Wegovy®, Ozempic®, MounjaroTM – Dissecting the Diabetes / Weight Loss Medication Trend

In this article, we’ll discuss a new trend that started online and has taken the social media world by storm. The trend is so popular that patients, once relying on the injections we are about to discuss, now have difficulty finding them to manage their diseases. This trend is using newer diabetes and weight loss medications, including Semaglutides like Ozempic and Wegovy, and other diabetes drugs like Mounjaro for weight loss, even if the patient does not qualify by FDA standards.

Let’s discuss some background. When a new drug is developed, the FDA must analyze clinical trial data and approve (or deny) it based on a strict set of criteria and only for certain patients that meet those requirements. For example, semaglutide, the active ingredient in Ozempic, was first approved for diabetic patients to help regulate insulin secretion from their pancreas and control diabetes. Research, however, showed that along with good diabetes control, this drug could also help patients lose weight. Due to a relatively favorable safety profile, the same pharmaceutical company received approval for the same drug but with a different indication or use – weight loss in patients with a BMI over 30 regardless of comorbidities or a BMI over 27 with one or more weight-related problems. Meet Wegovy.

However, physicians can prescribe off-label – this means prescribing a drug for conditions other than what it is approved for. In other words, if the physician believes that a medication or treatment can benefit the patient, they can prescribe it even if the patient is not part of the population for which the drug was developed and approved. And this is precisely what’s happening.

The Situation

Because of the incredible demand for these injections and the ability of certain medical professionals to prescribe them off-label, patients who only wish to lose a little weight, or do not have diabetes, are creating a distinct shortage throughout the US and the world. Patients who depend on these diabetes medications to control their blood sugar have difficulty finding them. Similarly, patients who rely on weight loss drugs to treat obesity often discover they can no longer access their injections. Instead, celebrities and regular people alike are getting a hold of these medications to lose relatively little weight – an amount that might be better managed by employing a diet and exercise program.

The Concerns With This Trend

• The concern with prescribing medication this way is obvious – patients who genuinely need it are having trouble finding it – and this can be problematic and even dangerous. Further, it’s not as simple as changing medication.
• Remember that drug therapy is only effective if the patient takes the medication. Once they stop, they are likely to gain most, if not all, of their weight back unless they have made significant lifestyle changes during that time to maintain the gains. Is this truly sustainable for life?
• Of course, there are also side effects associated with Semaglutides, including nausea, vomiting, diarrhea, pancreatitis, fatigue, muscle mass loss, and more.
• For patients with a BMI of 40, 50, or more, these drugs can be helpful but will likely not provide enough weight loss effect to match bariatric surgery, which remains the only long-term effective weight loss option for patients with morbid obesity.

Is There a Legitimate Use for These Drugs?

The short answer is that there is absolutely a use for these drugs, even in the bariatric world, as they are highly effective. We often rely on these drugs for certain patients that need them. For example, if a patient begins gaining some weight after a successful bariatric procedure, these medications may be vital to getting them back on track. Similarly, long-term medication therapy may help improve or resolve diabetes in the small number of patients that do not see resolution after surgery; of course, there is also the contingent of patients that aren’t suited to bariatric surgery and would benefit significantly from weight loss medication.

Further, most bariatric surgery patients have made significant progress in changing their lives. As such, they are more likely to keep the weight off after they no longer take the drug.

However, in all these use cases, we have determined that the potential side effects and considerations of taking the drug are lower than the risk of continuing to live with the disease or condition. As such, every time a treatment is prescribed, we ensure that the patient will truly benefit, that it is the best option for them, and that it will not deprive others that need it.

The Case for Bariatric Surgery

This brings up the argument for bariatric surgery, the only long-term proven solution for many obesity-related diseases from which those with excess weight suffer. While bariatric surgery may seem extreme at first glance, the risks of surgery are very low, especially when considering the health improvements if a patient is genuinely dedicated to changing their health for the better. Sadly, the shortage of these weight loss and diabetes drugs also shows how we are still looking for the easy way out of our excess weight epidemic and must do more to change the tide.