In the ever-evolving weight loss solution space, diabetes medications such as Ozempic, Mounjaro and Rybelsus have been stealing the spotlight in recent years. With a surge of articles and stories populating our Instagram feeds and TV channels, these medications have sparked a wave of curiosity and debate. Are they the game-changers they're touted to be in the realm of weight loss? How safe and effective are diabetes medications when used for weight loss? And how do you know if they’re right for you?
We spoke with Sesame’s medical director, Dr. Alison Edwards, MD, to answer some of the most pressing questions about the safety, efficacy, side effects and other considerations of using diabetes drugs for weight loss.
Q: Dr. Edwards, how have diabetes drugs - which were originally intended to regulate blood sugar levels - found a place in weight management?
A: Great question! Medications like semaglutide (Ozempic, Wegovy), liraglutide (Saxenda) and tirzepatide (Mounjaro) belong to a class of drugs called GLP-1 receptor agonists. These drugs mimic a hormone that targets areas of the brain that regulate how hungry you are, and how much food you consume, among other things.
They were originally developed to help patients with type 2 diabetes to regulate their blood sugar levels, but patients who were being treated with the medication noticed another side effect: weight loss. Basically, the medications were not just affecting insulin and blood sugar levels - they were helping to regulate appetite.
Researchers then began conducting clinical trials specifically to evaluate the efficacy and safety of these drugs for weight loss in non-diabetic individuals. The results were promising - people who took those drugs showed significant weight loss compared to placebo groups. This led to the U.S. Food and Drug Administration (FDA) approving certain GLP-1 receptor agonists for chronic weight management. For instance, liraglutide was first marketed as Victoza for diabetes and later as Saxenda for weight loss. Similarly, semaglutide - marketed as Ozempic for diabetes - was approved for weight loss at a higher dose under the brand name Wegovy.
Q: How do diabetes drugs like semaglutide, liraglutide and tirzepatide aid in weight loss?
A: These drugs, called GLP-1 receptor agonists, mimic the naturally occurring hormone GLP-1. GLP-1 is created within the gut and has a variety of effects all over the body. These effects eventually lead to the beneficial things we see when we take these medicines: reduced hunger/appetite, lower blood sugar through a couple of different mechanisms, and an increase in the time it takes for your stomach to empty, which helps you feel full longer.
Q: Are there any serious side effects of using these medications for weight loss?
A: The most common side effects for GLP-1 medications are typically gastrointestinal - nausea, constipation, vomiting and diarrhea were all reported during clinical trials.
However, there are concerns about more serious issues like pancreatitis, kidney disease, and increased risk of thyroid cancer in animal studies, as GLP-1 medication impacts those specific organs and glands. For that reason, providers are highly unlikely to prescribe GLP-1s if you have a history of pancreatitis, kidney conditions or a history of thyroid conditions in yourself or certain types of thyroid cancer in family members.
Other serious side effects include vision changes, low blood sugar (hypoglycemia) and allergic reactions like skin rash, swelling or breathing difficulties.
Q: What does 'off-label' use mean in the context of these drugs?
A: That’s a really important question! “Off-label” use means that someone is prescribing medication for a reason that the FDA hasn’t specifically approved. While some GLP-1 receptor agonists are FDA-approved for weight loss in people without diabetes (like Wegovy and Saxenda), using other diabetes medications primarily for weight loss falls into this category of “off-label” use.
Q: What should be considered before starting these medications for weight loss?
A: Individuals should be prepared to discuss their overall health, body mass index (BMI), and personal and family medical histories with their provider.
It’s unlikely that your doctor will prescribe GLP-1 medications if you have a history of pancreatitis, kidney disease, high blood pressure, heart disease, gallbladder problems, certain eye problems (retinopathy), Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), or a family or personal history of thyroid disorders such as medullary thyroid carcinoma, as GLP-1 medications may exacerbate those conditions.
It’s also unlikely that you’ll be prescribed a GLP-1 medication if you’re pregnant, trying to become pregnant, or breastfeeding - these medications have not been studied in pregnant or breastfeeding women, and it’s unknown if the hormones can pass through breastmilk.
Q: Is there a difference in dosage for weight loss compared to diabetes treatment?
A: Yes, often the dose for weight loss is higher than that used for diabetes treatment. This needs to be carefully managed to avoid adverse side effects.
Q: Are these drugs covered by insurance or Medicare for weight loss?
A: Generally, GLP-1 medications like Wegovy, Ozempic, Saxenda and Mounjaro are considered premium-priced prescription drugs, but the cost is largely dependent on your insurance status,
If you’re insured, the price of these medications depends on the rates negotiated by your insurer - it’s best to call your insurer directly to understand your coverage and out-of-pocket costs. Without insurance, these medications can range anywhere from about $950 to $1,600 per month.
Q: How do these drugs compare to other weight-loss methods?
A: In clinical trials, these medications have shown significant weight loss compared to lifestyle changes alone. However, they are not a substitute for a healthy diet and exercise - they should be part of an overall weight management plan.
Q: Are there any long-term studies on the safety and effectiveness of these drugs for weight loss?
A: GLP-1 receptor agonists have actually been around for some time. They were discovered in the 70s, and the first one to be approved by the FDA for the treatment of type 2 diabetes - exenatide - was approved in 2005. So even though they’re getting quite a bit of publicity lately, they have more than 3 decades of research behind them.
As clinical trials and post-marketing surveillance continue, the medical community will keep gaining insights about the safety and effectiveness of GLP-1 receptor agonists, but the drugs and their actions - such as their impact on weight loss and diabetes - have a strong clinical foundation.
Q: What kind of advice would you give to patients who are wondering if diabetes drugs for weight loss are the right choice for them?
A: The use of diabetes medications for weight loss represents a pretty significant advancement in obesity treatment. However, as with any medication, there are risks and benefits that must be weighed carefully. It's vital to have a thorough discussion with your healthcare provider to understand the implications, especially where it concerns potential side effects, your personal and family medical history, and long-term impacts on health – staying informed and asking questions is key to making safe and effective health decisions!
