The weight loss craze is on.
Injectable weight loss medications like Wegovy, Ozempic and Mounjaro are the new go-to for many Floridians displaying on social media platforms the large amounts of pounds they shed. Hyped by celebrities like Charles Barkley, Elon Musk and Amy Schumer, these drugs — intended for diabetes and obesity — quickly have become game changers for people struggling for years to slim down.
With demand high, the cost and shortages of these drugs have created a frenzy in Florida: Clinics are selling off-brand versions, Latin Americans are importing them from their home countries, and social media groups are forming to share information on low-cost suppliers.
Florida doctors say patients think they can use drugs like Wegovy to lose some weight and then stop taking them. It’s not that simple, doctors say. There’s a lot to know about how they work, the current off-brand use, and the risks.
“In the fight against obesity, in 2023 we now have medication that works. It’s a great development,” said Dr. Raul Rosenthal, a bariatric surgeon at Cleveland Clinic Florida. “However, nothing is perfect.”
How these medications work
Wegovy and Ozempic are made by Novo Nordisk and are different doses of the same drug, semaglutide. It works by slowing down movement of food through the stomach and curbing appetite, which has the bottom-line effect of causing weight loss.
After clinical trials, the Food and Drug Administration approved Ozempic for Type 2 diabetes and Wegovy for obesity. Both now are being 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 drug class. It technically is FDA-approved to treat type-2 diabetes, like Ozempic, and uses the same mechanism to suppress the appetite, but it also has an ingredient that causes an added weight-loss effect.
Some doctors believe the demand for Mounjaro soon could 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 be able to induce a loss of 21% of body weight, results almost as significant as that of bariatric surgery.
Rosenthal at Cleveland Clinic Florida said the rapid weight loss mostly likely will happen only during the initial start-up.
“I would say after a period of time, about three to four months, your weight loss will plateau,” Rosenthal said. “You will probably take the injections less frequently, just for maintenance.”
Where to get the drugs
To get these injectable weight-loss drugs, you need a healthcare provider to write a prescription. You can fill it at your local pharmacy or through an online pharmacy. However, demand for these drugs has soared over the last year, to the point that they are in short supply in some areas of the state.
In addition to supply issues, cost is a factor. These medications are pricy, and because they aren’t approved for weight loss in the way most people are using them, insurance doesn’t cover them.
Thus, a secondary market has cropped up of doctors and nurse practitioners who will prescribe these medications over the phone. In addition, Florida weight-loss clinics and medspas are selling injections created by compounding pharmacies. These local pharmacies combine ingredients to create lower-cost versions of semiglutide.
Dr. Dawn Sherling, associate professor of internal medicine at Florida Atlantic University, says Floridians need to be cautious: “There’s a lot of variation in what’s being produced. When there’s a huge demand quickly for this medication, it encourages some labs that are not super adept at doing this 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 decided not to continue.
Interesting. I’ve heard the opposite, that Wegovy works better than Monjaro. My insurance covers neither (already tried) but I can get generic semiglutides for $100 a week from the south Florida Botox doctor place where I live. lol.
Considering, but I did the 1st test shot and…
— Charlotte Dune (@charlotte_dune) April 24, 2023
The Tampa Weight Loss (Semaglutide/Wegovy) Referral Group on Facebook, has dozens of posts from people who are 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, took legal action. The drug maker filed multiple lawsuits against businesses selling off-brand versions of their popular drugs, including two in Florida.
The U.S. Food and Drug Administration said last month that it has received reports of adverse events after people took injections of semaglutide that came from compounding pharmacies.
Without insurance, the list price of Wegovy is $1,349.02 per package, which breaks down to $269.80 per week or $16,188.24 per year. The list price of Mounjaro is $1,023.04 per fill. That cost likely would be recurring monthly — indefinitely. While you may be willing to spend the money initially, you would need to take the shots continually to keep the weight off.
If you stop treatment, you can regain weight you’ve lost — or even more, doctors say.
“It’s a costly medication, 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 at a fraction of the cost that it sells for in the U.S.”
The side effects
When starting these medications, you are supposed to follow a schedule where your dosage is slowly increased every four weeks over several months. An often-reported side effect is digestion issues — horrific nausea, vomiting, and diarrhea.
On Twitter, Fort Lauderdale’s Dune writes: “I did the first shot and lost 11 pounds in two weeks and was the most nauseous I have ever been in my life.”
In a Facebook group for Florida Wegovy and Ozempic users, a Miami mom asks: “Has anyone else been vomiting for five weeks straight?”
The drugs also come with a warning that they may increase the risk of thyroid cancer, acute pancreatitis, gallbladder disease, low blood sugar, kidney injury, damage to the eye’s retina, and suicidal thinking or behavior.
Sherling said with any medication it’s necessary to weigh side effects against the benefit. “For people struggling with obesity or health problems or diabetes, this is a remarkable medication. But there are risks.”
A new side effect being reported is “Ozempic face” — what some people on social media say is an aged or gaunt look on the faces of people who use the medication and drop weight quickly.
Orlando dermatologist Dr. Sima Jain said that speeding up the process of weight loss — particularly for younger people — can lead to a sunken in or sagging look of your face. “That’s why it’s not healthy to lose a lot of weight too fast,” she said. “It hard to gain the weight back on your face.”
Florida doctors say these drugs should be only a component of a weight-loss effort. “I just hope fad diets are not being replaced by fad medications,” Sherling said. “It’s really about changing the way we live our lives.” She says healthy eating and exercise need to accompany the shots to sustain the weight loss over the long term.
Because these drugs are being used for weight loss off-label, some doctors worry there could be unknown repercussions. Sherling points out that people who want to keep the weight off are potentially committing to lifelong medication.
“These medications were studied in very specific populations,” she said. “People are doing a natural, real-time experiment when they are in a group that wasn’t studied. What happens in 10 or 20 years? We don’t know that yet.”
Rosenthal at Cleveland Clinic Florida says he likes having these drugs in his toolbox. For patients who have had bariatric surgery, these drugs are an option for him to offer when they regain weight.
Going forward, this new class of weight-loss drugs may be replaced by even more advanced medications.
In Women’s Health, Dr. Spencer Nadolsky, an obesity and lipid specialist in Maryland, said: “What I know is that the current drugs on the market are only the start — more options are coming soon, and they may be even more effective.”
Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].