Episode 241: Which Weight Loss Medication Is Right for You?

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:28] Hello, and welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. Today, it's all about one of the biggest questions I hear both in my clinic and online. What is the difference between Zeppan, Wagovi, Manjaro, Ozempic, and Fundeo? And honestly, I understand the confusion.

[00:00:53] Because some of these medications are injections, some of them are pills, some of them are FDA approved for diabetes, others are FDA approved for weight loss, and some are actually the same medication with different brand names.

[00:01:09] So today, we're going to break this down in plain language. What each medication is, how they work, which ones are approved for weight loss, which tends to lead to more weight loss than the other, the differences in side effects and insurance coverage, and how we decide what may be the best fit for you. So let's get into it. But first, let's organize these medications into groups. Now, here is the key thing to know.

[00:01:38] Wagovi and Ozempic have the same active medication called semaglutide. So their both generic name is semaglutide. The difference is that Ozempic is FDA approved for type 2 diabetes, whereas Wagovi is FDA approved for obesity and weight loss. And Zeppan and Manjaro are also the same medication as well.

[00:02:02] They both contain the generic name of terzapatide. The difference is Manjaro is FDA approved for type 2 diabetes, Zeppan is FDA approved for obesity and obstructive sleep apnea in individuals with obesity. The one thing I forgot to mention is that with Wagovi, it is also FDA approved for individuals who had a history of cardiovascular disease, such as a history of a heart attack, stroke, or peripheral arterial disease.

[00:02:31] It has been shown to reduce your risk of developing another heart attack, or peripheral arterial disease if you are taking this medication. Also, Wagovi is FDA approved to help individuals who have MASH and with F2 or F3 scar or fibrosis. And now, starting last month, we have Fundale and Wagovi pill, which are the oral formulations.

[00:03:00] Fundale is different because it's a daily pill that's taken daily instead of weekly. But then also, it could be taken at any time during the day. You can take it with water, you can take it with food, other medications, that's fine. Whereas Wagovi pill is also a daily pill, but you have to take it first thing in the morning on an empty stomach without food and take it alone. So, the oral pills can be exciting because some people just really dislike needles.

[00:03:29] They just don't like the thought of needles. And so this is another option. If you're somebody who travels often, you can carry the prescriptions in the bottle and it's a little bit easier. And for those people who just want to take a pill instead of an injection. Now, how do these GOP-1 medications work? Well, they help with regulating hunger. They decrease hunger. They increase your fullness so you don't feel quite as hungry throughout the day.

[00:03:54] They can help reduce the cravings and turn down that food noise so you're not even thinking about food. Also, it helps with lowering your blood sugar and it actually slows down digestion. They help improve the communication between your gut and your brain so they work a little bit better. And so let's talk about the Wagovi and Ozempic, which are semaglutide. These medications work on the GOP-1 receptor alone. So that's the only one.

[00:04:23] A GOP-1 is actually a natural hormone that your body releases after eating. It helps decreases appetite. It slows stomach emptying. It reduces food noise. It also improves insulin response so that it works better in bringing that sugar from the bloodstream into the muscles for energy. I often have patients tell me that they feel satisfied after eating and they're not constantly thinking about food anymore.

[00:04:46] And when I describe food noise to them, I'm like, it's basically you ate breakfast and then all of a sudden an hour later you're like, what am I going to eat for lunch? Like, at least thoughts that kind of come through your mind. Which is important because think about it. Like, you know, and when we were hunters and gatherers, we had to think about what's our next meal. So they were here for a reason. So, but sometimes at this point, we don't necessarily need it because we have full grocery stores where you can walk in and pay for food.

[00:05:15] So that makes a big difference for people to reduce those food noise. Now let's talk about Zepan and Manjaro, which have the same active ingredient or medication as Trisepatide. This one's a little bit different because it works on two hormones. The two hormones are the GOP1 and GIP. And that second hormone pathway is why many patients experience a stronger appetite suppression, better blood sugar improvement, and greater weight loss.

[00:05:42] A simple way to think about it is semaglutide has one pathway, Trisepatide has two pathways. Now let's talk a little bit about Fundale. Fundale is an oral GOP1 medication taken daily. Many patients like it because it avoids injections. And sometimes it may be a little less intimidating. We're used to doing pills. It must be taken consistently every day. And some patients may experience the same degree of weight loss.

[00:06:10] Their average weight, and we'll talk about that in a second, is around 11.1%. As well as the WAGOVI pill, which is also an oral medication as well that you take daily. So which one leads to the most weight loss? That's what people really want to know. So based on the clinical trial data, WAGOVI, you can lose on average 15 to 20% of your body weight loss.

[00:06:36] Whereas ZetBound slash Manjaro, you can use an average of 20 to 25% of your body weight loss. And with this, some people lose more, some people lose less. It really just depends on your body and your reason for having extra weight. Because that makes a difference too. Fundale, that average weight loss is 11.1%. Whereas with WAGOVI pill, it's around 13.6%. Now, I will say this. These are just averages. People lose more, people lose less.

[00:07:03] But I've had patients do amazing on WAGOVI. Others respond better to ZetBound. Some love the convenience of Fundeo or WAGOVI pill. I mean, medicine is just personalized. So it really just depends on how your body responds to the medication that's being given. And we can always change it if it's not responding as well. So let's talk about the side effects. The most common side effects for all of these medications include nausea, constipation, diarrhea.

[00:07:30] And these are the top four in vomiting, top four. Also, you can experience some bloating, reflux, vomiting, fatigue, hair loss. And sometimes these side effects can happen when you start taking the medication. Other times, it can happen when you increase the dose or down the line. Which is why it's important to slowly titrate up the medications. Because sometimes if you feel like, okay, I'm not feeling it as much and you titrate up too fast, you can get sick.

[00:08:00] And I've seen it where people have to go to the emergency room because they just feel sick. And it's important to know that your body needs time to adjust. And remember, more medication is not always better. Sometimes the slower dose increase helps people stay successful long term. So why do people respond differently? Now, this is something that social media does not talk about enough. Many patients respond differently to each medications.

[00:08:28] Some people tell me that Ozempic is controlling their cravings better. Other people feel like they get Wagovia's reduced food noise. Zeppon has a stronger appetite suppression. And they found one was better tolerated than the other. Or one had more nausea and then the other one did not. And the reason being is that we're all different. This is because obesity is complex. I mean, there's many different factors why people gain weight. Whether it's hormones, genetics, stress, sleep, menopause, insulin resistance, metabolism.

[00:08:57] They all play a role in why you may be gaining weight and somebody else may not. And this is why obesity medicine should be individualized. Because everyone is so different. And you should not compare yourself to your friend or your family member who's on the same medication. Because their response may not be your response. And sometimes I find when we get caught up in that, comparing ourselves, then we get discouraged because we may not see the results we're looking for. But you're still losing weight, which is important.

[00:09:26] So it's important to not compare yourself. Let's talk about insurance. Because this is often the most frustrating part of this. Because the doctor can write the prescription. But then the insurance may deny it. And so it's important to kind of talk about which medications can be used for what. So with Ozempic and Manjaro, they are both covered for type 2 diabetes. So you have to have type 2 diabetes to usually get these medications covered. It's rare. Very, very rare.

[00:09:56] I've had maybe one or two people where they have free diabetes and they were able to get it covered. But most of the time, it's usually type 2 diabetes that will get these two covered. Also, sometimes the insurances have more things that they offer. So even if you have type 2 diabetes, they may say, oh, you have to take Nefformin first. Or, oh, you got to try this first. These step therapies in order to get it covered, which is really unfortunate.

[00:10:22] Next, Wagovi and ZepBound are also approved for obesity. Wagovi is also approved for cardiovascular risk reduction in patients who have a history of a heart attack, stroke, or peripheral arterial disease. ZepBound is approved not only for obesity, but those who have moderate to severe obstructive sleep apnea. So sometimes with insurance, you have to share with them whether they have any of these FDA-approved conditions. Because then that can help them get it approved.

[00:10:49] So sometimes if you have a condition that's not necessarily FDA-approved for these medications, it's a long shot whether they will cover it or not. Now let's talk about Fundale. Fundale is definitely new to the market. It just came out last month. So right now, it's not really on everyone's formulary. It does take about a good three months to get on the formulary when you have a new med.

[00:11:13] But you can be able to access Fundale with their self-paid program where you would send the prescription to Lilly Direct and they would ship it to your home. And it would be a lower dose and you would taper up on it. But it makes it a little bit easier than having to wait for your insurance to put this on their formulary. Because unfortunately, many insurance plans exclude weight loss medications, require prior authorizations, require step therapy.

[00:11:41] Like I said, you have to try one other thing before they cover that. Or they require participation in online programs where you have to see somebody and do different modules. And I always tell my patients that the denial is not a reflection of your worth. It's often an insurance barrier, not a medical failure. So who may be a good candidate for these medications?

[00:12:03] These medications may help people who have obesity, overweight with medical conditions, insulin resistance, type 2 diabetes, moderate to severe sleep apnea, PCOS, hypertension, fatty liver disease with fibrosis, and cardiovascular disease. But most importantly, these medications are tools. They are not magic.

[00:12:24] Long-term success still requires movement, staying physically active, staying hydrated, getting a good night's rest with sleep, stress management, making sure you're eating a balanced diet and making sure you're getting your protein in as well as resistance training. But most importantly, it still requires consistency. So continuing to do the same things over and over again to kind of help with that weight loss. Because the medications help reduce the biologic resistance that makes weight loss so difficult.

[00:12:52] But you can't forget about the other things, the other factors that play a role. So in conclusion, let's summarize. Ozempic and Wagovi, they're semaglutide GLP-1 medications. They target one pathway. Manjaro and Zeppan, it's generic, it's terzepatide. And it has a dual action where it targets two medications. And then you have Fundeo and Wagovi, both oral GLP-1 pills.

[00:13:20] And they're helpful for people who may not prefer to do inject. So, and while Zeppan tends to produce the greatest average weight loss in studies, the best medication depends on the person, side effects, insurance, lifestyle, medical history, and of course, your own personal goals. Now remember, there's no perfect medication for everyone, but it is important to kind of figure out what works best for you.

[00:13:45] So I thank you so much for listening today on our today's episode of the Back on Track Achieving Healthy Weight Loss podcast. If this episode helped you to better understand the differences between Ozipic, Wagovi, Manjaro, Zeppan, Fundeo, and Wagovi pill, please share it with somebody else who may be confused too, because we may be able to help them have a little bit more understanding what these medications are and do. And don't forget to subscribe and leave a review.

[00:14:13] Follow along for more conversation about obesity medicine, hormones, lifestyle, and sustainable health. And remember, until next time, stay strong, stay committed, and stay consistent. And remember, we are stronger together. We are stronger together.