management for many years. This is still an important aspect, but the field is beginning to understand that there are many hormones at play in patients struggling with obesity.
There is currently a lot of media attention regarding a class of medications called GLP1 (glucagon like peptide 1 based therapies), which modify hormones between the GI tract and pancreas. These medications were initially approved to treat type 2 diabetes. They work in several ways including delaying the emptying of the stomach (so people feel full earlier and longer), inhibiting the release of hormones that inappropriately cause the release of glucose after meals (thus decreasing post-meal blood sugars), and giving feedback to the brain to reduce food intake. Physicians first started using these medications about 15 years ago and it was striking to finally have a diabetes medication that led to weight loss instead of weight gain. In 2014, the first GLP1 medication was approved for weight management in patients without diabetes, but it was not until 2021 when Wegovy was approved that the media started noticing. Ozempic, generic name semaglutide, is the FDA approved medication for type 2 diabetes. Wegovy, generic name also semaglutide, is the same molecule but is FDA approved for weight management. Dosing varies slightly between these two medications, but they are otherwise the same.
Most insurance plans, however, are not currently covering Wegovy and the cost for Wegovy out of pocket runs around $1000-1500 per month. Ozempic had a coupon card option that was not run through insurance and many were able to access the medication for weight management in this way. Unfortunately, with the significant uptake in use, there became a shortage on Ozempic for patients who were using this for type 2 diabetes treatment. Pharmacies had to stop filling the prescription for patients who did not have a diagnosis of type 2 diabetes so they could have adequate supply for patients with diabetes.
There are some studies ongoing currently looking at the use of these medications for prevention of type 2 diabetes in patients with prediabetes. Also, the other GLP1 players on the market are looking at weight management indications and these medications may be more accessible in the coming years. For example, a similar medication, tirzepatide (currently marketed for type 2 diabetes as Mounjaro), may gain FDA approval for weight management in late 2023 or 2024.
Some downsides to these medications are as follows. Because they inhibit stomach emptying, some patients really struggle with nausea and vomiting. Also, a rare but serious side effect is pancreatitis – inflammation of the pancreas that can cause severe upper abdominal pain, nausea, and vomiting. There are also some studies showing a slight increase in risk of thyroid cancer, so patients with personal or family history of thyroid cancer (particularly medullary thyroid cancer) are not ideal candidates. This medication has also not been well studied in patients who have had gastric bypass and with their physiology we are unsure as to the potential benefit of the GLP1 medications. This class of medication is most often provided as a weekly injection although there is an approved oral option (it is not quite as effective as injectable). Also, it appears lost weight is regained when the medication is discontinued, so the current belief is that these medications will need to be used life-long to sustain benefit.
The GLP1 medications are not a silver bullet to solve obesity, however, it is a new tool that we have to help those struggling to make changes with diet and exercise alone. With its high cost and limited insurance coverage, access is more challenging, but we may see more availability in the years to come and hopefully more long-term data on its safety and value over time.
With or without these medications, continue to work on the items we can modify. Improve chronic stress, poor sleep, increase exercise, and improve your diet. As Dr. Connolly noted in her post on diet, https://www.remedyim.com/news/diet, eat food that is in its original form or as close to it. Find dietary changes that you can stick to and feel sustainable. Our goal is to make these changes life-long adjustments and not short-term modifications. We will support you in your journey, but also remind you to honor the body you have and keep it safe.
References:
Dungan K and DeSantis A. “Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus.” Feb 09, 2023. Accessed on UpToDate April 10, 2023.
Berkeley Lovelace Jr. “A new weight loss drug could become the best-selling drug of all time. Who can afford it?” Jan 1, 2023. Accessed on NBC News April 10, 2023 at https://www.nbcnews.com/health/health-news/weight-loss-drug-affordability-rcna60422
