FDA Approves Zepbound (Tirzepatide) for Obesity: Addressing Common Myths
With the FDA's approval of Eli Lilly's diabetes drug, Manjaro (tirzepatide), for obesity under the new name Zepbound, it's crucial to address common misconceptions. This article will discuss three major myths surrounding GLP-1 agonists, based on experience treating patients with tirzepatide.
Myth 1: GLP-1 Agonists are Miracle Drugs
GLP-1 agonists like tirzepatide (Zepbound/Mounjaro) and semaglutide (Ozempic/Wegovy) mimic the GLP-1 hormone in our body. Tirzepatide also mimics the GIP hormone. These medications are effective at suppressing food noise and decreasing cravings for unhealthy foods.
However, they are not perfect and can cause unpleasant side effects. The most common side effects are gastrointestinal (GI) related, including nausea, vomiting, diarrhea, constipation, upset stomach, and heartburn. Studies indicate that semaglutide is more likely to cause nausea, with one study reporting it in 44% of users, compared to 25% for tirzepatide in another study. Less common side effects may include fatigue, trouble sleeping, headache, temporary hair loss, local injection site reactions, and skin hypersensitivity.
Pancreatitis, or inflammation of the pancreas, is a potential but rare side effect. It is difficult to definitively link GLP-1 agonists to pancreatitis, as obesity itself is a risk factor. The risk of GI side effects is increased by consuming highly processed foods, particularly those high in added sugar, refined carbohydrates, and fried foods. Eating healthy, unprocessed foods is crucial for optimal results. Exercise, including at least 150 minutes per week of moderate-intensity activity and resistance training to prevent muscle loss, is also important.
Weight loss also varies depending on the specific drug and dose. Tirzepatide has been shown to cause significant weight loss, with higher doses resulting in greater weight loss. In studies, after a year, the highest dose of semaglutide resulted in an average weight loss of 15% of body weight, while the highest dose of tirzepatide yielded an average weight loss of 22% in the SURMOUNT-1 trial. The SURMOUNT-3 and SURMOUNT-4 trials, with a duration of about a year and a half, showed an average weight loss of 26% with tirzepatide. Starting at a low dose of tirzepatide, such as 2.5 mg, can lead to an average of 5 pounds of weight loss in the first month; however, individual results vary.
Myth 2: You Need to Be on GLP-1 Agonists for Life
A common question is whether long-term use of these medications is necessary. While there aren't long-term studies specifically for tirzepatide, studies on semaglutide suggest that many people regain weight after stopping the medication.
However, individual experiences vary, and for some, these medications can serve as a bridge to healthier habits. Improving dietary habits by focusing on unprocessed foods, even if medication is eventually needed again, is beneficial. Being temporarily healthier is better than not being healthy at all.
Myth 3: Compounded Tirzepatide is the Same as Mounjaro/Zepbound
Tirzepatide is the active ingredient in both Mounjaro/Zepbound and compounded tirzepatide. Both contain the same 39 amino acid sequence molecule.
However, compounded versions do not come in an auto-injector pen and may be mixed with vitamin B6 or B12. While some believe these additions help with nausea, there is limited research to support this. Some individuals, particularly those who have undergone bariatric surgery, may have a higher risk of vitamin and mineral deficiencies, making B6 or B12 supplementation potentially beneficial. There are numerous compounding pharmacies, but only a select few are reputable and compound tirzepatide effectively.
With Zepbound's FDA approval for treating obesity and overweight individuals, insurance companies are expected to start covering the cost. Currently, Mounjaro and Zepbound cost approximately $1,100 out-of-pocket, compared to around $400 per month for compounded tirzepatide.