If your goal is to lose weight with Ozempic or Mounjaro in the new year, your doctor may prescribe the versions of those Type 2 diabetes drugs approved for weight loss — Wegovy or Zepbound.
Interest keeps growing, with millions of Americans getting a prescription for this class of medications in recent years. Oprah Winfrey revealed in December she’s taking a weight-loss drug.
“The medications offer an option for people to manage their weight by targeting some of the actual biology of obesity, which is something that lifestyle (changes) often fail to do,” Dr. Beverly Tchang, an endocrinologist and obesity medicine physician at Weill Cornell Medicine in New York, tells TODAY.com.
“So in that way, it makes it easier for people to achieve their New Year’s resolution goals.”
Tchang is an advisor for Novo Nordisk, the pharmaceutical company that makes Ozempic and Wegovy.
Patients can expect to lose about 15% to 20% of their body weight as the drugs reduce their appetite, based on results from clinical trials funded by the pharmaceutical companies, but the treatments can come with side effects, most commonly nausea, diarrhea, vomiting and stomach pain. Much more serious side effects are also possible.
They’re also expensive without insurance — more than $1,000 per month. Weight-loss drugs are not covered by Medicare and often not covered by commercial health insurance.
They’re intended to be used long-term in addition to a healthy diet and regular exercise.
Here’s a user’s guide for Wegovy and Zepbound:
How to get a prescription for a weight-loss drug
The first step is to talk with your doctor to find out if you’re a candidate and to see if there are other considerations when it comes to side effects or long-term concerns, Tchang says.
She recommends starting with a primary care physician or visiting the American Board of Obesity Medicine to find a certified obesity medicine doctor.
Eli Lilly, which makes Zepbound, is now providing direct access to the drug with a new website called LillyDirect, the company announced on TODAY in an exclusive interview that aired Jan. 4. It's the first pharmaceutical company to allow direct sales.
People using the program can find a doctor or telehealth provider and get some prescription medicines, including Zepbound, shipped directly to them.
Critics worry easier access may lead to abuse by people who just want to lose a few pounds.
Wegovy and Zepbound are approved by the U.S. Food and Drug Administration for people with obesity or those who have complications from being overweight. They’re meant for chronic weight management, not recreational or intermittent use.
LillyDirect users seeking a prescription must have a doctor's visit — just not in person. The drugs need to be used under the supervision of a physician, Eli Lilly CEO Dave Ricks told TODAY.
Dr. Roshini Raj, a gastroenterologist and clinical associate professor at the NYU Grossman School of Medicine, said she had mixed feelings about the new program.
"This could really open up the availability of this very important and potentially life-saving medication for many people," Raj said on TODAY.
"On the other hand, as someone who practices medicine both in person and telemedicine, I always feel like I prefer to use telemedicine for those visits with patients I already know."
She'd prefer to see a new patient seeking a weight-loss drug in person to get the full picture of the potential side effects and complications they might experience, she added.
It will be important to monitor the program and make sure it's not just a "free-for-all" two-minute tele-visit for anyone to get the treatment, Raj said.
The drugs are so popular that health officials have been warning about fake versions showing up in the U.S. and other countries. In December, the FDA reported counterfeit Ozempic was found in U.S. drug supply chain, along with counterfeit needles. The agency urged patients and doctors to check for a certain lot and serial number to spot the fake.
How the medications help you lose weight
The drugs, which patients self-inject once a week, work by mimicking the hormones the body releases when a person eats food, as TODAY.com previously reported.
People have reduced appetite, and when they do eat, they feel full sooner.
Semaglutide, the active ingredient in Ozempic and Wegovy, targets one hormone, known as GLP-1, TODAY.com previously reported.
Tirzepatide, the active ingredient in Mounjaro and Zepbound, targets two different hormones, GIP and GLP-1, which can lead to even greater weight loss, research shows.
Tchang tells patients to expect they’ll eat half of their usual portions. If they’re used to eating three meals a day, they might be satisfied with only two.
When people stop taking these weight-loss drugs — whether because of side effects, insurance changes, cost or because they’ve reached their goal weight — their appetite returns to previous levels or can feel even bigger, doctors told NBC News, and they can regain much of the weight.
What to know about side effects
Wegovy and Zepbound have similar side effects. The most common include nausea, diarrhea, vomiting, stomach pain and constipation, according to the drugs’ manufacturers. Some patients find the side effects so bothersome that they have to stop taking the medication.
More serious potential side effects for both medications include pancreatitis, gallbladder problems, kidney problems, and depression or thoughts of suicide, according to Novo Nordisk and Eli Lilly. Zepbound also includes severe stomach problems on its list of potential issues.
Which medication to choose
Wegovy has a list price of $1,349 for a month’s supply, while Zepbound’s list price is $1,059. Weight-loss drugs are not covered by Medicare and often not covered by commercial health insurance.
Because the tirzepatide in Zepbound targets two hormones, “you’re essentially getting more bang for the buck” when you take it, NBC news medical contributor Dr. Natalie Azar said in a Nov. 28 segment on TODAY.
Both Zepbound and Wegovy “are excellent medications,” Tchang says. “Unfortunately, most of the time the decision is made by a person’s insurance company as to which medication might be covered.”
It may also be a matter what’s available at pharmacies. Both semaglutide and tirzepatide injections used in Type 2 diabetes and weight-loss drugs are listed as “currently in shortage” by the FDA.
The shortages can mean Type 2 diabetes patients have to switch to another medication, which may not be as effective, NBC News reported.
“Having more medications that are slightly different is a good thing because some people may respond better to one and some may respond better to another,” Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian, previously told TODAY.com.
There’s currently more data supporting additional health benefits of Wegovy, Tchang adds. She points to a study funded by Novo Nordisk that found Wegovy can reduce the risk of heart attacks and strokes by 20% in adults with heart disease and obesity. Tchang is an advisor for Novo Nordisk, the pharmaceutical company that makes Ozempic and Wegovy.
Eli Lilly, the maker of Mounjaro and Zepbound, has trials underway looking at how Zepbound may impact obstructive sleep apnea and heart failure, with results expected this year, former FDA Commissioner Dr. Scott Gottlieb told CNBC on Jan. 2.
If the findings are positive, they’ll support the case for using these drugs to reduce health risks associated with weight gain, he added.
What foods to eat and avoid
Patients should commit to eating healthier food as the medications are reducing hunger and cravings for unhealthy options, Dr. Zhaoping Li, professor of medicine and chief of the division of clinical nutrition at the University of California, Los Angeles, previously told TODAY.com.
Experts recommend focusing on lean protein, fruits and vegetables, and healthy fats.
Be sure to drink plenty of water because these medications can suppress the ability to sense thirst, leading to side effects like constipation, Tchang says.
“We don’t realize how much water or liquid we drink when we eat meals and if we’re eating less, then we are actually hydrating less as well,” she notes. “So we do have to be more attentive and intentional about getting in enough water during the day.”
It’s best to avoid foods high in fat or sugar, which tend to make the side effects worse, she adds. Greasy foods are slower to digest and tend to stay in the stomach the longest, potentially leading to nausea and excessive fullness, as TODAY.com previously reported.
How to exercise when taking weight-loss drugs
The drugs are meant to be used in the context of increased physical activity, according to the FDA.
Strength training is particularly important because people can lose muscle mass when they lose weight rapidly with these medications, Tchang cautions. She recommends doing strength training two or three times a week to preserve muscle mass while losing fat.
Bottom line:
It’s important to talk to your doctor about whether these drugs are right for you.
When considering taking them, every person needs to weigh the risk-benefit to themselves, including how continued obesity will affect their health, Tchang says.
“For a lot of my patients, I know they have struggled with obesity for all of their childhood and adulthood already, and the benefits outweigh the risks as soon as they start the medication,” she says.
“Certainly, I think (the drugs) will put a dent in the obesity epidemic… It’s remarkable and I think it gives us so much hope.”
