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Treating Obesity with Diabetes Drugs Growing in Popularity

Obesity affects nearly half of American adults and costs the U.S. nearly $150 billion in healthcare spending each year, making it one of the most significant and costly health conditions. Obesity is associated with a laundry list of issues such as diabetes, heart disease, certain cancers, sleep apnea and even early death. For decades, the standard course of treatment has been diet and exercise. But as obesity rates continue to climb, a new approach is here: antidiabetic drugs semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro).

Ozempic and Wegovy have gained a lot of attention in recent months. The Food and Drug Administration (FDA) first approved Ozempic as a diabetes treatment in 2017. While Ozempic is intended to combat diabetes, the drug has a secondary effect: significant weight loss. As a result, some doctors began prescribing the medication for off-label use as a weight-loss aid. In response, people looking to lose weight started seeking Ozempic prescriptions from their doctors and even online. In 2021, the FDA approved a higher-dose semaglutide drug, Wegovy, for weight loss and obesity treatment.

How it Works and Efficacy

Sold under the brand names Ozempic and Wegovy, semaglutide functions by mimicking a hormone called glucagon-like peptide-1 (GLP-1), which is involved in regulating insulin and blood sugar levels. GLP-1 also helps signal fullness and satiety to the brain and prompts the stomach to empty more slowly. As a result, users feel fuller faster and eat less overall. In many cases, users no longer feel a preoccupation with food and stop experiencing intense cravings that contribute to overeating as well.

Another drug on the rise is tirzepatide, sold under the name Mounjaro. Mounjaro works similarly to Ozempic and Wegovy by reducing appetite and regulating blood sugar. But unlike semaglutide, which targets only GLP-1, tirzepatide targets both GLP-1 and another hormone called glucose-dependent insulinotropic polypeptide (GIP). The combination enhances tirzepatide’s efficacy. Mounjaro is currently FDA-approved for diabetes, but not yet approved as a weight-loss treatment.

Side Effects and Risks

While these drugs offer promising benefits, semaglutide and tirzepatide come with potential side effects and risks to consider, including nausea, fatigue, dehydration and changes in bowel movements. In rare cases, semaglutide may increase the risk of pancreatitis and gallstones. And in very extreme cases, some users may become malnourished from an overly suppressed appetite. Patients should be closely monitored by a healthcare provider to address any potential side effects. It’s worth noting these drugs are only effective when combined with diet and exercise, and need to be taken indefinitely to maintain results. Going off these drugs can lead to increased blood sugar and a resurgence of hunger, cravings and can result in regaining around two thirds of lost weight.

Additionally, these medications are expensive, with Wegovy and Ozempic priced at over $1300 and $892, respectively, for a 28-day supply. Even with a doctor’s prescription, they may not be covered by insurance depending on benefit plan design. This can be especially true for people who don’t meet the FDA’s diagnostic criteria or for plans that don’t cover weight loss drugs. However, the reported cardiovascular benefits of these drugs may influence insurers to provide coverage.

An Effective Obesity Treatment, Not Cosmetic Cure-All

Many view obesity as a moral failing rather than a chronic disease, assuming that if someone is overweight or obese, it’s because they eat too much, move too little or lack the self-control to make lifestyle changes. However, obesity is more complex than a lack of willpower. For some people, movement and calorie-counting isn’t enough. Some people are genetically predisposed to insulin resistance, for example, and therefore experience abnormal fat storage. Others may turn to food as a way to deal with stress, sadness or other emotions. There are also certain social factors – such as socioeconomic status, access to nutritious food and even race – that contribute to a person’s likelihood of becoming obese or overweight.

In clinical trials, Mounjaro helped obese patients lose up to 26 percent of their body weight. Ozempic has been shown to help patients lose up to 15 percent of their body weight. In comparison, numerous studies show that diet and exercise lead to about a 5-10 percent average weight loss. Drugs like semaglutide and tirzepatide, paired with a healthy diet and exercise, have the potential to change the game for how we approach obesity, as well as help many people live healthier lives.

Experts stress, however, that these medications are not intended for normal-weight individuals looking to lose weight for cosmetic purposes. There’s concern that semaglutide and tirzepatide are becoming associated with vanity, instead of as the critical diabetes and obesity medications they are. Overall, those who struggle with obesity and can’t lose enough weight with diet and exercise alone may be good candidates for these drugs and can consult a healthcare provider to learn more, while continuing to pursue a healthy diet and exercise regimen.

[Hannah Sabitoni]

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