Wegovy vs. Ozempic: The truth about new ‘weight-loss’ drugs

Interested in diabetes drugs for weight loss? Eight reasons to think carefully before starting semaglutide injections, also known as Wegovy or Ozempic.
April 5, 2023
Wegovy vs. Ozempic vs. staying fit and eating a healthy diet. What's the best way to be healthy and lose weight? Photo: Getty Images.
Wegovy vs. Ozempic? Should you consider new diabetes drugs for weight loss or skip medications and stay fit? It’s vital to know that the newest weight loss drugs are extremely expensive, and most insurance companies do not cover them. Photo: Getty Images.
If you’re interested in losing weight, perhaps your ears perked up when Jimmy Kimmel cracked a joke during his opening monologue at this year’s Academy Awards.

“Everybody looks so great,” Kimmel said. “When I look around this room, I can’t help but wonder ‘Is Ozempic right for me?’”

Or maybe you took note when Elon Musk tweeted about Wegovy as his magical weight loss method.

What are Ozempic and Wegovy, and if they’re working so well for Hollywood stars and social media influencers, should I think about trying these weight loss drugs?

Before you race to your doctor to get a prescription, it’s vital to consider the fine print for the medications.

Here are eight reasons you might want to be cautious before using Wegovy or Ozempic for weight loss:

  1. Wegovy and Ozempic are not for everyone. Ozempic is approved for people with Type 2 diabetes. And Wegovy is approved for people with obesity or those who are overweight and have health problems related to excess weight.
  2. If you lose weight with new drugs, you likely will need to keep taking the medications forever to keep the weight off. People who stop taking Wegovy and Ozempic often gain weight back relatively quickly.
  3. The drugs are expensive, and in general, insurance plans don’t cover them for weight loss (although they often do for people with diabetes).
  4. The popularity of the new drugs has led to some shortages.
  5. The drugs can cause unpleasant gastrointestinal side effects.
  6. A small percentage of people who take the drugs can suffer from a diabetes eye complication called retinopathy. Along with consulting with your primary care provider or endocrinologist, you should also see your eye doctor.
  7. The drugs tend to suppress a person’s appetite but to lose weight, you’ll still need to reduce your intake of desserts, sugar-sweetened beverages and fatty foods. And, of course, exercise is important to keep your body healthy.
  8. Some people have complained about looking older due to “Wegovy or Ozempic face.” While many people taking weight loss drugs are pleased to shed some pounds, some say they’re dropping weight in the wrong place: their face. Some have complained of looking old and gaunt due to fat loss in the face.

While there are reasons to be cautious about the newest drugs, Ozempic and Wegovy are helping many people lose considerable weight — about 12% of body mass, on average — which can dramatically improve a person’s health.

And for decades, leading medical experts blamed people who were overweight or obese for the extra pounds they were carrying without giving them much help or considering the physiological causes for weight gain. Some blamed obesity on simple math: “Overweight people simply needed to eat less and move more.”

While sedentary lifestyles and consumption of high-calorie, processed foods most certainly have boosted obesity rates in the U.S. and around the world, experts have learned much more in recent years about genetic causes for weight gain. Some people’s bodies may, in fact, want them to pack on fat. So, drugs that dramatically reduce appetite and help people lose significant pounds, may be a game changer.

Dr. Cecilia Low Wang is an expert on diabetes and weight loss drugs. Photo: UCHealth.
Dr. Cecilia Low Wang is an expert on diabetes and weight loss drugs. Photo: UCHealth.

To get answers to your questions, we consulted with Dr. Cecilia Low Wang, a UCHealth expert in endocrinology, diabetes and metabolism.

Low Wang is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus. And she chairs the committee that advises the U.S. Food and Drug Administration (FDA) on drugs related to endocrinology and metabolism.

The FDA approved Wegovy in June of 2021, marking the first time since 2014 that federal health authorities had given the green light to a new weight loss drug.

(Low Wong’s views do not represent those of the FDA or the FDA Endocrinologic and Metabolic Drugs Advisory Committee.)

Wegovy vs. Ozempic: Are they the same drug? What are they?

It’s correct that Wegovy and Ozempic are two names for the same drug: semaglutide. Ozempic is the name of the drug as prescribed for people with diabetes. The FDA approved Ozempic for people with diabetes in 2017 and approved Wegovy for people who have obesity or are overweight and have additional health problems in 2021.

“They are just prescribed under different names with slightly different doses and different indications,” Low Wang said. “The drug product itself is the same.”

How do Wegovy and Ozempic work?

The drugs decrease appetite and slow down emptying of the stomach so people feel less hungry and eat less. They can cause some unpleasant gastrointestinal side effects.

Who is eligible for Wegovy?

Under the FDA authorization, Wegovy is supposed to be used for people who are obese or overweight. Those who have a body mass index (or BMI) of 30 or greater are eligible along with those who have a BMI of 27 or greater who also have other health problems such as high blood pressure, diabetes or high cholesterol that make weight loss important.

In reality, some people who do not have obesity or weight-related health conditions have been saying that they’re using Wegovy or Ozempic to drop 10 pounds and “get skinny.”

Are children or teens eligible to take Wegovy?

Yes. The FDA has approved Wegovy for some children and teens ages 12 and older who are dealing with obesity.

Who is eligible for Ozempic?

FDA officials approved Ozempic for people with Type 2 diabetes.

How do these drugs work?

Wegovy and Ozempic mimic a hormone called glucagon-like peptide-1, which targets areas of the brain that regulate appetite, according to the FDA authorization.

Why are weight loss drugs a big deal?

In the U.S., about 70% of adults are obese or overweight, and many have serious health problems that put them at greater risk for heart disease, stroke, diabetes and some types of cancer.

“Losing 5% to 10% of body weight through diet and exercise has been associated with a reduced risk of cardiovascular disease in adults,” Dr. John Sharretts of the FDA’s Center for Drug Evaluation and Research said when the FDA approved Wegovy.

What are the most common side effects of Wegovy?

Gastrointestinal problems are the most common side effects since Wegovy can slow down people’s digestive systems. During clinical trials, some participants experienced nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion, dizziness, bloating and gas.

Was it wise for federal health officials to authorize Wegovy for weight loss?

In Low Wang’s opinion, yes, it was wise for the FDA to authorize Wegovy for people who truly need to lose weight.

Along with persuasive data about weight loss, Low Wang said there is evidence that people with Type 2 diabetes who take Ozempic can improve their cardiovascular health.

“A 5-to-7% weight loss, for example, can significantly lower blood pressure,” Low Wang said.

Cardiovascular risk factors improve in people with obesity or overweight who take Wegovy, but evidence for cardiovascular risk will have to wait until later in 2023 when the SELECT trial is completed.  (Learn more about the clinical trial.)

If you take Wegovy or Ozempic to lose weight, will you need to keep taking the drugs indefinitely?

Yes. As with many chronic conditions, most people who use the drugs for diabetes or weight loss will need to keep taking them to keep benefiting from them.

“Sometimes people can decrease or eliminate the need for chronic medications through significant lifestyle changes,” Low Wang said.

Of course, that takes work and commitment.

“Depending on your individual situation, and without sustained lifestyle changes, it is likely you would need to be on these medications indefinitely to maintain weight loss,” Low Wang said.

What about the cost of the drugs? How much do they cost, and is the high cost a problem?

Using Ozempic or Wegovy without insurance coverage can cost more than $15,000 a year.

That’s causing some challenges for doctors and patients.

So far, many of the people who are publicly discussing using the medications are wealthy individuals for whom cost is not a problem.

“And my sense is that many people posting on social media are using these drugs but don’t meet the medical criteria for using them,” Low Wang said.

“The cost really affects access. That’s a huge issue related to health equity,” she said.

Who is supposed to be eligible to receive Wegovy for weight loss?

Here are the criteria for use of Wegovy (meaning it’s meant for you, and health insurance plans might pay for the prescription).

If your body mass index, or BMI, is 30 or above, then you are eligible. If your BMI is 27 or higher and you have additional health risks, then you’re eligible to get a prescription for Wegovy, Low Wang said.

If you don’t meet those criteria, Low Wang said you would be using the medications “off-label,” or not as the FDA has approved them. This is OK if your health care provider feels the drug is necessary for you, but not if Wegovy is being prescribed by someone who is not one of your providers.

She said insurance plans do tend to cover these drugs for people with Type 2 diabetes.

I hear you have to inject yourself with these drugs. Is that true? What about people who have needle phobias?

Yes. It’s true that the medications come as injectables, although there is one pill form. (See more information about that below.)

“Wegovy and Ozempic are injected once a week,” Low Wang said. “So that can be a challenge for anyone who is absolutely against all injections. But because you only need to do the injection once a week, I think it’s doable for many people.”

Tell us about the other version of the medication.

There is a tablet form of semaglutide. It’s called Rybelsus and is for people with Type 2 diabetes. Patients need to take one tablet every day.

In terms of side effects, please tell us more about the risk of retinopathy

People who have uncontrolled diabetes can get retinopathy, a complication that involves damage to blood vessels in the eyes, and can result in vision loss or blindness.

During the clinical trials for Ozempic, a small percentage of study volunteers developed new or worsening retinopathy.

“There was an almost three-fold increase in the rate of people getting retinopathy when they were placed on Ozempic (semaglutide) as compared to those who were not receiving Ozempic,” Low Wang said. “This was the relative risk, not absolute risk, but it is still concerning. However, it occurred in a small percentage of people.”

People who have retinopathy should talk with their health care providers before starting Ozempic or Wegovy. And patients also should have a thorough eye exam and regular follow-up eye exams.

Are there any other rare side effects if you take Wegovy or Ozempic?

People may be at increased risk for pancreatitis, which is inflammation of the pancreas often caused by gall stones, alcohol use or high triglycerides.

“We generally do not use this class of medicines if someone has a history of pancreatitis,” Low Wang said.

If you have a history of MEN2 (multiple endocrine neoplasia 2) or medullary thyroid cancer, you should not take Ozempic or Wegovy.

How do you evaluate the safety and efficacy of drugs like Ozempic and Wegovy?

“As with any drug, you always have to weigh the benefits and risks,” Low Wang said. “Even though this can be an amazing drug for many people, each person is unique and you need to make an informed decision.”

“We know that if you start out with very uncontrolled diabetes and you have underlying retinopathy, if you lower the A1C (estimated blood sugar levels) too quickly, you have a higher risk of worsening retinopathy,” Low Wang said.

That’s one reason that it’s really important to discuss weight loss drugs with your primary care provider and specialists who focus on both eye care and common conditions like diabetes so you can make good decisions.

Many people skip annual eye exams and some who are at risk of kidney disease — like those with diabetes and high blood pressure — don’t get essential blood and urine tests. Having a full health picture is vital for safe use of weight loss drugs.

“Yes, these are potentially awesome medications that can lead to dramatic weight loss, but people need to be committed to following up with their ophthalmologist (eye doctor) regularly,” Low Wang said.

Is there any concern about stopping the drugs suddenly?

No, they don’t need to be tapered before stopping, Low Wang said.

“You can always choose to stop the medications, but it’s important to know that you will have a very high risk of regaining lost weight and worsening diabetes control,” she said. “These medications are like others. Whatever you were treating is likely to recur.”

Do you think people who are overweight or obese have been unfairly blamed for their challenges and thus, fewer have been encouraged to use medications to lose weight?

Yes. Low Wang said the medical community has learned a great deal in recent years about genetic causes for obesity.

“As with many medical conditions, especially chronic conditions, there’s a genetic component and an environmental component. In the past, many people mistakenly thought that weight gain was all environmental, and it’s not,” Low Wang said.

“What we’re trying to do now is to address the end goal: decreased weight that can lead to better health,” she said.

“We’re acknowledging the physiology that is dysregulated and contributes to excess weight for people with obesity or who are overweight. And the newer weight loss medications are able to address this.”

What do researchers know about the genetic causes for weight gain?

Finding the exact genetic causes for weight gain has proven to be challenging, Low Wang said.

“For most people, it’s not a single-gene disorder. There are multiple genes that affect appetite, hunger, fullness and metabolism,” Low Wang said.

In addition, individuals have different microbiomes and different metabolic set points, all of which affect weight and weight gain. Furthermore, researchers don’t yet fully understand the connection between the brain and the gut.

“It’s extremely complex. We’re learning a lot, but there is a lot more to learn, and the causes for obesity are definitely multifactorial, including social determinants of health and the built environment,” Low Wang said.

Do you support insurance coverage for weight loss medications?

“I do,” Low Wang said. She’d like to see insurance coverage that fosters long-term good health for patients.

“These drugs could prevent health problems down the line,” she said.

“For example, if a person with diabetes reduces their weight by 15% or so, that can be enough to cause diabetes remission. That’s huge because we know that Type 2 diabetes is associated with increased risk of heart attacks and strokes,” Low Wang said.

Reduced weight can also help with lower blood pressure, reduced cholesterol levels and a reduction in fatty liver disease.

“Right now, fatty liver is the leading cause of cirrhosis,” Low Wang said.

Many people mistakenly think alcohol consumption is the leading case of cirrhosis. In fact, fatty liver disease is a bigger driver of cirrhosis.

“And weight loss treats that,” Low Wang said.

If Wegovy or Ozempic are not right for a patient, are there any other medications that may work for diabetes or weight loss?

Yes, there are other medications called Jardiance, Farxiga, and Invokana that are used to treat diabetes, but can also cause weight loss. They are what are known as SGLT2 inhibitors.

Patients who qualify also can consider bariatric surgery.

Or if people don’t want to take drugs indefinitely, there are other options.

“We have non-medication weight loss strategies. The specialists at the Anschutz Health and Wellness Center are terrific and can discuss other options with you,” Low Wang said.

I understand it’s really important to be careful about the doses you take of Wegovy or Ozempic. Tell us about dosing, and what is dose titration?

To minimize gastrointestinal side effects, Low Wang said patients need to start with the lowest level dose and stay on that dose for about four weeks before moving to a higher dose.

“That minimizes side effects like nausea, bloating, diarrhea and overall gastrointestinal upset,” Low Wang said.

Dose titration means that a person starts with a less powerful dose, then builds up to the goal dose, which is a higher dose.

Do some people quit taking the medications because they feel lousy?

Yes. Low Wang said it’s common for patients to stop taking the medications because they don’t like the adverse effects.

“About one in five people might stop because they are experiencing bad side effects,” she said.

“I encourage some patients to stay at the lower dose level for a longer period of time to see if they can tolerate it better and still get some benefit from the medication. Or if they don’t tolerate this medication, we might try a different one,” Low Wang said.

What about Ozempic face? Some people complain of losing too much fat in their face and looking gaunt or old.

Low Wang said she’s not hearing that concern from her patients. But she understands why some people could feel that way.

“It’s probably because of the degree of weight loss. It can be pretty quick and dramatic,” she said.

How do most people react to the medications?

“Most people are pleased. Some aren’t used to the decreased appetite. But of those who are able to tolerate the medications, most have been happy with the effects,” Low Wang said.

It sounds like using weight loss drugs may be more complicated than simply starting a prescription. What is your key advice to people?

“See your health care provider. Be aware of the side effects. And the costs may be an issue. It’s not just for one year. The cost is a long term issue unless insurance plans start covering these medications for everyone who needs them,” Low Wang said.

She is eager to help her patients with diabetes learn about ways to manage the condition and consider the new medications if appropriate.

“It doesn’t have to be Ozempic, but this class of diabetes medications controls your blood sugar and causes weight loss without putting people at risk for hypoglycemia,” Low Wang said. “That affects quality of life. Repeated hypoglycemia puts people at risk for car crashes and falls.

“Many of the medications in this class also prevent heart attacks and strokes,” Low Wang said.

For people with diabetes, the medications make a lot of sense.

For people who are healthy but want to lose weight, Low Wang would not recommend Wegovy.

“It’s not even worth discussing because it’s not indicated,” she said.

About the author

Katie Kerwin McCrimmon is a proud Coloradan. She attended Colorado College thanks to a merit scholarship from the Boettcher Foundation and worked as a park ranger in Rocky Mountain National Park during summers in college.

Katie is a dedicated storyteller who loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as an award-winning journalist at the Rocky Mountain News and at an online health policy news site before joining UCHealth in 2017.

Katie and her husband, Cyrus — a Pulitzer Prize-winning photographer — have three adult children and love spending time in the Colorado mountains and traveling around the world.