The weight loss craze is on.
Injectable weight-loss drugs like Wegovy, Ozempic, and Mounjaro are the new benchmark for many Floridians showcasing on social media platforms the vast amounts of pounds they’re losing. Promoted by celebrities such as Charles Barkley, Elon Musk and Amy Schumer, these drugs aimed at diabetes and obesity have quickly become game-changers for people who have been struggling to lose weight for years.
With demand high, cost and shortages of these drugs have created a frenzy in Florida: clinics are selling off-brand versions, Latinos are importing them from their home countries, and social media groups are forming to share information about low cost suppliers.
Florida doctors say patients think they can use drugs like Wegovy to lose weight and then stop taking them. It’s not that simple, doctors say. There’s a lot to know about how they work, current off-brand use, and the risks.
“In the fight against obesity, 2023 we now have medicines that work. It’s a big development,” said Dr. Raul Rosenthal, a bariatric surgeon at the Cleveland Clinic Florida. “However, nothing is perfect.”
How these drugs work
Wegovy and Ozempic are made by Novo Nordisk and are different doses of the same drug, semaglutide. It works by slowing down the movement of food through the stomach and curbing appetite, which ultimately has the effect of causing weight loss.
After clinical trials, the Food and Drug Administration approved Ozempic for type 2 diabetes and Wegovy for obesity. Both are now given off-label for weight loss and need to be injected under the skin once a week to work. Rybelsus, also made by Novo Nordisk, is essentially Ozempic in pill form with the same active ingredient, semaglutide
Mounjaro, known generically as tirzepatide, has joined this class of drugs. It’s technically FDA-approved for the treatment of type 2 diabetes, like Ozempic, and it uses the same appetite-suppressing mechanism, but it also has an ingredient that causes an added weight-loss effect.
Some doctors believe that demand for Mounjaro could soon surpass other weight-loss injectables. Wegovy has been shown to help people lose up to 15% of their body weight. At certain doses, Mounjaro has been shown to induce a 21% loss of body weight, almost as significant a result as that of bariatric surgery.
Rosenthal of the Cleveland Clinic Florida said rapid weight loss will most likely only happen during the initial boot.
“I would say after a period of time, about three to four months, your weight loss will stabilize,” Rosenthal said. “You’ll probably be injecting less frequently, just for maintenance.”
Where to find the drug
To get these injectable weight-loss drugs, a health care professional must write a prescription. You can fill it out at your local pharmacy or through an online pharmacy. However, the demand for these drugs has soared over the past year, to the point where they are in short supply in some areas of the state.
In addition to supply issues, cost is a factor. These drugs are expensive, and because they aren’t approved for weight loss the way most people use them, insurance won’t cover them.
Thus, a secondary market of doctors and nurses has arisen who will prescribe these drugs over the phone. Additionally, Florida weight loss clinics and medspas sell injections created by compound pharmacies. These local pharmacies combine ingredients to create low-cost versions of semiglutide.
Dr. Dawn Sherling, an associate professor of internal medicine at Florida Atlantic University, says Floridians need to be cautious: “There is a lot of variation in what is produced. When there’s a huge demand for this drug quickly, it encourages some labs that aren’t very proficient at it to make it.
On Twitter @Charlotte_Dunne of Fort Lauderdale says she can get generic semiglutide injections for $100 a week from a local botox doctor and recently tried it. She has decided not to continue.
Interesting. I’ve heard the opposite, that Wegovy works better than Monjaro. My insurance doesn’t cover either (already tried), but I can get generic demiglutides for $100 a week from the South Florida Botox doctor where I live. lol.
Considering, but I did the first test shot and
— Charlotte Dune (@charlotte_dune) April 24, 2023
The Tampa Weight Loss Focus Group (Semaglutide/Wegovy) on Facebook has dozens of posts from people selling and buying off-brand versions of these drugs and sharing their experiences.
Just this week Novo Nordisk, the pharmaceutical company that makes Ozempic and Wegovy, filed legal action. The drugmaker has filed several lawsuits against companies selling off-brand versions of their popular drugs, including two in Florida.
The U.S. Food and Drug Administration said last month it had received reports of adverse events after people took injections of semaglutide sourced from compounding pharmacies.
Without insurance, Wegovy’s list price is $1,349.02 per package, which breaks down to $269.80 per week or $16,188.24 per year. Mounjaro list price is $1,023.04 per fill. That cost would likely recur monthly indefinitely. While you may be willing to spend the money initially, you should be taking the shots continuously to keep the weight off.
If you stop treatment, you may regain the weight you lost or even more, doctors say.
“It’s an expensive drug, and as a result, people are finding other ways to get it,” said FAU’s Sherling. “In our area, people are traveling to Latin America where they can get it for a fraction of the cost it is sold for in the US”
The side effects
When starting these medications, you should be on a schedule where the dosage is slowly increased every four weeks for several months. An often reported side effect is indigestion resulting in horrific nausea, vomiting, and diarrhea.
On Twitter, Fort Lauderdale’s Dune writes, “I took the first shot and lost 11 pounds in two weeks and it was the most nauseous I’ve ever had in my life.”
In a Facebook group for Florida Wegovy and Ozempic users, a Miami mom asks, “Has anyone else thrown up for five weeks straight?”
The drugs also come with a warning that they can increase the risk of thyroid cancer, acute pancreatitis, gallbladder disease, low blood sugar, kidney injury, damage to the retina of the eye, and suicidal thinking or behavior.
Sherling said that with any drug, you need to weigh the side effects against the benefit. “For people struggling with obesity, health issues or diabetes, this is an amazing drug. But there are risks.”
A new side effect reported is “Ozempic face,” which some people on social media say is an aged or gaunt look on the faces of people who use the drug and lose weight rapidly.
Orlando dermatologist Dr. Sima Jain said speeding up the weight loss process, particularly for young people, can lead to a sunken or saggy facial appearance. “That’s why it’s not healthy to lose a lot of weight too fast,” he said. “It’s hard to put the weight back on your face.”
Florida doctors say these drugs should only be one component of a weight-loss effort. “I just hope that fad diets aren’t replaced by fad drugs,” Sherling said. “It’s really about changing the way we live our lives.” She says healthy eating and exercise must accompany shots to sustain long-term weight loss.
Because these drugs are used off-label for weight loss, some doctors are concerned that there may be unknown repercussions. Sherling points out that people who want to maintain weight are potentially committed to lifelong medication.
“These drugs have been studied in very specific populations,” he said. “People are doing a natural experiment in real time when they are in a group that hasn’t been studied. What happens in 10 or 20 years? We do not know yet”.
Rosenthal of Cleveland Clinic Florida says he likes having these drugs in his toolbox. For patients who have had bariatric surgery, these drugs are an option to offer when they regain weight.
Going forward, this new class of diet drugs could be replaced by even more advanced drugs.
In Women’s Health, Maryland obesity and lipid specialist Dr. Spencer Nadolsky said, “What I do know is that the current drugs on the market are just the beginning. Other options are coming soon and may be even more effective.”
Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].
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