Forget About Wegovy and Ozempic for Weight Loss; Here’s a Drug That is Twice as Powerful

By Dr. Mokotoff

Eli Lily’s Monjuro will be the most powerful weight loss drug on the market.

Hardly a day goes by without weight loss drug news. Recently, Ozempic and Wegovy (brand names for the same drug semaglutide) have been popular with the Hollywood, Instagram, and Tik Tok crowds. Ozempic has FDA approval for Type II diabetes, and Wegovy is approved for weight loss without diabetes. Since one of the side effects is weight loss, off-label usage has surged to the point of drug shortages in some locations.

Both drugs are manufactured by the Denmark-based drug company Novo-Nordisk A/S. Ozempic costs about $900 monthly without insurance, and Wegovy $1350. Yes, they are the same drug. They must be given by injection, like insulin.

But Mounjaro (tirzeparte) has been approved for diabetes, pending approval for weight loss. How much better is it than semiglutide? The latter produced an average loss of 15% of body weight in obese patients. In comparison, tirzeparte produced an average loss of 22.5% of body weight. The difference is huge (pardon the pun). For the moment, it costs about $975 monthly, but Eli Lily won’t speculate what they will price it at for weight loss. But you can rest assured it will be significantly higher.

All of these drugs are not without significant side effects. Common ones are nausea, vomiting, low blood pressure, rapid heart rate, abdominal pain, belching, and flatulence. And those are the mild ones. Both manufacturers say these side effects are mild and often pass with chronic use. I wouldn’t bet on that.

Serious, although rarer, are thyroid cancer, kidney failure, gallstones, and passing out. Three questions are 1)How badly do you want to lose weight? 2) Can you afford them? and 3) Are you willing to risk the side effects?

I recall one patient asking her oncologist,” Does this medication have any side effects other than bankruptcy?”

Yet, the market for these drugs is enormous. “More than 40% of American adults, or about 100 million, meet the criteria for obesity of a body-mass index of 30 and above, according to the National Institute of Diabetes and Digestive and Kidney Diseases. More than 30 million Americans have Type 2 diabetes.”

The other downside is if these drugs are stopped, all of the weight is often regained. And there is some evidence that yo-yo dieting can lead to more adverse heart events than being obese and staying that way.

Another more significant question is why drug companies charge more for the same drug. The short answer is that they can. The demand for the holy grail in weight loss medicines is insatiable. People who can afford it and are vain enough will try anything to lose even 5% of their body weight. And many use it (as in Hollywood stars and social media influencers) who are not clinically obese but only mildly overweight.

Most “breakthrough” or “blockbuster” drugs follow a similar pattern. Their pre-release is full of hope, hype, and promises. The release coincides with greatly exaggerated television and media commercials showing beautiful people playing and smiling. The pharmaceutical reps also invade the doctors’ offices to push the drug. Next comes months, or sometimes one to two years, of bad news, like less-than-promised results or side effects. Only after a few years post-release do we finally learn about the true risk/benefit of the drug and who should take it.

Undoubtedly, the US and Western societies have an obesity epidemic. However, only time will tell what role these drugs have, if any, in helping to curb it.

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