Ozempic, Rybelsus, Wegovy, Monjauro, OH MY
Lately, it seems some diabetes medications have taken on a whole new life in the spotlight with med spa giveaways, feature news stories, and catchy commercials that I even catch my kids randomly singing. Some of these meds have caught the attention of people without diabetes too, specifically the medications that lead to weight loss. This has led to supply chain shortages, fake products, and the manufacturing of products in short supply by compounding pharmacies. This is a problem because compounded meds are not FDA approved or evaluated for safety, quality, or effectiveness and there have been adverse reactions reported.
Perhaps you are taking or have considered taking one of these medications. The information I will present here is not meant to steer you in one way or another and I am not advising or recommending for or against any medication. Medication decisions should be discussed with your medical practitioner. What I do hope to offer here is information that you can use to guide your conversations and make informed decisions.
As of this writing, semaglutide, which belongs to a class of drugs called Glucagon-like peptide-1 (GLP-1) agonists are in the spotlight. There are currently three FDA-approved semaglutide products: Ozempic, Rybelsus, and Wegovy. There’s also a similar medication called Mounjaro. Ozempic, Mounjaro, and Wegovy are taken as once-weekly injections. Ozempic, Mounjaro, and Rybelsus are approved as a treatment for type 2 diabetes, while Wegovy is approved for adults and children 12 years of age and older with “obesity” or “overweight with weight-related medical problems.” These drugs act to lower blood sugar and induce weight loss in a number of ways, including stimulating insulin secretion after eating, slowing digestion of food in the stomach (a.k.a. delayed gastric emptying), and inhibiting the release of stored glucose (known as glycogen) from the muscle and liver cells if blood sugar is already high. In sum, this leads to more insulin, less glucose, and slower food digestion. Those taking the drug report less hunger and longer satiety due to the drug’s effect of slowing digestion, and for many, this means they eat less.
While you might be thinking that less hunger and lower blood sugar sounds great, let me pause you right there. Do you know about the FDA’s black box warning? These drugs were found to cause thyroid c-cell tumors in animal testing. Other adverse events reported include nausea, vomiting, intestinal blockage (ileum), diarrhea, acute kidney injury, dizziness, mild tachycardia (elevated heart rate), infections, headaches, dyspepsia, skin irritation at the injection site, and low blood sugar. Patients taking this medication report nausea and vomiting with more than a toddler-sized food portion, hair loss due to rapid weight loss, and rebound weight gain. Despite the reports of significant weight loss and metabolic improvements using GLP-1 agonists, patients who have used and then discontinued use of the medication have reported immediate weight regain. This was confirmed by a 2022 study that found that one year following the discontinuation of once-weekly semaglutide, participants regained two-thirds of their prior weight loss and any positive cardiovascular or metabolic changes while on the medication were also lost.
In addition, these GLP-1 agonists cannot be taken during pregnancy, so women of childbearing age are advised to use contraception. Further, this medication should not be used in people with kidney disease, gastrointestinal disease, or any history of pancreatitis. There is concern over the long-term effects of this medication on the thyroid as well. Plus, without insurance coverage, the drugs are extremely expensive, with some patients reporting a cost of $1400 per month. All of this, plus the increased risk of organ damage and lack of long-term safety data lead many health professionals to remain skeptical and fearful for the malnutrition, weight cycling, and other negative effects that will likely result. I believe in patient autonomy, so if you take one of these meds or decide to start one, at the recommendation of your physician, I support you. However, many people in larger bodies are feeling pressured to use one of these products and you too have the full autonomy to ask for other options.
References:
Collins L, Costello RA. Glucagon-like Peptide-1 Receptor Agonists. [Updated 2023 Jan 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/
Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564.
https://fortune.com/well/2023/03/14/ozempic-wegovy-what-happens-when-you-stop-taking/