“The Wegovy data is very exciting news,” says Dr. Mohini Aras, an obesity medicine specialist at NewYork-Presbyterian/Weill Cornell Medical Center. “We want people to treat obesity as a chronic medical condition that requires medical management.”
Dr. Aras spoke with Health Matters about how drugs like Ozempic and Wegovy work, who should (and shouldn’t) take them, and their risks and side effects.
How do weight loss drugs work?
Dr. Aras: First, it’s important to understand that our brain is designed to defend against starvation and retain our weight. When we lose weight, naturally occurring hormones send a message to our brain to increase hunger and cravings and slow our metabolism down. Our brain even makes our muscles more efficient, so we don’t burn as many calories with the same activity; this is a starvation response. As a result, people tend to yo-yo: They will lose, regain, lose, and regain weight.
Weight loss medications activate the hormones that we naturally produce to regulate weight. There are five different weight loss drugs now approved by the FDA for the long-term treatment of obesity. These medications target appetite and hunger, helping people feel full sooner and stay full longer. They may also impact cravings, thoughts of food, and binge eating.
Who are they recommended for?
Ozempic and Wegovy contain the same active ingredient, semaglutide, and are approved by the FDA to treat obesity and diabetes.
Ozempic is approved by the FDA for the treatment of type 2 diabetes. Wegovy is approved by the FDA for people with a body mass index of 30 or above or people with a BMI of 27 or above who also have a weight-related medical condition.
The purpose of these medications is not to just drop down a clothing size.
Weight affects so many chronic medical conditions, including diabetes, high blood pressure, cholesterol, fatty liver, and certain cancers — as well as issues like sleep apnea and osteoarthritis. Our goal with weight loss is to improve these conditions, and even a modest weight loss of 5% to 10% can make a difference.
How are these medicines taken?
Ozempic and Wegovy are once-weekly injectable medications. They come as a pen, and you do the injection yourself at home. It’s a subcutaneous injection, so you can do it in your upper thigh, in your abdomen, or in your arm, and it’s a tiny needle that is just enough to poke the skin — so it’s not too bothersome for people.
The oral version, taken once a day, will further open up options for people and allow for individual preferences. Also, the pills are easier to transport, as opposed to the injectables, which have specific temperature requirements.
How can you get a prescription?
We require a comprehensive medical evaluation, including labs, vitals, and a full medical history. We tailor individual plans for patients, with the foundation being diet and physical activity, and select appropriate weight loss medications that can help support the hard work that they are doing. We also have a team of providers, including registered dieticians, nurse practitioners, and physicians, who aid patients in achieving their health goals.
We don’t prescribe Ozempic or Wegovy to patients who have histories of gallbladder disease, pancreatitis, or family histories of medullary thyroid cancer or rare disorders of the endocrine system.
How much do they cost?
These medicines are quite expensive if they’re not covered by insurance — from $900 to $1,400 a month. We have an entire pharmacy team dedicated to processing the authorizations required by insurances to try to obtain these medications for our patients.
Obesity is chronic, so when we start a medication, we have to plan for it long-term. Given the cost of being on these medications, most of my patients wouldn’t be able to afford these drugs without insurance coverage. Medicare and Medicaid do not cover anti-obesity medicines.
What about the new weight loss drugs being developed?
The first anti-obesity medicines were stimulants that were approved in the late 1950s, and we’ve seen a lot of advances in the field of obesity medicine in the last 10 years.
On the near horizon as an anti-obesity medication is Mounjaro, which is currently FDA-approved for the treatment of type 2 diabetes. Mounjaro (tirzepatide) could lead to even more weight loss than Ozempic or Wegovy because it activates two gut hormones instead of one.
Both Ozempic and Wegovy may also soon be available in the form of a daily pill, and two recent studies showed that the oral versions are about as effective as the injectables. Taken once a day, they will further open up options for people and allow for individual preferences. Also, the pills are easier to transport, as opposed to the injectables, which have specific temperature requirements.
Recently, another study was published about a drug called retatrutide. It activates three gut hormones, and according to the study, it helped patients with obesity lose an average of 24% of their body weight over 48 weeks.