INDIANAPOLIS — Chances are your circle of friends or family is talking about Ozempic — not to treat diabetes, but for weight loss.
Ozempic, or Semaglutide, is a weekly injectable for those with type 2 diabetes. However, last year, Dr. Teri Greco, assistant professor of clinical medicine at Indiana University School of Medicine and a staff physician at Eskenazi Health, began having more conversations with patients wanting to use it for weight loss. Her diabetes patients were having a difficult time finding the medication as a result.
The FDA has not yet approved Ozempic for weight loss.
Greco said patients will want to be aware of a couple things.
Since the medication is prescribed off-label, insurance doesn't usually cover the cost. Out of pocket, Ozempic costs anywhere from $1,000 to $1,600 per month.
Patients may not be a candidate if they have thyroid cancer, endocrine disorder or pancreatitis.
"If you are wanting to take Ozempic for more short-term or cosmetic weight loss, you have to be aware that once you stop that weight loss, you're probably going to gain all of the weight back," Greco said.
Greco said that's because the medication mimics a hormone produced in the gut, which acts on different areas of the body.
"The first action is your body produces insulin in response to a really sugary, carb-heavy meal. The second is that you have decreased stomach emptying. After you eat a meal, it takes longer for your stomach to empty, so you feel fuller," Greco said. "It may act on hunger cues in the brain, meaning that it may decrease appetite, as well as cravings. Once you stop that medication, all of those actions stop, so you kind of go back to baseline. Unless you've made significant (changes) in your diet or exercise routine, you likely would gain the weight back Greco said.
Side effects can include nausea, vomiting, diarrhea and constipation, which Greco said usually improves over time but not in everyone.
Greco said she would begin by trying to lose weight the old-fashioned way with diet and exercise.
"Most physicians will agree that this is a long-term medication. This is not something you would take short-term to lose 10 pounds," Greco said. "It's typically a long-term medication for the treatment of type 2 diabetes but also patients are using it for obesity."
Eli Lilly is working to develop a pill that's similar to the Ozempic shot. While Greco said it looks promising, it's very early in the process to know if it'll be a good fit.
Greco said Mounjaro is similar to Ozempic in that it mimics the gut hormone, but it also mimics the actions of a different gut hormone, GIP. Side effects are similar to Ozempic.
In 2022, a clinical trial evaluating the effectiveness of Mounjaro showed participants taking the 5 mg dose lost around 15% of their body weight, which is similar to Ozempic, but as the dosage increased, participants lost more weight.
Trial participants taking the 15 mg dose lost around 21% of their body weight. This means that individuals may be able to lose more weight with higher doses of Mounjaro.
Metformin is an oral medication prescribed for patients with type 2 diabetes to help control their blood sugar. It is especially effective in patients with insulin resistance, which is a decreased sensitivity to insulin. Metformin works by lowering the amount of sugar released from the liver and by making the insulin produced by the body work better. It occasionally is prescribed off-label for weight loss, but it has side effects of abdominal pain and diarrhea, which occur in a significant amount of patients.
The average weight loss over a year with Metaformin is around four to seven pounds. Weight loss is usually significantly less as compared to Ozempic or Mounjaro.