If you have been listening to the news, been online or reading tabloids lately, you have more than likely heard about tons of celebrities who are losing massive amounts of weight using “diet shots”. What are they using to accomplish this you might ask? The answer is probably one of two medicines: Semaglutide or Tirzepatide. Semaglutide was originally a drug used for the treatment of Type 2 Diabetes (Ozempic or Rybelsus), and now for weight loss as Wegovy. Tirzepatide was originally marketed as Mounjaro for Type 2 Diabetes and now Zepbound for weight loss.
Semaglutide belongs to a class of drug called GLP-1 receptor agonists. This drug targets the area of your brain (your GLP-1 receptors) that regulates your appetite and how much you eat. It mimics a hormone that you naturally have called incretin, which your body manufactures in the GI tract. Since it targets these receptors, it can help you eat less. It also slows the emptying of your stomach when you eat, so that you feel full longer. It stimulates insulin secretion and lowers glucagon secretion in your body.
Tirzepatide mimics the actions of two hormones. GLP-1, like Semaglutide , and GIP, which stands for glucose-dependent insulinotrophic polypeptide receptor agonist. They work together to decrease hunger and slow the movement of the food you eat from your stomach to your small intestine, leaving you less hungry and full longer. It also may change how fat is distributed in your body.
Semaglutide has been studied and found to not only help people lose weight and to control Type 2 Diabetes, but to prevent future cardiovascular events and kidney dysfunction that can go along with Type 2 Diabetes. Tirzepatide has been found to help control Type 2 Diabetes and help people lose weight and is currently being studied to determine its effects of future cardiovascular events.
When used on-label for weight loss, Zepbound and Wegovy come in shot form. The shots are given once a week and the doses are gradually titrated upwards over time. Because these drugs have been wildly popular since their inception, there has been an issue at times with supply shortages and in some cases the drugs are not covered by people’s insurance. This has prompted the development of compounded versions of the drugs as well.
These medicines are an excellent choice for many, but not all, people suffering from obesity. Patients should discuss these treatments in detail with their own health care provider to determine whether they are appropriate.
People who are GOOD candidates may include:
People with a BMI (body mass index) over 30
People with a body mass index over 27 with other conditions such as high blood pressure and/or high cholesterol
People who have made appropriate life-style changes and are still unable to lose weight are generally good candidates.
People who are NOT good candidates for these medications include:
Those with a history of or family history of Medullary Thyroid Cancer
Those with a history of or family history of Multiple Endocrine Neoplasia
Pregnant Women
People who have or have had pancreatitis
People on medications that do not interact well with Semaglutide or Tirzepatide
What to expect if you do decide to use Semaglutide or Tirzepatide:
Everyone’s metabolism is different, so some people may notice changes in appetite during the first week or two, while others may not notice the effects for several weeks. The medicines can be used long term and often the most weight loss will be seen between weeks 5-20. Long term use will often result in sustained weight loss and other improvements in overall metabolic health.
These medications can help you lose weight, but they do have to be combined with the appropriate lifestyle changes to be successful in the long term. A nutritionally balanced diet, drinking plenty of water, getting plenty of sleep, stress reduction and proper exercise are essential parts of this journey.
Many patients tolerate these drugs quite well. Some of the more common side effects that people notice may include:
Some nausea. Most of the time it is mild or more common as doses, but in certain people may be more severe.
Constipation or diarrhea
Hypoglycemia (low blood sugar)
Commercial or Compounded Medications?
For those appropriate patients whose insurance covers Zepbound or Wegovy, these can be very good options. They are very expensive to pay for out of pocket without the insurance though. For people who are comfortable giving themselves a shot at home, they can be more convenient. There have been some issues with availability of different doses of the commercial preparations, leaving patients to scramble trying to find a drugstore that has their particular dose or medication.
For those patients who cannot find the proper dose, or whose insurance does not cover the medications, compounded versions of Semaglutide or Tirzepatide can be a good option. BUT it is very important to do the proper research to make sure that they are from a reliable source AND to make sure that you discuss their use with your health care provider. Personally, in my practice, I do not allow patients to take vials of the compounded medications home, because I need to know my patients are getting the proper dose. I also do not personally recommend buying any of these drugs online EVER because you do not always know what you are getting.
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