'We've Mastered the Molecule': Weight Loss Medications Explained

Ozempic. Wegovy. Trulicity. Victoza. Words that sound straight out of a Lord of the Rings book but that have transformed the weight loss landscape over the last few years. The controversies over GLP-1 drugs are rampant, begging questions like: isn't the influx of people using these medications for weight loss is creating a shortage for diabetes patients? If you start taking them, don't you have to take them forever? Is one better than the others?

To gather all the facts, we asked EvergreenHealth Weight Loss & Bariatric Care's Endocrinologist Sonia Hans, MD, FACE, DABOM, DABIM, to join our podcast, Check-Up Chat, and explain the complicated and hopeful world of GLP-1 medications.

Same Medication, Different Uses

On the podcast, Dr. Hans was quick to define some terms. "We have a couple of FDA-approved weight loss medications under the names of Semaglutide and Tirzepatide," she said. These medicines are also used in different medications to help manage diabetes. And that, Dr. Hans added, is where the situation becomes complex.

"The brand names when used for diabetes care are Ozempic and Mounjaro, and they have the exact same drug molecule the FDA approved under different brand names, Wegovy and Zepbound, when used for weight loss." Ozempic and Wegovy both use Semaglutide, and Mounjaro and Zepbound use Tirzepatide as their active ingredients.

How Did We Get Here?

Dr. Hans says that when the first GLP-1 receptor agonists – Victoza and Trulicity – entered the market in 2004, they weren't a perfect match to GLP-1 hormone in the human body, but they were very effective in helping lower patients' blood sugar levels. An agonist is a chemical or substance that activates a cellular receptor to produce a biological response.

As technology advanced and researchers were able to "master the molecule," as Dr. Hans says, providers and their patients began to see an "array of benefits." One of the most promising benefits was patients reporting weight loss and a better ability to control their appetite and hunger.

And then came Ozempic.

"That's when Novo Nordisk realized, 'my goodness, GLP-1s aren't just a glucose metabolism medication.' We see cholesterol coming down. We see the fatty liver and liver metabolism improving. We are now seeing all by itself, Semaglutide can prevent a heart attack and stroke, so there must be some sort of anti-inflammation, some prevention of making plaque in those arteries."

Dr. Hans went on to say that with the release of Mounjaro (for weight loss) and Zepbound (for diabetes), patients have seen strong improvement of diabetes symptoms, including A1c reduction and "significant" weight loss.

"When patients were on it for about 72 weeks, they saw almost 20% body weight loss, which is the most we've ever seen in a weight loss drug in history. It's really exciting and hopefully we're going to see some information about all the other comorbidities that it helps to reverse and prevent."

What Caused Access Issues with GLP-1 Drugs?

Dr. Hans said the controversy over access to GLP-1 medications began when Wegovy and Zepbound were approved for weight loss management, and most insurance plans initially did not cover them.

Without insurance coverage, the cost of these medications was "astronomical." So many patients who didn't have diabetes asked their doctors to prescribe Mounjaro and Ozempic off-label for weight loss.

This practice caused an ethical conundrum among medical providers.

"Diabetics are already at a high risk of co-morbidities, cardiovascular disease and stroke," Hans said. And when those patients don't have access to medications like Ozempic and Mounjaro, major complications can develop.

"On the flip side, you have patients who struggle with obesity, metabolic disease and weight who are trying to prevent themselves from becoming diabetics who want access to these medications, and others doing it for vanity," she said. "And so, the controversy became, well, who should get the drug?"

That question has no easy answers, but the results of GLP-1 medications speak for themselves.

A Seismic Shift in Weight Loss Medication

Throughout history, some of the greatest advancements in science have been discovered purely by accident. According to Dr. Hans, this is one of those times.

"This discovery and the mastery of research and technology to create the GLP-1 receptor agonist is truly, I think, in my lifetime, one of the greatest scientific discoveries on metabolism and overall trying to prevent every single obesity-based chronic disease related to metabolic disease."