In recent news, Ozempic, Wegovy, and Mounjaro have gained attention for their potential use in weight loss among celebrities. Although these drugs are primarily intended for managing type 2 diabetes, healthcare providers may prescribe them off-label to promote weight loss in patients who meet specific criteria. However, it is essential to understand the differences between these drugs, their mechanisms of action, and their approved indications.
Here’s what you need to know.
Ozempic, which is the brand name for semaglutide, is a prescription medication that assists in managing type 2 diabetes in conjunction with a healthy diet and regular exercise. Developed by Novo Nordisk, this drug helps enhance blood sugar regulation and minimizes the likelihood of events such as heart attack or stroke. It’s worth noting that Ozempic isn’t intended to treat type 1 diabetes, nor is it a form of insulin.
What Is Ozempic Approved For?
Ozempic, also called semaglutide, has been approved by the FDA in the United States to manage type 2 diabetes and reduce the risk of cardiovascular events like heart attack or stroke in individuals with type 2 diabetes and cardiovascular disease. However, as Jamie Alan, PharmD, PhD, an associate professor of pharmacology at Michigan State University, explains, Ozempic may also be prescribed off-label for weight loss to improve health outcomes, such as high blood pressure, which is more common in overweight patients. According to Kunal Shah, MD, an assistant professor of endocrinology at Rutgers University in New Brunswick, New Jersey, anyone with diabetes who needs to lose weight and reduce their risk of cardiovascular complications is an ideal candidate for these medications. Ozempic has been proven to decrease these risks.
Who Can Get Ozempic Off-Label?
One criticism of Ozempic is that some healthcare providers prescribe it too freely for weight loss purposes. Since the drug is not yet approved by the FDA for obesity or weight loss, there are no established guidelines regarding who should receive it for weight management. However, experts suggest that individuals who meet the criteria for other weight control medications may be appropriate candidates for Ozempic. These criteria include either a lack of weight loss or inadequate weight loss after six months of lifestyle changes and a BMI of 30 or higher, or a BMI of 27-29.9 with a weight-related health condition such as diabetes or prediabetes or hypertension.
How Does Ozempic Work?
Ozempic, a GLP-1 receptor agonist, is used to improve blood sugar control in patients with type 2 diabetes. It functions by stimulating insulin production and increasing insulin sensitivity. Ozempic also curbs appetite and inhibits excess sugar release by the liver. This medication’s weight-loss benefit arises as a secondary mechanism, by promoting satiety and reducing sugar cravings. Ozempic can be a valuable weight loss tool for overweight or obese individuals with a legitimate need to shed pounds, but the inappropriate use of this drug for weight loss purposes can be hazardous. Alan warns against the promotion of a toxic diet culture and suggests that the drug be reserved for those who genuinely require it.
How Do You Take Ozempic?
Ozempic is administered by injection using a traditional insulin pen-type device. According to Andrew Kraftson, MD, an associate professor of endocrinology at the University of Michigan, the medication is injected under the skin of the abdomen, thigh, or upper arm. The drugmaker advises against injecting Ozempic into a muscle or vein, or combining insulin and Ozempic in the same injection.
Patients should also rotate their injection site with each dose. The appropriate dosage of Ozempic depends on the patient’s individual needs. For patients managing type 2 diabetes and reducing the risk of heart attack or stroke, the initial dose is 0.25 milligrams (mg) per week for four weeks, followed by an increase to 0.5 mg. Healthcare providers may adjust the dose as needed, but patients should always consult with them before making any changes.
Ozempic Side Effects
Ozempic’s side effects may include nausea, vomiting, and diarrhea, which can lead to dehydration, especially if the patient is not eating enough. The drug can also cause constipation since it slows down the digestive system. While rare, severe side effects of Ozempic may include thyroid tumors, gallbladder problems, and kidney issues. However, the risk of pancreatitis is minimal, and there is no evidence of thyroid cancer risk in humans.
What Is Pancreatitis?
Pancreatitis occurs when the pancreas, a gland located behind the stomach, becomes inflamed due to activation of digestive enzymes attacking the organ. If left untreated, the condition can result in organ damage. For individuals with a history of disordered eating, Ozempic may trigger or worsen the illness due to its ability to cause reduced appetite and weight loss, according to Kraftson. Therefore, adding the medication without addressing underlying mental health issues could potentially exacerbate the condition. Additionally, some patients who have used diabetes drugs like Ozempic have reported a condition colloquially known as “Ozempic face,” which involves facial aging and sagging due to sudden weight loss and a loss of facial fat. Although any significant weight loss can result in facial changes, experts state that this is purely cosmetic and not a pathological condition.
According to Alan, Ozempic and Wegovy contain the same medication (semaglutide) and function in the same way, but Wegovy has a higher maximum dose and a slightly different dosing schedule due to the fact that they have different brand names. Novo Nordisk produces both drugs, and their primary difference is their FDA-approved uses.
What Is Wegovy Approved For?
While Ozempic is FDA approved for diabetes, Wegovy has full FDA approval for weight loss. In June 2021, Wegovy was approved for chronic weight management in patients with:3
- A body mass index (BMI) of 27 kg/m2 or greater with at least one weight-related condition, like high blood pressure, type 2 diabetes, or high cholesterol
- A BMI of 30 kg/m2 or greater
How Does Wegovy Work?
According to Kraftson, Wegovy, like Ozempic, is a GLP-1 receptor agonist, which can help regulate blood sugar and keep the body feeling full between meals, resulting in weight loss. Additionally, the drug can prevent the liver from producing excessive sugar. Kraftson explains that these drugs slow down the digestive tract’s food movement, which causes food to remain in the stomach longer and leads to a sense of fullness.
How Do You Take Wegovy?
Wegovy, like Ozempic, is administered through injection, but it differs in terms of the delivery device. According to Kraftson, the injection device for Wegovy resembles an EpiPen rather than an insulin-type device. Patients are advised to inject the medication once a week into their upper arms, abdomen, or upper legs. The drug is typically started at a dose of 0.25 mg once a week for the first four weeks before being gradually increased in intervals to a maximum dose of 2.4 mg.4 “These types of medications have been used since 2005 to treat diabetes, and there has been a progression,” Kraftson said. “Previously, people had to inject twice a day, then there was a once-daily product, and now we mostly use once-weekly self-injections.”
Wegovy Side Effects
Patients taking Wegovy may experience common gastrointestinal side effects, such as nausea, due to the slowed digestion caused by the drug. However, not all patients may experience relief from these symptoms. In addition, other potential side effects of Wegovy are similar to those of Ozempic, including constipation, upset stomach, diarrhea, and vomiting. Therefore, it is important to consult with a healthcare provider to determine if the medication is appropriate for the patient. According to Shah, using these medications without medical supervision can lead to side effects.
In addition, the safety of these drugs during pregnancy is unknown and can pose a risk to the developing fetus if taken while pregnant. The drugmaker warns that serious side effects of Wegovy may include pancreatitis, gallbladder problems, kidney problems, and thyroid tumors, including cancer.
A New Drug for Managing Type 2 Diabetes and Weight Loss Mounjaro, developed by Eli Lilly, is a drug used to manage type 2 diabetes along with a healthy diet and exercise. While it belongs to the same class of drugs as Ozempic and Wegovy, Mounjaro has a unique advantage: it targets two key hormones that regulate blood sugar levels and help patients lose weight – GLP-1 and glucose-dependent insulinotropic polypeptide (GIP).
FDA Approval and Potential for Weight Loss The FDA approved Mounjaro for type 2 diabetes treatment in May 2022. Although not yet approved for weight loss, Mounjaro may be used off-label for obesity and is expected to gain FDA approval for this use soon.
How Mounjaro Works
Like other type 2 diabetes medications, Mounjaro helps lower blood sugar levels, increase insulin sensitivity, slow the digestive system, and decrease appetite. However, because Mounjaro targets two hormones that have important metabolic roles, patients may experience greater weight loss.
Mounjaro is a once-a-week injection that can be used in addition to insulin. Patients usually start with a weekly dose of 2.5 mg and inject it under the skin of the abdomen, thighs, or the back of the upper arm.
Possible Side Effects
While Mounjaro is generally safe, some common side effects include nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion, and stomach pain. Serious side effects, though rare, may include pancreatitis, low blood sugar, kidney failure, allergic reactions, and gallbladder problems. Patients with a family history of medullary thyroid carcinoma should not use Mounjaro as it may cause tumors in the thyroid.
A Powerful Medication
Mounjaro is a game-changer for people with type 2 diabetes and obesity who have tried all the traditional approaches but still struggle to manage their conditions. However, taking this medication under the guidance of a licensed medical physician who understands the risks and benefits is important.
- Food and Drug Administration. FDA approves new drug treatment for chronic weight management, first since 2014.
- National Library of Medicine: DailyMed. Mounjaro—tirzepatide injection, solution [drug label].
- Ozempic. About the Ozempic pen.
- National Library of Medicine: DailyMed. Ozempic—semaglutide injection, solution [drug label].
- National Library of Medicine: DailyMed. Wegovy—semaglutide injection, solution [drug label].