Weight-loss drugs Ozempic, Wegovy, Mounjaro booming, bringing hope, costs

Tara Johnson has lost more than 110 pounds since March 2021, and it wasn’t from the type of fad diet that often leads people to lose significant weight only to gain it back.

The medication the Merrick woman takes, semaglutide, sold under brand names such as Wegovy and Ozempic, is transforming weight loss. It could allow people to keep pounds off for many years, although the drugs are not effective long term for everyone, medical experts say. Studies show another drug, tirzepatide, sold as Mounjaro, which, like Ozempic, was first developed for people with type 2 diabetes, may be even more effective.

Johnson, 51, had gastric bypass surgery about 15 years ago, but eventually regained most of the weight. When she was nearing age 50 and weighed 299 pounds, she thought of the array of serious health conditions linked to obesity and worried about not seeing her children grow into adulthood.

“I was afraid,” she said. “I’m like, ‘I'm getting into heart attack territory.’ And I have young children. At the time, they were 8 and 10. So I had to do something.”

Johnson is among a growing number of people on Long Island taking these drugs, bringing hope to people struggling with obesity. But the drugs' popularity also has created shortages for people with diabetes. And a small number of people have suffered severe abdominal pain after taking the medications, with nausea and diarrhea among the more common side effects, research shows.

Weight-loss patients are getting prescriptions in traditional doctors' offices, as well as in "wellness centers," where the drugs sometimes are offered alongside Botox treatments and vitamin drips.

Ozempic, Mounjaro and Wegovy can carry a list price of $1,300 a month or more outside insurance coverage, doctors say, and many insurers refuse to cover them for weight loss. That makes them out of reach for many seeking to lose weight. Ozempic and Mounjaro are more often covered for diabetes, experts say, because the U.S. Food and Drug Administration approved the drugs for type 2 diabetes, but not for weight loss. Doctors, though, can legally prescribe the medications for weight reduction. Wegovy is only FDA-approved for weight loss, for those with obesity and weight-related health conditions.

The number of prescriptions written for semaglutide and tirzepatide increased 300% between the first quarter of 2020 and the fourth quarter of 2022, to more than 9.1 million prescriptions, according to an analysis by the health care research and analytics firm Trilliant Health.

About 42% of Americans 20 and older have obesity, according to 2017-20 data from the Centers for Disease Control and Prevention. Long Island adult obesity rates are lower: 25% in Nassau and 29% in Suffolk, according to state health department data.

Studies show significant weight loss with the medications, but they “are not foolproof,” said Dr. Jamie Kane, chief of obesity medicine for Northwell Health.

“I’ve had people gain back most of their weight while still on these meds. And I’ve had other people do fine.”

No long-term studies of drugs

The drugs are so new that there are no studies that follow people for many years to measure their long-term effectiveness for weight loss, Kane said. And the generations-old advice to eat a healthy diet and exercise still holds and will help maintain weight loss, he said.

Some of Kane’s patients have said the medications work well in making them feel satiated.

“I hear a lot from patients saying for the first time, ‘I actually feel like I’m done eating. I’m not constantly thinking about food,’ ” he said. Kane received a consulting fee from Eli Lilly, which makes Mounjaro, according to federal records. He said the consulting did not involve Mounjaro and was his only consulting fee in the past 17 years.

Semaglutide mimics a natural hormone, GLP-1, that targets areas of the brain that regulate appetite and how much you eat, according to the FDA.
A study published in 2021 found that a weekly injection of Wegovy led to an average loss of nearly 15% of body weight, compared with about 2% with a placebo. The study was financially supported by Wegovy manufacturer Novo Nordisk, which also makes Ozempic.

Tirzepatide mimics the actions of two hormones, not just one like semaglutide does, and studies show that can lead to even more weight loss. A study published Oct. 15 in the journal Nature Medicine found that participants who took Mounjaro following three months of a low-calorie diet, exercise and counseling lost on average about a quarter of their body weight after 72 weeks compared with a 4% loss of body weight for those on a similar regimen who received a placebo. Eli Lilly, which funded the study, is seeking FDA approval for Mounjaro as a weight-loss drug. Other studies have found either similar or more modest weight loss with Mounjaro.

Changing attitudes toward obesity

The medications are increasing in popularity as attitudes are changing about obesity, said Dr. Fatima Cody Stanford, an associate professor of medicine and pediatrics at Harvard Medical School and an obesity medicine physician at Massachusetts General Hospital in Boston. 

For years, people with obesity have been told it’s their fault they can’t lose or keep off weight, she said.

“It’s definitely a blame game, a shame game,” Stanford said.

Today, more medical professionals understand that some people are biologically predisposed to store more fat, she said. Yet some physicians are still reluctant to prescribe the new medications, because they mistakenly believe anyone can lose enough weight with diet and exercise, said Stanford, who has been a paid consultant for Eli Lilly and Novo Nordisk.

Diets, though, are notorious for not working long term.

Studies show people who stop taking semaglutide also typically regain weight.

“The desire of the body to regain the weight is so profound that there’s a very good chance you’re going to be on medications to lose weight long term, the same way a lot of people are on medications for their blood pressure or their cholesterol,” Kane said.

Dr. Nirav Desai, a surgeon in the Roslyn Heights office of New York Bariatric Group, said he’s used Wegovy for patients who regained weight after surgery. He’s also prescribed the medication for those who don’t have a level of obesity that qualifies them for surgery, and to help people lose weight to make surgery less risky.

Johnson, who has documented her weight-loss journey to 75,000 followers on TikTok, said that after watching herself regain weight following surgery, she’s prepared to be on Wegovy long-term.

“If I have to stay on it forever, that’s what I’ll do," said Johnson, whose husband's insurance covers Wegovy, except for a $25 monthly copay.

Since losing weight, her doctor took her off blood pressure medicine, her cholesterol is down, and she no longer has prediabetes.

Celebrity speculation gives sheen

Rumors in gossip magazines about which Hollywood celebrities are taking the medications to shed a few pounds have given the drugs a sheen of glamour.

But for people with obesity, the drugs offer the potential of significant health improvement, Stanford said.

“Obesity is a disease that is a precursor to 230 other chronic conditions,” she said.

Eighty-one percent of patients with a semaglutide prescription this year have obesity and fewer than 3% are of “healthy” weight, according to an analysis of prescription data through Sept. 15 by health research organization Epic Research. Nearly 59% have diabetes.

Many people looking for semaglutide or tirzepatide turn to businesses that market themselves as wellness centers and that, in addition to prescribing obesity medications, may offer skin-tightening and other cosmetic services.

Stanford worries that some of those centers offer “a quick fix” and may not follow through with patients, which is critical to ensure maximum effectiveness.

Nurse practitioner prescribes, takes medicine

Nicole Imbasciani, a nurse practitioner who owns Rock Star Recovery and Wellness in Massapequa, said she does comprehensive follow-ups, including nutritional counseling and lifestyle coaching. 

Imbasciani, 47, of Deer Park not only prescribes the drugs: Her doctor prescribes her Mounjaro. Her weight has dropped from 185 to 145 in little more than a year, she said.

“I was looking to use this not only to lose weight for my appearance, but also my energy had been sluggish and I had developed arthritis in one of my knees that was bothering me,” she said.

Several previous attempts at weight loss through a better diet and exercise were followed by weight regain, she said.

Compounding pharmacies to address supply

High demand for the medications has caused shortages of all three, affecting people with diabetes and those without the disease.

One way some health care professionals have addressed shortages is by prescribing versions of semaglutide and tirzepatide that are mixed in compounding pharmacies.

Dr. Frank Ocasio of North Shore Medical Wellness in Huntington said he mostly prescribes compounds because it’s often the only way his patients can get the medication. Either they can’t find them because of shortages or their insurance company won’t pay for them — and compounds are about half the price of the $1,300 to $1,500 monthly list price for the drugs, he said.

The FDA warned in May it does not verify the safety or effectiveness of compounded drugs and that it has received “adverse event reports” from compounded semaglutide.

Jessica Baylis, 43, of Greenlawn, a patient of Ocasio, said she occasionally feels nausea after taking a compounded version of tirzepatide, which she knows is not FDA-approved. Nausea is listed as one of the possible side effects of Mounjaro and semaglutide.

Mounjaro, as well as Wegovy and Ozempic, also can cause severe side effects in a small number of patients. A study released Oct. 5 found higher rates of pancreatitis and other major gastrointestinal problems among people taking semaglutide.

Dr. Eileen Barr, an obesity physician in East Setauket, said patients should consult with a doctor to go over potential side effects and make sure the medications are right for them.

Baylis has lost 32 pounds since June, dropping from 169 to 137 pounds.

“It’s a miracle,” she said.

Baylis said before she lost weight, “I didn’t feel good in my own skin” and felt depressed. Now, she said, “I’m less tired, I’m way more confident, and I feel a lot better in my clothes.”

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.