Weight-loss drugs like Ozempic and Wegovy are seemingly everywhere — discussed on podcasts, speculated on by celebrity followers, whispered at dinner parties. And onefueled further speculation about who gets them as they exploded in popularity.
— semaglutide, sold under the brand names Ozempic and as well as tirzepatide, sold as Mounjaro, and liraglutide, known as – all work the same way. And they’re very effective: A doctor told CBS News that these drugs can help people lose about 15 percent of their body weight, more than previous generations of weight-loss drugs.
For people struggling with their weight — 73.6% of American adults over the age of 20 are considered overweight or obese — they may seem like a miracle drug. Here’s what doctors have to say about them.
Who are they for and how do they work?
Semaglutide drugs work by mimicking a gut hormone called GLP1, or glucagon-like peptide hormone, which “enhances the functioning of this gut hormone to improve communication between the gut and the brain and make us feel fuller and also help reduce appetite,” said Dr. Amanda Velazquez, who works at the Cedars-Sinai Center for Weight Management and Metabolic Health in Los Angeles. “Overall, it tells the body that it’s okay to be at a lower set point.”
Ozempic and Mounjaro, which have a slightly different mechanism, are FDA-approved to treat type 2 diabetes, while Saxenda and Wegovy are FDA-approved for weight loss. And insurance companies usually look for certain criteria before approving payment for any of these drugs.
Velazquez says she would prescribe these drugs to patients who have a BMI between 27 and 30 — classified as overweight — and who have a weight-related medical condition, such as diabetes, high blood pressure or sleep apnea.
Or, patients with a BMI of 30 or more — classified as obese — would qualify for a weight-loss drug, she said.
But these drugs can have side effects, including nausea and constipation. Some believe these are factors that contribute to weight loss, but Velazquez said “that’s not the drug’s job.”
“The goal is not to prevent someone from eating,” she told CBS News. “The goal is to help someone be able to navigate and manage what they eat to have healthier choices and feel more full with those options.”
Velazquez says patients should also practice a healthy lifestyle in conjunction with medication.
Dr. Holly Lofton, who specializes in obesity medicine at NYU Langone, said she prescribes these drugs to people who are not technically obese or overweight. overweight or obese – a practice known as off-label prescribing.
“We always follow up with patients and make sure they have a life plan and we follow up,” she said. “It’s not that we give it to them saying, ‘Good luck to you. “”
Lofton said she wouldn’t give a patient with a normal BMI Ozempic or Wegovy because the drugs could put them at suboptimal weight. But in addition to BMI, she also considered factors such as race and comorbidities.
“Let’s say there was a patient of Asian descent and his BMI is 25 – that BMI is technically overweight in an Asian patient – and he has fatty liver disease. This patient qualifies in my mind because he’s not only overweight as a diagnosis, he has a comorbidity, even though the guidelines don’t specify that,” she said.
Lofton said she wouldn’t prescribe these drugs to people with a history of thyroid cancer or pancreatitis — studies have found they may increase the risk of thyroid cancer in rodents, and the researchers don’t. have not explored their effect on humans with medullary thyroid cancer or a family history of thyroid cancer.
Velazquez said it’s not yet known how the drugs will affect people who aren’t considered overweight or obese because the drugs haven’t been tested in those patients.
How effective are they?
Velazquez said the main driver of demand is that these drugs are very effective. “That’s what really grabbed the attention and the interest,” she said. “Providers are more interested in trying this because they can see greater changes in the health of their patients, there’s more demand because they can see the benefits.”
Dr. Alex Foxman of Achieve Health and Weight Loss, a Beverly Hills medical practice specializing in weight loss programs, has seen with his own eyes how effective these drugs can be, as he has both prescribed and also used them himself.
“I’m 51. A year ago I weighed 190 pounds, which puts me at a body mass index of 27, which is just overweight,” he said, adding that he had trouble maintaining her weight, despite her efforts to diet and exercise. “I started taking semaglutide a year ago and in three and a half months I lost 30 pounds.”
“It was probably one of the most effective and amazing experiences I’ve had as a doctor or as a person,” he said. “It decreased my appetite, I felt full faster. There are a few side effects, but overall I kept a healthy schedule, exercised, and continued to do it and I’ve been able to maintain my weight now for seven months.”
Foxman said that since obesity is not just a medical problem, but a vanity problem, people may turn to these drugs in search of a “quick fix.” “It’s not a silver bullet,” he said. “These drugs are a tool. And it must be used as a tool with other medically supervised programs and services for that to be successful.”
Velazquez said that as a specialist in obesity medicine, she prescribes these drugs “day after day.”
Velazquez believes patients shouldn’t have to “prove themselves” by trying to diet and exercise before being prescribed a weight-loss drug. “The same way if someone has diabetes. You’re not going to ask them to prove to you that they’re cutting carbs before you give them meds, when their blood sugar is out of control.”
What about patients who are not obese or do not have diabetes?
Foxman said sometimes doctors, including himself, practice what’s called off-label prescribing.
“The vast majority of patients who come to see us currently would not be considered morbidly obese or obese, many of them do not have diabetes. Many of them are either overweight or struggling to maintain their weight to the point where they need it,” Foxman told CBS News.
Foxman said patients with diabetes will likely be approved by insurance to get Ozempic. “But those who are not eligible for this, we have a very frank conversation. We explain to them that we will not lie or mislead the insurance company or Medicare about their health, so if they don’t don’t have diabetes, we’re writing this. And if they’re not approved, it’s going to cost them $1,300 or $1,000 a month for meds.”
Why are there shortages of these drugs?
The combination of the high demand for these drugs and the fact that some doctors are prescribing them off-label may have contributed to another rumor: wealthy patients who do not qualify for these drugs can still get a prescription and pay their pocket, thus creating A lack.
Velazquez said he heard anecdotally that some doctors were prescribing the drugs to patients who don’t qualify but can afford them without insurance.
“Nevertheless, I think there are several factors that explain why there is such high demand,” she said. “Although, yes, some of those people potentially get it who don’t meet the criteria, that’s a minority of patients.”
The same pharmaceutical company makes Ozempic and Wegovy, but Ozempic is approved for diabetes and helps people lose weight, while Wegovy is a higher dose and is only approved for weight loss. When a Wegovy shortage began, providers began prescribing Ozempic, Lofton said.
But aside from popularity, supply chain issues have also contributed to the shortage, according to Velazquez. “The demand has exceeded expectations that any of these drugmakers could have imagined.”
Lofton said obesity affects about 40% of Americans and diabetes affects about 11%. “To say that obese people are stealing these drugs from people with diabetes is not really fair,” she said. “Obesity is also a real disease, it leads to social problems, medical problems, psychological problems.”
She said people seeking these drugs should do so from a doctor — not, as she heard, from a medical spa or hair salon. “These must be prescribed by a doctor who has decided, on the one hand, that you are a candidate and, on the other hand, if you have a side effect, you could be treated.”
Still, there are things to consider before asking your doctor for a prescription — and things doctors need to think about before prescribing them.
Foxman said these drugs are very potent and patient use should be monitored by doctors. “The problem is that many doctors don’t understand these drugs and are pressured by their patients to prescribe these drugs,” he said. “They’re prescribing them without caring about putting the right things on the forms, and I think what you’re going to start to see is a lot of doctors getting reprimanded, losing their licenses and stuff, if they are not. careful.”
“Patients who think they can just inject and be successful will fail,” he said. “And you’re going to find a lot of stories of people getting sick if they inject the wrong dose.”