What you need to know about Ozempic, the new diet drug

We, doctors and patients, have been hoping for a solid weight-loss drug for all of human history. Currently, obesity affects 42% of Americans; by 2030, the number will reach 50%. We need help.

The problem is complex. It’s social, biological, environmental. Thus, success of the new diet, GLP-1 like drugs (Ozempic, Mounjara, Saxenda, etc.) deserves the rave. But they aren’t a panacea.

I hear celebrity claims – like Sharon Osbourne, Ozzy Osbourne’s wife – of losing a whopping 42 pounds on Ozempic yet warning others not to use it.

What’s up?  

GLP-1, glucagon-like peptide 1, is a natural appetite-regulating hormone. And scientists have identified dozens of other appetite hormones/chemicals. The potential for other or better drugs is good.

We have five GLP-1 like drugs. The first, exenatide (Byetta), has been around for almost 2 decades, long enough that we know they’re good for sugar and blood pressure, protective of hearts and kidneys.

They tell our brains that we’re not that hungry and slow down stomach emptying to reinforce that message.

Taken alone (that is, without other diabetic drugs), they rarely drop blood sugar and are safe to use in non-diabetics.

You ask, “What’s the difference between Wegovy, Ozempic, and Mounjaro, which all carry the same obscene price tags?”

The Danish drugmaker Novo Nordisk owns two of the five GLP-1 like golden geese – semaglutide and liraglutide. Only Wegovey (active ingredient: semaglutide) and Saxenda (liraglutide) are approved for weight control.

Novo Nordisk sells semaglutide under three brand names – Ozempic, Rybelsus, and Wegovy (monthly cost: $936, $936, $1349).

The biggest difference is strength. Approved for diabetes, Ozempic (a weekly shot) and Rebylsus (a daily pill) deliver lower doses of semaglutide.  

Approved for weight loss, Wegovy (a weekly shot) delivers a higher dose. So technically, if you’re given Ozempic for weight loss, it’s off-label use.

Novo Nordisk also sells liraglutide as Victoza for diabetes and Saxenda for weight control ($745, $1349). Saxenda (a daily shot) is not as strong a weight loss drug as Wegovy.

Other good news: a third GLP-1 drug, tirzepatide (Mounjaro, weekly injection, $1000 per month), from Eli Lilly, is associated with even greater weight loss in trials. Tirzepatide mimics not one, but two appetite hormones. It’s expected to be approved for weight loss by the end of the year.    

You ask, “How do these drugs compare with the older diet pills and gastric bypass?“

Well, GLP-1 like drugs are better than the older pills – and are close but not as good as what bypass can do.

What’s average weight loss? For a person who is 5 feet 5 inches tall and weighs 250 pounds: older diet pills bupropion-naltrexone (Contrave), orlistat (Xenical, Alli), phentermine-topiramate (Qsymia) range from 12 to 30 pounds; Wegovy at 37 pounds; Saxenda, 12 pounds; Mounjaro, 50 pounds; and gastric bypass, 60 to 80 pounds.

Like gastric bypass, drug-induced weight loss will plateau. Some do better or worse. But unlike gastric bypass, a more permanent solution, weight can return if you stop the drug.

Regardless, I believe these new and yet-to-come drugs will rewrite the chronic disease that is obesity. Money is pouring into this area of research. Denmark-based Novo Nordisk’s market value ($419 billion) now exceeds the country’s GDP ($409 billion). I pray, I hope the competition will bring down the cost so all who need it can benefit.