When it comes to ultra-popular weight-management medications like Wegovy and Zepbound, take care to look beyond the hype.
That’s the word from bariatric surgeon and medical bariatrician Dr. David Voellinger of Novant Health Bariatric Solutions Elizabeth in Charlotte. Here, he shares 5 common misconceptions — and the truth behind them — to help you learn if these tools might be right for you.
Balanced and personalized weight loss programs
5 common misconceptions about weight loss medications
Misconception 1: All the injectable weight loss medications are the same.
Truth: They’re not exactly the same, but they have similar results.
"Ozempic" and "Wegovy" are two brand names for the same drug, semaglutide. However, only Wegovy is FDA-approved for weight loss. Likewise, "Mounjaro" and "Zepbound" are two brand names for the same drug, tirzepatide. But only Zepbound is FDA-approved for weight loss. (See sidebar)
So for a discussion here about weight-loss drugs potentially covered by insurance, we’re focusing on Wegovy and Zepbound.
Both Wegovy and Zepbound are weekly, self-injectable shots. They work in slightly different ways, but they both reduce cravings and hunger. Patients taking them typically eat less than they did before, but still feel satisfied, leading to weight loss.
What’s different: Studies show that Zepbound leads to a little more weight loss than Wegovy. The dosing is different, so someone who struggles with side effects on one may do better on the other.
The drugs are also Food and Drug Administration approved for different indications: for example, Wegovy is approved for adolescents 12 and older, while Zepbound is only approved for adults.
Wegovy is approved for reducing the risk of heart disease in overweight or obese adults, and Zepbound is approved to treat moderate to severe obstructive sleep apnea in adults with obesity.
The bottom line is that both help with weight management. If you’re a good candidate for injectable weight loss medications, we will look at your overall health profile (including body mass index, co-existing conditions and medical history), preferences, and insurance coverage to determine which drug to prescribe.
Misconception 2: Using these medications is “cheating.” We should all be able to lose weight with willpower alone.
Truth: Obesity is a disease; these medications can help treat and manage it.Many people believe obesity is a lack of willpower, instead of what it is: a metabolic disorder.
Would you say somebody with diabetes is "cheating" because they are on Ozempic? No. Similarly, somebody with obesity who uses these drugs isn't cheating — they're treating their disease.
I even look at it the opposite way: People who are willing to go on these medicines are really going above and beyond — taking on the side effects and possible costs of the medication to try to treat their disease.
Are there Hollywood stars with a body mass index of 23 taking Ozempic to keep them there? Yes, there are always extremes, but in our patient population, we are treating a disease. It’s brave to step up and take care of their weight and help themselves live longer and better.
Misconception 3: These medications are so pricy that there’s no point in trying to get on them.
Truth: We’ll have to check your insurance plan.Coverage has improved, but it’s still not consistent. Sometimes insurance will cover it, and sometimes it won’t. If they do, there are also lifetime maximum limits to potentially worry about.
These two cost roughly $1,000 a month before insurance. I’ve had patients get the cost down to $200 to $300 a month with manufacturer’s discounts and couponing, but the cost is something to consider before starting. For some patients, it may be more cost-effective to have bariatric surgery.
Some good news: As of January 2025, Medicare is now covering Zepbound for obstructive sleep apnea, and North Carolina’s state Medicaid program will cover these drugs for obesity. It’s one of only 13 state Medicaid programs across the country to cover it. There were supply issues for a while, but those have resolved, so that’s one less barrier.
Also worth noting: Oral weight loss medications (examples include phentermine, Contrave and topiramate) often have better insurance coverage. We can find the right set of tools to help you.
Misconception 4: You don’t need to see your doctor; just find a concierge provider online to prescribe them and let the weight loss begin.
Truth: Some patients shouldn’t go on these medications, and there is potential for side effects. A comprehensive approach is important.People don’t think about the side effects; they just think of weight loss. But this is prescription medication, and it can be dangerous. Your decision to take this — or not — needs to be driven by a comprehensive approach. You want a doctor who is looking at your chart, your medical history, and talking with you about symptoms that you've had.
Some patients shouldn’t take these at all based on their health history. About 5% to 10% of my patients experience side effects like nausea, constipation, bloating and cramping, and some need to discontinue the medications as a result. There can be serious health outcomes from these medications. And because they're so effective at curbing appetite, some people end up dehydrated, malnourished or facing muscle loss.
In our clinic, we monitor patients with visits, labs, and body composition analysis to make sure that they are staying healthy while they’re on these medications. We also help them make other changes to their diet, exercise, sleep and behaviors. Without these changes, the medication won't be as effective and may not work at all.
For these reasons, I strongly advise going to a comprehensive weight loss provider instead of just “doctor shopping” online or going to a med-spa for a prescription. Sure, they’re giving you what you want, when you want it — but if you’re not making those other changes, they're not doing right by you, and they might even be harming you.
Similarly, I don’t recommend “compounded" GLP-1 medications; since compounded medications are custom-made by a pharmacist, they are not FDA-regulated. That means the formulary is different and the effects can be different — including the adverse effects. You just don’t know what you’re getting, and that could have serious consequences.
Misconception 5: “These medications will work forever.”
Truth: We don’t know that yet.These drugs were originally created to be a long-term treatment … for diabetes. When a patient starts Ozempic for diabetes, they’re meant to be on it forever unless their diabetes gets better or worse and they need a stronger drug.
Now, these drugs are approved for weight loss, too. But obesity can have a lot more factors involved than diabetes, and we don’t know yet. Is it going to be the same as diabetes, where you get on the right dose and it helps control your weight forever? Or is tolerance going to develop? Or will there be side effects the longer you're on these medications? Since it’s new, we don’t have 10-, 20-, or 30-year data yet.
That’s why we cover all the bases in our clinic — sleep, nutrition, exercise, behavioral modification, mental health and stress management — and offer a variety of surgical and medication options. That way, regardless of what happens with this patient and this particular medication, we have a way to help.
There are always people who want that “quick fix,” but at our practice, we’re focused on providing multidisciplinary, comprehensive and individualized care. We are treating a chronic disease, and we are playing the long view for better health.
A deeper dive into the differences between Ozempic and other weight loss drugs
- Wegovy and Ozempic are both manufactured by Novo Nordisk and contain the same active ingredient (semaglutide). Although they contain the same active ingredient, they are FDA approved for different indications, covered by insurance for different reasons, and marketed for different populations. Both drugs start at a .25 injection/once weekly for the first month, moving up to .5/once weekly for the second month. Many people taking Ozempic for diabetes will stop at that dose of .5 mg/once weekly, although those who need to can continue to a maximum dosage of 2 mg. In contrast, those who are taking Wegovy for weight loss generally continue increasing until they arrive at a recommended target dose of 2.4 mg/once weekly.
- Zepbound and Mounjaro are both manufactured by Eli Lilly and contain the same active ingredient (tirzepatide). Although they contain the same active ingredient, they are FDA approved for different indications, covered by insurance for different reasons, and marketed for different populations. Both drugs start at a 2.5 mg injection, working up in incremental doses as tolerated. The maximum dosage for either drug is 15 mg/once a week.
