Background
Wegovy and Zepbound are both approved for weight loss but started as medications for type 2 diabetes. Wegovy was originally approved under the name Ozempic in 2017, followed by Wegovy in 2021 for weight loss. Ozempic and Wegovy both contain the active ingredient semaglutide, a GLP-1 receptor agonist that helps with weight loss via three pathways:
1) lowering the “body set weight,” essentially a thermostat determining when you feel full, that is believed to be located in the hypothalamus
2) delayed gastric emptying leading to a feeling of fullness
3) stimulation of insulin release from the pancreas that also leads to a feeling of satiety
The only other difference between these two medications is that while Ozempic goes up to a maximum dose of 2mg, Wegovy has a maximum dose of 2.4mg.
In contrast, Zepbound was originally approved under the name Mounjaro for type 2 diabetes in 2022, followed by Zepbound in 2023 for weight loss.
Both medications contain the active ingredient which also mimic the naturally occurring gastrointestinal hormone GLP-1 but also mimics the GI hormone gastric inhibitory peptide (GIP).
Comparison per the FDA approval submissions
As seen in the table above, Wegovy and Zepbound have their advantages and disadvantages. Zepbound appears to have greater weight loss and fewer side effects but fewer patients quit Wegovy due to those side effects.
Alopecia is lower with Wegovy but keep in mind that alopecia is not a direct result of the medications. Alopecia, or in this case, telogen effluvium, is hair loss due to a stressor. Any stressor, of which weight loss is a type.
There is an unexplained increase in heart rate with both medications, but slightly less with Zepbound. The cause is unclear but a recent study released by NovoNordisk, the makers of Ozempic and Wegovy showed a 20% reduction in major cardiac events like cardiovascular death, non-fatal stroke and heart attack. Therefore, the cardiac benefits seem to outweigh the risk associated with a slightly increased heart rate, which may resolve with time.
Comparison in our practice
Because of the large number of patients being seen in the BuildMyHealth network of providers, we have our own data. This data suggests greater weight loss, 1-3 pounds on average, per month with tirzepatide (active ingredient in Mounjaro and Zepbound) over semaglutide (active ingredient in Ozempic and Wegovy).
Our data also shows that patients experiencing gastrointestinal side effects on semaglutide will be less likely to experience them on tirzepatide.
Which do we recommend to patients?
Both of these medications are amazing. Not only for weight loss but also the reduction in cardiac death, heart attack and stroke. Even anecdotally, patients are experiencing a reduction in other vices or cravings like alcohol consumption, smoking, vaping, nail biting and online shopping!
So the best way to determine which medication is best for a patient is actually up to the patient. If they want a less expensive compounded version of these medications, semaglutide costs less per month (on average $400-$500) whereas trizepatide is approximately $600 per month.
If a patient feels like the greater cost is worth a 1-3 pounds average greater weight loss per month, then they can choose tirzepatide. And if they’re concerned or are experiencing GI side effects, then they should consider tirzepatide.
To find a provider near you with these medications, please visit BuildMyBod.com/weight-management and if you’re a provider looking to implement a weight management program into your practice, request an account here.
