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Tag: weightloss

  • Comparing GLP‑1 Injectable Weight‑Loss Meds, Semaglutide vs Tirzepatide, and Real Side Effects

    Comparing GLP‑1 Injectable Weight‑Loss Meds, Semaglutide vs Tirzepatide, and Real Side Effects

    The debate of Ozempic vs Mounjaro has become one of the most discussed topics in modern weight management. These injectable weight-loss meds, often referred to as GLP‑1 weight-loss drugs, have gained massive attention for their effectiveness in helping people lose significant weight while also improving blood sugar control.

    Both medications were initially developed to treat type 2 diabetes, but clinical results showing dramatic weight reductions sparked their evolution into tools for obesity management.

    While Ozempic and Mounjaro share some similarities, they differ in composition, mechanisms, and potential side effects. Understanding how each drug works and what distinguishes semaglutide vs tirzepatide can help individuals and clinicians make informed choices about treatment options.

    What Are GLP-1 Weight-Loss Drugs?

    GLP-1 receptor agonists are medications that mimic the natural hormone glucagon-like peptide-1 (GLP-1). This hormone helps regulate blood sugar and satiety by slowing down digestion, promoting insulin release, and reducing appetite. When administered as once-weekly injections, these drugs assist patients in feeling full longer and eating less.

    Ozempic (which contains semaglutide) and Mounjaro (which contains tirzepatide) are among the most well-known of this group. Other related drugs include Wegovy and Zepbound, versions approved specifically for weight management rather than diabetes.

    Ozempic vs Mounjaro: Key Differences

    When comparing Ozempic vs Mounjaro, the key difference lies in the drugs’ active ingredients and how they act on the body.

    • Ozempic (semaglutide) targets only the GLP‑1 receptor.
    • Mounjaro (tirzepatide), on the other hand, acts on both the GLP‑1 and GIP (glucose-dependent insulinotropic polypeptide) receptors.

    This dual mechanism allows Mounjaro to potentially offer stronger effects on both insulin control and appetite regulation. Some studies suggest that tirzepatide may lead to greater average weight loss than semaglutide, though long-term outcomes are still being studied.

    Both medications are injectable and typically used once a week. Ozempic has been FDA-approved for type 2 diabetes, while Wegovy (its higher-dose version) is approved for chronic weight management. Similarly, Mounjaro is FDA-approved for diabetes, while its twin drug Zepbound is approved for obesity.

    How Do Ozempic and Mounjaro Help You Lose Weight?

    The success of GLP‑1 weight-loss drugs such as Ozempic and Mounjaro comes down to appetite control and metabolic balance. These medications not only lower blood sugar but also trigger signals that make the body feel full sooner.

    GLP‑1 and GIP hormones play a critical role in sending satiety messages to the brain. By mimicking these hormones, semaglutide and tirzepatide slow gastric emptying (the speed at which food leaves the stomach). As a result, people consume fewer calories without feeling deprived.

    In clinical trials, individuals using semaglutide reported an average weight loss of around 15% of their body weight over 68 weeks, while tirzepatide users experienced reductions as high as 20% in some studies. These results position injectable weight-loss meds like these as some of the most effective non-surgical treatments available today.

    Side Effects of Ozempic and Mounjaro

    As with any medication, both Ozempic and Mounjaro come with potential side effects. For most people, these are temporary and mild, but understanding them helps in managing expectations and safety, according to the World Health Organization.

    Common side effects include:

    • Nausea and vomiting
    • Constipation or diarrhea
    • Bloating or indigestion
    • Mild fatigue or dizziness

    More serious side effects, though less common, can occur. These include pancreatitis, gallbladder inflammation, kidney complications, and in rare cases, thyroid-related tumors. Patients are often monitored for early signs of these conditions, especially if they have a family history of thyroid disease.

    When comparing Ozempic side effects vs Mounjaro side effects, reports suggest that Mounjaro users might experience slightly stronger gastrointestinal symptoms initially, possibly because of its dual-agonist action.

    However, gradual dose adjustments and dietary changes, like eating smaller meals and avoiding greasy foods, can minimize these effects.

    Doctors typically start patients on the lowest dosage to allow the body to adjust. Staying hydrated and taking injections on the same day each week also help reduce discomfort.

    Who Should and Shouldn’t Use Injectable Weight-Loss Meds

    These medications are designed for adults with type 2 diabetes or those classified as overweight or obese (BMI of 30 or higher, or 27 with weight-related conditions). They are not intended for short-term or cosmetic weight loss.

    People with a personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia type 2, pancreatitis, or severe gastrointestinal conditions should avoid GLP‑1 weight-loss drugs unless specifically advised by their physician.

    It’s crucial for potential users to consult their healthcare providers before starting these treatments. A comprehensive health assessment ensures safety and identifies whether related lifestyle changes may be sufficient before turning to medication.

    Cost, Accessibility, and Insurance Coverage

    Access and affordability remain major challenges. Ozempic and Mounjaro can cost anywhere from $900 to $1,300 per month without insurance, and coverage often depends on medical necessity. While insurers frequently cover these drugs for diabetes, weight-loss-only prescriptions may face denials.

    To help offset the price, both drug manufacturers offer savings programs and patient assistance plans. Prices also vary by region and dosage strength, making it worthwhile to consult pharmacies or clinics to find cost-effective options.

    For those comparing Ozempic vs Mounjaro, it’s worth noting that tirzepatide-based drugs (Mounjaro or Zepbound) might have limited availability in some areas due to high demand, as per the Centers for Disease Control and Prevention.

    Ozempic vs Mounjaro: Which One Is Better for You?

    The choice between Ozempic vs Mounjaro depends on a person’s health goals, metabolic profile, and tolerance. Clinical trials show both drugs yield significant weight loss and improved glucose control, but the response varies individually.

    • Those seeking steadier blood sugar control with proven long-term data may prefer Ozempic (semaglutide).
    • Those targeting faster or more substantial fat loss may respond better to Mounjaro (tirzepatide).

    Doctors often base their recommendation on the patient’s overall health, co-existing conditions, and potential side effect management.

    In practice, both options can be effective, success largely depends on consistency, proper dosing, and accompanying lifestyle adjustments such as balanced meals and physical activity.

    Frequently Asked Questions

    1. Can you stop taking Ozempic or Mounjaro once you reach your goal weight?

    Stopping these medications often leads to regained weight because appetite and metabolism return to baseline. Ongoing medical guidance is recommended before tapering off.

    2. Do Ozempic and Mounjaro affect muscle mass as well as fat loss?

    Some users may lose small amounts of lean muscle alongside fat, but maintaining protein intake and resistance exercise helps preserve muscle mass.

    3. Can you drink alcohol while using GLP‑1 weight-loss drugs?

    Light to moderate drinking is generally safe, but alcohol can worsen nausea or affect blood sugar control. It’s best to consult your healthcare provider for limits.

    4. Are there any natural alternatives to GLP‑1 weight-loss drugs?

    Certain lifestyle changes, like high-protein diets, fiber-rich foods, and regular exercise, can naturally boost satiety hormones, though not as powerfully as medical GLP‑1 therapy.



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  • Weight-Loss Devices to the Extreme

    Weight-Loss Devices to the Extreme

    Let’s discuss the safety and efficacy of various weight-loss methods, ranging from Botox and corsets to siphons and tapeworms.

    A moderately obese person doing moderately intense physical activity, like biking or brisk walking, would burn off approximately 350 calories an hour, but most drinks, snacks, and other processed junk are consumed at a rate of about 70 calories (293 kJ) per minute. Therefore, it only takes five minutes to wipe out a whole hour of exercise.

    Enter the AspireAssist siphon assembly.

    It’s a percutaneous gastrostomy device, meaning surgeons cut a hole in a person’s stomach and tunnel a fistula out through the abdominal wall. So, after each meal, the person can attach a suction gadget to the hole and directly drain out their stomach contents, as you can see below and at 0:47 in my video Extreme Weight-Loss Devices.

    This means you could gorge on donuts, spew them out through the hole in your stomach, then gorge on more donuts. Have your cake, and eat it, too…and two, three, and four times!

    It seems to be the quintessential American invention, straight from the land that brought us Jell-O salads, spray cheese, and deep-fried Snickers bars. Patients do lose weight, perhaps in part because the fistula may interfere with the relaxation of the stomach wall during a meal. The process also requires drinking lots of water and thoroughly chewing food, both of which may help with weight loss by increasing hydration and slowing the eating rate. Patients also started making healthier choices to avoid the unpleasant sight of gastric aspirate from unhealthy foods. (The tubing is clear, and, evidently, fried foods look particularly gross as they are pumped out.)

    All patients need to take supplemental potassium, since it’s sucked out in stomach juices. Otherwise, they risk becoming potassium-deficient (a common complication in bulimia), but most side effects are just minor wound complications. Serious adverse effects, like abdominal abscesses, are rare. The big selling point is that the siphon device doesn’t change the gastrointestinal tract’s anatomy. That seems like a low bar, but in today’s Wild West world of weight-loss procedures, you can’t take anything for granted. Take the duodenal-jejunal bypass liner, for example.

    Gastric bypass surgery works in part by cutting out a portion of the small intestine so it’s no longer in the flow of food, thereby helping to prevent the absorption of calories. Instead of major surgery, how about just dropping down a couple of feet of plastic tubing to line the intestinal walls? The problem with the EndoBarrier is that it has to be anchored in the digestive tract. This is accomplished with 10 barbed hooks that cause lacerations, accounting for the majority of the 891 adverse effects reported in 1,056 patients—nearly 9 out of 10 people. Severe penetrating trauma, resulting in esophageal perforation or liver abscesses, is rarer (occurring in only about 1 in 27 patients).

    Concern has been raised about the “palatability” of the AspireAssist stomach pump, but the most cringeworthy endoscopic procedure I discovered in my research was intestinal “resurfacing.” Why cover the inside of your intestines with plastic to prevent absorption when you can just “thermally ablate the superficial duodenal mucosa”? In other words, have your intestinal lining burned off—or rather, “resurfaced.”

    Surgeons have tried injecting Botox into the stomach walls of obese individuals, hoping it would partially paralyze their gastric muscles, slow stomach emptying, make people feel fuller longer, and lose weight. It didn’t work.

    Researchers in Sweden tried randomizing people to wear corsets for 12 to 16 hours a day, seven days a week, for nine months. And it didn’t work. The study participants just didn’t wear the corsets—they were “perceived as uncomfortable.” Duh.

    “Sanitized tapeworms” have evidently been widely advertised as a weight-loss remedy since back in the early 1900s. The fact that living tapeworms have been discovered during bariatric surgery operations suggests that infesting yourself with parasites may not be particularly effective either.

    Speaking of disgusting strategies, how about disgust itself? A study entitled “Harnessing the Power of Disgust: A Randomized Trial to Reduce High-Calorie Food Appeal Through Implicit Priming” tried using subliminal messages to ruin people’s appetite. Just before showing images of healthy foods, researchers briefly flashed happy images—such as a group of kittens—for 20 milliseconds. That’s too quick to consciously register, but the hope was to plant a positive imprint on the brain. Before showing images of high-calorie foods like ice cream, they flashed negative scenes, like a cockroach on a pizza slice, vomit in a dirty bathroom, and a burn wound. Apparently, it worked! Subjects subsequently reported a reduced desire to eat high-calorie foods, though this wasn’t tested directly. The researchers concluded that subliminal revulsion might be “a successful tactic to combat the onslaught of food cues that promote unhealthy eating….”

    The rest of the world looks on, bemused by American machinations, penning commentaries like “Don’t Let Them Eat Cake! A View from Across the Pond.” A paper in the journal Obesity Surgery entitled “What Are the Yanks Doing?” reviewed “The U.S. Experience with Implantable Gastric Stimulation,” inserting electrodes into the muscular layer of the stomach wall. When that didn’t work, colon electrical stimulation was tried.

    Even more shocking were studies like “Repetitive electric brain stimulation reduces food intake in humans.” Though placing deep-brain electrodes is considered a complication-prone operation, scientists have long pondered whether “placing an electrode somewhere in the brain could make people eat less.” Holes were drilled through the skulls of five obese individuals, and wires were pushed into their brains for “electrostimulatory exploration.” Once the researchers poked around and found spots where they were able to elicit convincing hunger responses, they sent in enough juice to fry out electro-coagulatory lesions. It seemed to work in cats and monkeys, but the researchers found that burning holes in people’s brains did not result in weight loss in obese humans. Thankfully, as I explained in my book How Not to Diet, healthy, sustainable weight loss isn’t brain surgery.

    Doctor’s Note

    Check out Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    What about drugs? See Are Weight Loss Pills Safe? and Are Weight Loss Pills Effective?.

    So, what’s the best way to lose weight? I wrote a whole book about it! How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.) To whet your appetite, take a peek: Trailer for How Not to Diet: Dr. Greger’s Guide to Weight Loss.

    For more on this topic, check out related posts below.



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  • Bariatric Weight-Loss Surgery and Mortality

    Bariatric Weight-Loss Surgery and Mortality

    Today, death rates after weight-loss surgery are considered to be “very low,” occurring in perhaps 1 in 300 to 1 in 500 patients on average.

    The treatment of obesity has long been stained by the snake-oil swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine (derived from the Greek word baros, meaning “weight”) is pervaded by an “insidious image of sleaze.” Beguiled by advertising for fairy tale magic bullets of rapid, effortless weight loss, people blame themselves for failing to manifest the miracle or imagine themselves metabolically broken. On the other end of the spectrum are overly pessimistic practitioners of the opinion that “people who are fat are born fat, and nothing much can be done about it.” The truth lies somewhere in between.

    The difficulty of curing obesity has been compared to learning a foreign language. It’s an achievement virtually anyone can attain with a sufficient investment of energies, “but it always takes a considerable amount of time and trouble.” And, of those who do stick with it, most will regain much of the weight lost. To me, this speaks to the difficulty, rather than the futility. It may take smokers an average of 30 attempts to finally kick the habit. Like quitting smoking, curing obesity is just something that has to be done. As the chair of the Association for the Study of Obesity put it, it doesn’t take “will power” to do essential tasks like getting up at night to feed a baby; it’s just something that has to be done.

    Our collective response doesn’t seem to match the rhetoric or reality. If obesity is such a “national crisis” reaching alarming proportions, dubbed by the post-9/11 Surgeon General as “every bit as devastating as terrorism,” why has our reaction been so tepid? For example, governments meekly suggest the food industry take “voluntary initiatives to restrict the marketing of less healthy food options to children….” Have we just given up and ceded control?

    Our timid response to the obesity epidemic is encapsulated by a national initiative promulgated by a Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council: the “small-changes approach.” Since “small changes are more feasible to achieve,” suggestions include “using mustard instead of mayonnaise” and “eating 1 rather than 2 doughnuts in the morning.” Seems a bit like bringing a butter knife to a gunfight. Proponents of the small-changes approach lament that, unlike other addictions—for example, alcohol, cocaine, gambling, or tobacco—we can’t counsel our obese patients to give up the addictive element completely, as “[n]o one can give up eating.” But just because we have to breathe, doesn’t mean it has to be through the end of a cigarette. And just because we have to eat doesn’t mean we have to eat junk.

    What about bringing a scalpel to the gunfight instead? The use of bariatric surgery has exploded from about 40,000 procedures noted in the first international survey in 1998 to hundreds of thousands performed now every year in the United States alone. The first technique that was developed, the intestinal bypass, involved carving out about 19 feet of intestines. More than 30,000 intestinal bypass operations were performed before we recognized “catastrophic” and “disastrous outcomes” resulted from these procedures. This included protein deficiency-induced liver disease, “which often progressed to liver failure and death.” This inauspicious start is remembered as “one of the dark blots in the history of surgery,” as I discuss in my video The Mortality Rate of Bariatric Weight-Loss Surgery.

    Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to impacting 1 in 500 patients. The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of the stomach is left so as to restrict how much food people can eat at any one time. It’s ironic that many patients choose bariatric surgery convinced that, “for them, ‘diets do not work,’” when, in reality, that’s all the surgery may be—an enforced diet. Bariatric surgery can be thought of as a form of internal jaw wiring.

    Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging one’s anatomy to bypass the first part of the small intestine. It appears to be more effective than just cutting out most of the stomach, resulting in a loss of about 63% of excess weight compared to 53% with a gastric sleeve. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new “surgical procedures…do not require premarket testing and approval by the Food and Drug Administration (FDA)” and are largely exempt from rigorous regulatory scrutiny.

    Doctor’s Note

    I didn’t know there wasn’t some kind of approval process for new surgical procedures!

    This is the first video in a four-part series on bariatric surgery. Coming up are:

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local public library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

     



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  • What’s the Best Weight-Loss and Disease-Prevention Diet? 

    What’s the Best Weight-Loss and Disease-Prevention Diet? 

    The most effective diet for weight loss may also be the most healthful.

    Why are vegetarian diets so effective in preventing and treating diabetes? Maybe it is because of the weight loss. As I discuss in my video The Best Diet for Weight Loss and Disease Prevention, those eating more plant-based tend to be significantly slimmer. That isn’t based on looking at a cross-section of the population either. You can perform an interventional trial and put it to the test in a randomized, controlled community-based trial of a whole food, plant-based diet.

    “The key difference between this trial [of plant-based nutrition] and other approaches to weight loss was that participants were informed to eat the WFPB [whole food, plant-based] diet ad libitum and to focus efforts on diet, rather than increasing exercise.” Ad libitum means they could eat as much as they want; there was no calorie counting or portion control. They just ate. It was about improving the quality of the food rather than restricting the quantity of food. In the study, the researchers had participants focus just on a diet rather than exercising more exercise because they wanted to isolate the effects of eating more healthfully.

    So, what happened? At the start of the study, the participants were, on average, obese at nearly 210 pounds (95 kg) with an average height of about 5’5” (165 cm). Three months into the trial, they were down about 18 pounds (8 kg)—without portion restrictions and eating all the healthy foods they wanted. At six months in, they were closer to 26 pounds (12 kg) lighter. You know how these weight-loss trials usually go, though. However, this wasn’t an institutional study where the participants were locked up and fed. In this trial, no meals were provided. The researchers just informed them about the benefits of plant-based eating and encouraged them to eat that way on their own, with their own families, and in their own homes, in their own communities. What you typically see in these “free-living” studies is weight loss at six months, with the weight creeping back or even getting worse by the end of a year. But, in this study, the participants were able to maintain that weight loss all year, as you can see below and at 1:57 in my video.

    What’s more, their cholesterol got better, too, but the claim to fame is that they “achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy [caloric] intake or mandate regular exercise.” That’s worth repeating. A whole food, plant-based diet achieved the greatest weight loss ever recorded at 6 and 12 months compared to any other such intervention published in the medical literature. Now, obviously, with very low-calorie starvation diets, you can drop down to any weight. “However, medically supervised liquid ‘meal replacements’ are not intended for ongoing use”—obviously, they’re just short-term fixes—“and are associated with ‘high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years.’” In contrast, the whole point of whole food, plant-based nutrition is to maximize long-term health and longevity.

    What about low-carb diets? “Studies on the effects of low-carbohydrate diets have shown higher rates of all-cause mortality”—meaning a shorter lifespan—“decreased peripheral flow-mediated dilation [artery function], worsening of coronary artery disease, and increased rates of constipation, headache, halitosis [bad breath], muscle cramps, general weakness, and rash.”

    The point of weight loss is not to fit into a smaller casket. A whole food, plant-based diet is more effective than low-carb diets for weight loss and has the bonus of having all good side effects, such as decreasing the risk of diabetes beyond just weight loss.

    “The lower risk of type 2 diabetes among vegetarians may be explained in part by improved weight status (i.e., lower BMI). However, the lower risk also may be explained by higher amounts of ingested dietary fiber and plant protein, the absence of meat- and egg-derived protein and heme iron, and a lower intake of saturated fat. Most studies report the lowest risk of type 2 diabetes among individuals who adhere to vegan diets. This may be explained by the fact that vegans, in contrast to ovo- and lacto-ovo-vegetarians, do not ingest eggs. Two separate meta-analyses linked egg consumption with a higher risk of type 2 diabetes.”

    Maybe it’s eating lower on the food chain, thereby avoiding the highest levels of persistent organic pollutants, like dioxins, PCBs, and DDT in animal products. Those have been implicated as a diabetes risk factor. Or maybe it has to do with the gut microbiome. With all that fiber in a plant-based diet, it’s no surprise there would be fewer disease-causing bugs and more protective gut flora, which can lead to less inflammation throughout the body that “may be the key feature linking the vegan gut microbiota with protective health effects”—including the metabolic dysfunction you can see in type 2 diabetes.

    The multiplicity of benefits from eating plant-based can help with compliance and family buy-in. “Whereas a household that includes people who do not have diabetes may be unlikely to enthusiastically follow a ‘diabetic diet,’ a low-fat plant-based approach is not disease-specific and has been shown to improve other chronic conditions. While the patient [with diabetes] will likely see improvement in A1C [blood sugar control], a spouse suffering from constipation or high blood pressure may also see improvements, as may children with weight issues,” if you make healthy eating a family affair.

    This is just a taste of my New York Times best-selling book, How Not to Diet. (As with all of my books, all proceeds I received went to charity.) Watch the book trailer. You may also be interested in its companion, The How Not to Diet Cookbook.

    Check out my hour-long Evidence-Based Weight Loss lecture for more. 



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