Losing weight with Wegovy, Ozempic, Mounjaro, Saxenda & Co.

The Problem

Overweight and obesity are not just disruptions to personal well-being. As we know today, they are serious conditions that, in addition to the negative impact on mental health, also entail a significantly increased risk of high blood pressure, heart diseases, various types of cancer, as well as a reduced lifespan.
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What new pharmacological options are available?

Currently, there is a significant hype, even in the mass media, surrounding newly approved medications that promise a weight reduction of approximately 15% of body weight. Among these medications, Wegovy© and Ozempic©, both containing the active ingredient Semaglutide, are drugs that correspond to a natural hormone but are less rapidly broken down. In the brain, this induces a feeling of satiety. While Ozempic© is only approved for the treatment of diabetes mellitus, the higher-dose Wegovy© is aimed at weight reduction. When overdosed, Ozempic© can also be used for weight loss, termed "Off-label use." Studies on both medications show that with the appropriate dosage, a weight loss of about 15% of body weight can indeed be achieved. This requires a treatment period of approximately one year, during which the medication must be injected under the skin once a week. After this time, there is typically no further weight loss, leading to a phenomenon known as a plateau.

Another medication that promises even greater weight loss, up to 25%, is the active ingredient Tirzepatide, marketed as Mounjaro©. It is not yet approved for the treatment of diabetes mellitus type II and weight reduction. The mechanism of action is similar to Semaglutide, but it simulates not only one but two natural hormones, apparently making weight loss more effective. The active ingredient Liraglutide, sold as Saxenda©, follows the same mechanism of action as the aforementioned drugs but shows significantly less effective results.

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Is this now the answer to weight problems?

Prof. Dr. Dr. Matthias Tschöp, Neuroendocrinologist at the Munich Helmholtz Center:

"This is not a cure; these patients are, so to speak, still obese in the brain, only the body weight is adjusted."

When the medications are discontinued, patients immediately regain weight. Therefore, it is a lifelong necessary treatment. Prof. Dr. med. Joachim Spranger, Director of the Medical Clinic with a focus on Endocrinology and Metabolism at the Charité in Berlin:

"If one imagines that an obese 30-year-old patient injects this medication for the next 40 years, then we naturally have insufficient experience regarding what can happen."

All the above-mentioned substances have a comparable spectrum of side effects:

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What are the side effects?

Very common (> 10%) side effects include: nausea, vomiting, abdominal pain, constipation, and headaches.

Common (> 1%) side effects include: gallstone formation, dizziness, hair loss, gastritis, heartburn, and flatulence.

Rare (0.1 – 1%) side effects include increased heart rate, orthostatic dysregulation (sudden drop in blood pressure upon change of position), and acute inflammation of the pancreas (pancreatitis). Acute pancreatitis is a life-threatening condition and generally requires intensive medical treatment.

Very rare (0.01 – 0.1%) side effects include anaphylactic reactions and angioedema.

It is noteworthy that in animal studies on rats, an increased rate of thyroid and pancreatic cancer was observed for Semaglutide. Despite this, approval was granted, as this effect has not been observed in studies on patients so far. However, the average follow-up period of the existing studies is only 48 (26 – 104) weeks, so not even quite a year on the average.

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How do I obtain these medications, and what is the cost of the treatment?

All the mentioned medications are prescription-only!

When prescribing these medications according to their approval, a prescription is only possible if the Body Mass Index (BMI) is above 27 kg/m^2 and there is at least one complication of increased weight, such as diabetes, high blood pressure, or heart disease.

Prescribing for patients without any of these complicating conditions is considered only with a BMI of 30 kg/m^2 or higher. While Ozempic© is already available in German pharmacies, there are significant supply shortages for Wegovy, and it is practically not available throughout Germany. It is mainly supplied to the larger market in the United States. This leads to a shortage of Ozempic©, as it can be used, in multiple doses, as a "substitute" for Wegovy©.

According to the manufacturer Novo Nordisk, the cost of treatment with Wegovy is expected to be "around" €300 per month. Therefore, annually, it amounts to approximately €3600 – €4000. This is a treatment that must be paid for privately.