PATIENT BLOG ORANGE COUNTY OZEMPIC

The Doubting Doc- Ozempic, Wegovy, Mounjaro…Oh My! Weight Loss FAQ’s

Let’s play a short game of Jeopardy…
 
Answer:
I need to lose weight
I’m overweight
I’m obese
I’m fat
I’m going to stop eating carbs
No, meat
No, gluten
No, dinner
I’m going to exercise more–at least twice a week
 
Question:
What does a typical doctor hear 99 times a day from their patients?
 
Especially post Covid, we are seeing more obesity than ever. Recent studies put at 80% the number of people over their ideal body weight.
 
With obesity comes obesity humor. While its felt to be in poor taste to fat shame anyone, since MY BMI is teetering around 30, maybe I should poke fun at myself.
 
Why does me remembering my diet not kick in until my 10th donut?
or
My wife and I went on a diet and lost 10 pounds combined…she lost 20 just herself!
 
We define obesity as a BMI over 30. (All you need to calculate your BMI is your height, weight, and Google.) As doctors, our advice has been very simple over the years- diet, exercise, reduce stress, and if all else fails, have surgery to shrink the stomach.
 
But weight loss surgery seems a bit extreme for most, and diet pills had their share of issues- some are not safe or are addictive. Others have poor long-term results. Most were only good for 20 pounds. Few were FDA approved for weight loss.
 
Introducing…the current game changer for weight loss in patients who need to lose 25 or more pounds!!
 
GLP-1 agonists.
 
In plain English, they reduce hunger and food intake at the biochemical level. They are considered by the medical community to be safe and effective.
 
The three most popular choices are Ozempic, Wegovy, and Mounjaro. Since we don’t have a horse in this race, let’s discuss each one to see if any may be right for you or a loved one. Remember, Caduceus never allows drug “detailing,” so no Laker tickets were used in preparation for this blog. Not even a coffee cup.
 
Ozempic (Semaglutide)
 
It is FDA approved for Type 2 Diabetes—it is NOT FDA approved for weight loss, but patients who take it tend to lose weight—10-15% of body weight is common. Many patients have been able to reduce or go off diabetic, lipid, and hypertensive medications with the weight loss. It requires a weekly shot and a monthly follow-up. Once weight loss is established, it is safe to continue taking it long term. In fact, going off of it risks returning to you to your original weight.
 
Wegovy (Semaglutide)
 
It is an identical version of the drug Ozempic – with a few differences. For one, the dose used can be higher, resulting in higher weight loss. For another, it IS FDA approved for chronic weight management, and NOT for diabetes. You will need a BMI of 30, or 27 plus a “co-morbidity” such as hypertension or high cholesterol for FDA approval and insurance payment. Otherwise the cost, weekly shots, and monthly long term follow-ups apply to both.
 
Mounjaro (Tirzepatide)
 
It is a GLP-1 agonist plus it inhibits a second peptide that curbs appetite and produces “early satiety”–i.e. you feel fuller faster. It is FDA approved for diabetes but has an application into the FDA for approval for weight loss. It is expected to be approved, which would give it the distinction of the only medication that is FDA approved for both diabetes AND weight loss. In fact, the FDA has agreed to “fast-track” its weight loss approval. It also is the same weekly shot story, but the dose can be pushed even higher than the semiglutides. In head-to-head studies, Mounjaro has the highest weight loss, but the most side effects. The cost is comparable.
 
There were “Hollywood whispers” that Adele, Rebel Wilson, and Kim/Khloe Kardashian all have used these medications successfully—but in fact all four, they deny it loudly, saying diet and exercise were the methods for their weight loss. Being trusting, we will take them at their word. We do caution our readers that it is very difficult to get a 30-pound weight loss (or more) with diet and exercise alone, especially keeping it off.
 
Since nothing is too good to be true, what are the downsides to taking these meds? I counted five right off the bat.
 
1. They are expensive unless you allow us to get insurance approval. About $450/week, maybe half that if you try to use a compounding pharmacy (see BEWARE below). That is just for the drug itself. Most office visits may be paid for by the insurance company if there is medical necessity.
 
2.They are so popular, no one takes them anymore (Thanks to Yogi Berra for the inspiration) –meaning their popularity has caused severe shortages in some areas. Finding the meds may be tough depending on the doctor and pharmacy you pick. Hopefully the shortages are being fixed.
 
3.The main side effects are GI- nausea, cramping, etc. Some report an intolerance for alcohol. Rare reports of hair loss. These seem more pronounced with Mounjaro.
 
4.To maintain the weight loss you probably will take the medication long term–and still diet and exercise. Seems there’s no getting around that advice.
 
5. You ideally need an experienced provider who can help select the right medication,  know how to get insurance approval if necessary, and correctly adjust the dose monthly.
 
And now for this commercial break—endorsed by the CEO and CMO of Caduceus:
 

• At Caduceus and PDQ Urgent Care and More, we have trained providers to assist you if you feel you may benefit from these medications.
• We can do most of the visits via Zoom telehealth if preferred. 
• We will assist in selecting the medication best suited for you depending on your health conditions and weight loss needed, plus the financial situation. Also, we will work hard to obtain insurance pre-authorization.
• If a compounding pharmacy is to be used, we will vet them for you.
• If you need a quick lesson in giving the subcutaneous shots, we will teach that to you.

My BMI is so high, when I contracted a case of flesh-eating bacteria -they died from exhaustion.


Certainly, there are various options for getting this prescription–let us offer a few cautions.

1. There are hundreds of “online weight clinics” offering these meds with a quick ten-minute video visit. There are too many other legit choices to resort to these; we plead you to use caution.
2. Many “clinics” offer just one drug, and have you enroll in a “subscription” model where you pay one monthly or even yearly fee to cover the compounded medication, office visits, blood work etc. Where subscriptions are great for your TV streaming, beware of using them with your health care. Most legit doctors do not need to resort to a subscription gimmick that ties you down to that provider long term.
3. Beware of providers that do not require blood tests, do not ensure you are up to date on your screenings, or decline to offer to teach you how to give the shots. These are signs of a “mill” and should be avoided.
4. “No need for preauthorization” advertised. Either they may be dispensing counterfeit medications, or using a compounding pharmacy that may or may not be legit.
5. The FDA has announced they will be investigating these meds from compounding pharmacies – why?

Semaglutide is governed by the regulations that restrict compounding pharmacies from making replications of patented therapeutics.

In defiance of these regulations, some compounding pharmacies have compounded semaglutides with other medications, thinking that gets around the FDA scrutiny.

It doesn’t. 

If this is all Greek to you, we get it. Just be very careful accepting “cheap” or “generic” semaglutides. If you cannot vet them, be sure your doctor can.

I for one, am not offended when I am called overweight– I’m much bigger than that.


In Summary:

1. At least three newer medications are available to assist with chronic weight loss management and may be FDA approved and/or covered by insurance.
2. These medications are not addicting, not short term solutions, and recognized as safe and effective by most doctors.
3. They all require a weekly shot, a monthly follow up, and serial blood tests – as well as diet and exercise.  
4. There is NO evidence any celebrity has ever used any of these medications. 
5. Be aware of possible shortages, inexperienced doctors, shady online weight loss clinics, unvetted compounding pharmacies, or poor technique at giving your own shots.

Gregg DeNicola MD CEO & Chairman
Caduceus Medical Group & PDQ Urgent Care & More