The recent social media buzz about Ozempic and Wegovy has made the injectable weight-loss drug a household name. The so-called miracle diet pills have been in short supply and are even facing a nationwide shortage.
Ozempic is currently FDA-approved to treat type 2 diabetes, but doctors often prescribe the weight-loss drug off-label. Wegovy is the same drug as Ozempic, which is FDA-approved for weight loss.
The excitement about this class of drugs is well deserved. They are glucagon-like peptide 1 agonists, or GLP-1, that mimic the actions of hormones in the body that help regulate blood sugar and appetite. They are more effective at losing weight than other obesity drugs.
“They mimic the exact same things that happen naturally or should happen in the body in that they increase your satiety, or satiety,” says Dr. Lydia Alexander, chief medical officer and chair of obesity medicine at Enara Health. As a result, your appetite is suppressed and you eat less.
Monika Smyczek, 40, who started Wegovy in the summer of 2021, says it makes her forget about food in the most pleasant and gentle way.
“In a way, it feels like a miracle drug,” she said. “It allows me to limit my calorie intake in a sustainable way. As someone who has a fraught relationship with food, it feels really good not to have to battle this thing that's always been on my mind.”
These drugs are best for those who need “significant” weight loss, meaning at least 40 pounds or more, especially if you have at least one obesity comorbidity, such as high blood pressure, cholesterol or sleep, Alexander said Apnea. And the health benefits are significant.
“For example, we know that people with a BMI over 40 or 45 live eight to 10 years less than people without a BMI, which is equivalent to being a smoker,” she said. “Thus, long-term weight loss can improve quality and quantity of life. By treating obesity, we get to the root cause of many different chronic diseases that primary care providers treat.”
Discontinuation of GLP-1 drugs
Liz Baker, 46, has had no trouble losing the pounds she gained during pregnancy after the birth of her third child. But after a few months, she noticed that the weight was slowly coming back, even though she was still breastfeeding and hadn't changed any diet.
“I saw my endocrinologist and said, ‘Hey, there's something going on here that has nothing to do with willpower,'” she says.
Her doctor agreed and prescribed Wegovy. Eight months later, Baker had lost 50 pounds. Other than some early nausea and vomiting, everything went well. Then all of a sudden, her insurance informed her that they were no longer covered.
Wegovy's average out-of-pocket costs are $1,400 per month, which means Baker can't afford to think about it financially. She is off the drug.
Over the next six months, she regained all the lost weight and gained 10 pounds. In addition, her A1C and fasting blood sugar levels were elevated, putting her at risk for diabetes—a problem she had never had before starting the medication.
“I didn't know it would change so quickly,” she said. “I've reached my ideal weight and shape and am very comfortable and happy with where I am. Then, boom. My appetite and cravings have been going crazy for a while. I'm hungry all the time. I've been wanting Eat candy.”
In the end, she and her doctor put her on Mounjaro, a GLP-1/glucose-dependent insulinotropic polypeptide (GIP) combination drug approved by the FDA in 2022 to manage blood sugar control in people with type 2 diabetes .
So far, she's lost 18 pounds. Mounjaro is not yet approved for weight loss treatment, but Baker's insurance is currently covering her because she is prediabetic.
The high cost also forced Smyczek to abandon her “magic bullet.” She rearranged her household budget to be able to pay the $800 monthly “special,” but once that ran out, the price shot up to $1,400.
“For a split second, I thought, ‘Well, what do I have to do to afford this drug? Do I need to work another job?'” she said. “Then I realized it was time to explore other approaches that might work.”
Of the 40 pounds Wegovy lost, Smyczek gained 25 more, and she says she's trying not to feel too disappointed in herself.
“I'm trying to be kind to myself,” she said. “The problem is, without drugs, it's as if you don't have to build the skills you need, and you don't learn how to deal with hunger or cravings or things that inevitably come back.”
a long-term medical condition, not a personal failure
GLP-1 drugs are typically not used for cosmetic or cosmetic purposes, or for quick fixes, said Dr. Amanda Velazquez, director of obesity medicine at Cedar Sinai Surgery and acting assistant professor of surgery and medicine.
They are considered long-term medications for obesity, like the treatments you take to control blood pressure, high cholesterol, or diabetes.
“Obesity is a disease in which the body will work against you for a long time,” she said. “So to prevent these biological stresses from working against you, we need drugs. Once you stop the drugs, the weight comes back.”
A 2022 study looked at what happened after stopping Wegovy and found that people regained two-thirds of the weight they lost while taking the drug.
“The goal with these drugs is always to align it with healthy behaviors, and it can help patients stick to those healthy behaviors more easily because it helps the physiology work together,” Velazquez said. “However, if you stop taking the drug, And the physiology goes back to trying to make you hungry, lower your metabolism, and sabotage your efforts, and it's going to be very difficult to maintain that weight loss.”
Monica admits she believes she needs to be on medication for life to maintain a healthy weight, but is trying to “do it mentally”.
“What I struggled with was that food culture had completely infiltrated my worldview,” she says. “Eating culture doesn't view obesity as a chronic disease. So even knowing that it's a long-term obesity drug that should be taken, I still feel like the message is just: lose weight by whatever means are necessary. But then? After What will happen?”
Baker, who was already on several other long-term medications such as thyroid therapy, saw it from a more immediate and practical perspective.
“Among other things, I knew that this weight thing was chemical, and it wasn't something I could use willpower to get rid of,” she said. “If I had to take something for the rest of my life to help me manage it and keep me from type 2 diabetes, I could cope.”
