Which GLP-1 is right for me? Navigating your options

Your weight loss journey can be filled with twists and turns. Fortunately, new medications called GLP-1 RAs (glucagon-like peptide-1 receptor agonists) are emerging as potential allies in reaching your goals. With several options now available – from Wegovy to Contrave to Ozempic – you might be wondering… “Which GLP-1 is right for me?” Here’s what you need to know.

Note: Always consult your doctor before making any changes to your weight loss plan or medication regimen.

What are GLP-1 RAs?

Imagine tiny keys unlocking the doors to your appetite control center. That’s essentially what GLP-RAs do. By mimicking a natural hormone your body produces, they slow down digestion, keep you feeling fuller for longer, and reduce cravings. This translates to potential weight loss. 

What different types of weight loss medications are there?

Semaglutide, the key component in medications including Wegovy (and the diabetes-branded medications Ozempic and Rybelsus), imitates the action of your body’s natural GLP-1 hormone. This prompts your body to increase insulin production after eating sugars and starches, helping to control how your body uses and stores blood sugar. It also triggers a sensation of fullness in the brain (a pretty important bonus!)

Medications that have semaglutide as their active ingredient include:

• Ozempic: Injected weekly, Ozempic can reduce your appetite and may help you to lose weight. The FDA has not approved Ozempic as a weight loss medicine (it is, however, approved for type 2 diabetes). Ozempic is effective in lowering blood sugar in patients with type 2 diabetes, along with diet and exercise. 

In clinical studies, patients taking Ozempic lost an average of 14 lbs. over a 30 to 56-week period.

• Rybelsus: The FDA has not approved Rybelsus as a weight loss medicine, but when it’s prescribed for diabetes, it has been shown to aid in weight loss. It’s the only oral GLP-1 RA (tablet form, once-a-day). However, for some people it might be less effective than injectable versions.

In a 6-month study, people with an average weight of 194 lbs. lost about 8 pounds taking 14 mg of Rybelsus.

• Wegovy (semaglutide): Specifically FDA-approved for chronic weight management, Wegovy showcases weight loss similar to Ozempic but comes in higher dosages. It is also a weekly injection.

Tirzepatide, found in medications such as Mounjaro and Zepbound, acts as a glucose-dependent insulinotropic polypeptide (GIP), a hormone generated in the upper gut and released into the bloodstream when foods, mainly those high in fat, are consumed. It is also a GLP-1 RA and aids in weight loss by reducing appetite and delaying the passage of food from the stomach to the small intestine (like semaglutide). This effect can lead to a quicker and prolonged sense of fullness. Tirzepatide also lowers blood sugar levels by boosting insulin production and reducing the liver’s sugar production. It’s a win-win-win.

Medications that have tirzepatide as their active ingredient include:

• Mounjaro: Approved for use in those with type 2 diabetes (but not specifically for weight loss), recent studies have found that patients who are overweight or obese lost more weight on Mounjaro, a once-weekly injection, than patients did on Ozempic. In a Truveta Research study, people using Mounjaro had higher probabilities of achieving 5%, 10%, and 15% body weight loss. Additionally, they experienced more substantial weight loss at the three-month, six-month, and one-year marks than participants using Ozempic.
• Zepbound: Like Mounjaro, Zepbound is injected weekly and features the same compound (tirzepatide) as Mounjaro. According to Eli Lilly, the makers of Zepbound, individuals taking Zepbound along with diet and exercise experienced significant weight loss compared to those on a placebo over 72 weeks. At the highest dose of 15 mg, Zepbound users experienced an average weight loss of 48 lbs., and at the lowest dose (5 mg), individuals lost an average of 34 lbs., a notable difference compared to the 7 lbs. weight loss observed in the placebo group. Zepbound is specifically branded and FDA-approved for individuals with obesity.

How do I weigh the side effects?

Be aware that different weight loss medications have differing risks of side effects, so discussing them with your doctor is crucial. Nausea, vomiting, and upset stomach are common, but usually temporary. These types of side effects appear to be similar across medications. 

But what’s more of a differentiator is your own individual health factors. Your doctor will consider these before making a recommendation. It’s also important that your clinician tailor any prescribing based on your concerns, pre-existing health conditions, and co-morbidities. For example… 

• Because Zepbound and Mounjaro can both make birth control pills less effective, this may not be a first-line recommendation for you if you can only take pill birth control to prevent pregnancy. 
• Another example of this is the possible correlation with Ozempic, Wegovy, and Rybelsus to worsen eye disease associated with diabetes.  
• Finally, if you have a condition like heart disease, your doctor might suggest a specific GLP-1 RA with proven benefits in those areas (e.g., Wegovy and its positive impact on cardiovascular health). 

There are also individual responses to different medications that can be hard to predict: some individuals may tolerate Ozempic better, some Mounjaro. 

Discuss any concerns you may have and your medical history with your doctor to find the safest and most appropriate option for you. And if you are concerned that a current medication may not be a fit, you can work with your clinician to explore other options too. 

Okay … so how do I actually take these medications? Am I required to give myself an injection?

When choosing a GLP-1 RA, convenience and injection frequency play essential roles. Do you envision yourself easily swallowing a pill daily, like Rybelsus, or are you comfortable with a once-weekly injection routine offered by Ozempic, Mounjaro, Wegovy, and Zepbound? Consider your lifestyle and preferences:

• Pill preference: If daily pills resonate with you, Rybelsus might be a good fit. It offers the convenience of oral medication, fitting seamlessly into your daily routine, and side effects may be more mild. However, oral medications might have slightly lower efficacy for weight loss than injectables for some individuals.
• Injection comfort: If you’re OK with injections and prefer the potentially higher effectiveness of injectables, then Ozempic, Mounjaro, Wegovy, or Zepbound could be options. However, remember that these require weekly self-injections, and some people might find that less convenient than taking a daily pill.

Weighing cost and insurance coverage

GLP-1 RAs can be expensive, and insurance coverage varies. Some plans might cover a portion of the cost, requiring co-pays, deductibles, or prior authorization. Some plans only cover GLP-1 RAs with certain diagnoses (such as Type 2 Diabetes). Others might not cover GLP-1 RAs at all. 

Talk to your insurance provider and clinical team to understand your out-of-pocket costs and weigh the potential benefits of a weight loss medication vs. the cost, considering its overall impact on your health and well-being.

The bottom line: Shared decision-making with your clinician is key

Choosing the right GLP-1 RA is a collaborative process. Discuss your needs, preferences, and health history with your doctor, preferably an obesity medicine specialist.

Remember, this is not a one-size-fits-all situation. If, for any reason, your initial choice isn’t ideal, there are other options, and new medications are being developed all the time.

Also, don’t forget that medication is just one piece of the weight loss puzzle. A nutritious diet, regular exercise, stress and sleep management, along with sustainable lifestyle changes are vital for long-term success. Consider using a weight loss app or program like Noom alongside your medication for comprehensive support and guidance.

You can unlock your weight loss potential and achieve your health goals with the correct information, communication, and a healthy lifestyle alongside your chosen weight loss medication. Remember, with Noom, you’re not alone on this journey!

Note: GLP-1s, like Ozempic, are not FDA approved to treat obesity or for weight loss.

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