I get several questions pertaining to the newer weight loss medications which include Ozempic (semaglutide) and Mounjaro (tirzepatide). These are the names for the medications for diabetics. Wegovy and Zepbound are the names when they are utilized for weight loss. Ozempic and Wegovy are identical medications except for the names. The same can be said for Mounjaro and Zepbound. These medications have been a tremendous benefit for weight loss. They were initially marketed for diabetics, and we subsequently found that the diabetics were losing as much is 18 to 22% of their weight while on these medications. I am asked regularly if everyone should be on these medications. My answer is diabetics who are overweight definitely could benefit from these medications. The answer for nondiabetics is not exactly clear. If someone is obese as evidenced by a BMI of greater than 30 or >27.5 with a comorbid illness and they have exhausted all other attempts for losing weight then I would say it would be worth a try. My reluctance to use these medications in nondiabetics is that they have not been studied for a long period of time in nondiabetics. They have side effects that are not only gastrointestinal but psychological albeit a low percentage. Also, for those individuals who do lose weight on them 85% of them we will have to remain on these medications to maintain that weight loss. I am not a fan of giving a hormone when we do not know what the side effects will be and particularly when your body does not need that hormone. For example, if I give a male testosterone when he does not need testosterone he will eventually stop producing testosterone on his own. These medications increase insulin production so increasing insulin production and an individual who does not need increased insulin production may not be a good thing down the road. Another potential issue with these medications is that they are not necessarily covered by insurance and can be quite expensive ranging from $500 to $1000 dollars per month. In spite of what many clinics and physicians will tell you there is no evidence that microdosing will enable you to get off of these medications. Another concern is when these medications were initially released, there was an emergency use authorization due to the shortage and now there are multiple compounding pharmacies that are making what is supposed to be semaglutide or tirzepatide but we cannot say for sure because the compounding pharmacies are not regulated. So, we cannot say with certainty it is actually the true medication that you are receiving. I would tell you to be honest with yourself and if you failed all measures and you have a BMI greater than 30 and are clinically obese or BMI greater than 27 with a comorbid illness and it could be a consideration. When I say exhaust all measures, I recommend starting with calorie restriction (smaller portions), dietary restriction (low-carb low sugar low-fat) and timing restriction (intermittent fasting) not eating for minimum of 12 hours. This is not as difficult as it sounds. If you sleep 8 hours all you have to do is wait another 4 hours and you have done it. A lot of weight gain is based on insulin surges and insulin will stick in your system for approximately 4 to 6 hours after each meal promoting fat deposition. I know it is not easy but do not give up. Have a great day and let’s make increased exercise and decrease intake a New Year’s resolution for 2026.
Doug
