Medications for Weight Loss and Type 2 Diabetes

Recent headlines have heralded the weight-loss medications Ozempic and Wegovy as representing the end of obesity as we know it. Celebrities and TikTok influencers have been touting them as miracle drugs. These are both wildly exaggerated claims. 

Physicians at Weill Cornell Medicine note that obesity is still a widespread health challenge. They also state unambiguously that these medications are not miracle drugs. They’re serious medicine, with risks and benefits to patients with type 2 diabetes, obesity or both.  

To manage these conditions, people count on the availability of Ozempic and Wegovy—a drug that also has been shown to reduce the risk of heart attacks, strokes and cardiovascular deaths by 20 percent. But rising demand has created shortages, and that’s cause for frustration among patients and doctors alike. 

The physicians associated with Weill Cornell Medicine’s Comprehensive Weight Control Center recently issued a statement regarding the need for patience as manufacturers rush to make up for the shortfall. They’ve also reassured patients that missing a dose or taking a different dose of Wegovy or Ozempic may be inconvenient but not dangerous. 

In the meantime, Dr. Mohini Aras, an internist and obesity medicine specialist as well as an Assistant Attending Physician and Assistant Professor of Clinical Medicine at Weill Cornell Medicine, offers answers to your FAQs about these innovative medications. If you aren’t already taking one of them, this is your chance to consider whether you’re a candidate for doing so. 

How do Ozempic and Wegovy work? 

“It’s important to understand that our brain is designed to defend against starvation,” Dr. Aras says. “When we lose weight, naturally occurring hormones send a message to our brain that it’s time to increase our hunger and slow down our metabolism.”  

Weight-loss medications like Ozempic and Wegovy activate the hormones we produce to regulate weight. They target appetite and hunger, helping people feel full sooner and stay full longer, she explains. They may also curtail cravings and binge eating. 

How are these drugs administered? 

Both of them  are once-weekly injectable medications. They come as a pre-filled pen, and you inject yourself in your upper thigh, abdomen or arm. It’s a tiny needle, so self-injection isn’t painful or bothersome for most people. 

Oral versions are expected to become available later this year. Easier to transport, they promise to open up options and make room for individual preferences.  

There also is an oral version of semaglutide on the market, called Rybelsus, approved for type 2 diabetes. Higher doses of that drug along with other oral medications are being looked at for obesity. 

Who are they recommended for? 

Ozempic and Wegovy contain the same active ingredient: semaglutide. Ozempic has been approved by the Food and Drug Association (FDA) for the treatment of type 2 diabetes, while Wegovy is approved as a anti-obesity medication for people with a BMI of 30 or above, or for people with a BMI of 27 or above who also have a weight-related medical condition, such as high blood pressure, high LDL cholesterol, low HDL cholesterol or high triglyceride levels. 

“The purpose of these medications is not to just drop down a clothing size,” says Dr. Aras. “Our goal with weight loss is to improve these weight-related medical conditions. Even a modest weight loss of 5 to 10 percent can make a big difference.” 

Who shouldn’t take them? 

We don’t prescribe Ozempic or Wegovy for patients who have histories of gall bladder disease, pancreatitis, or family histories of medullary thyroid cancer or rare disorders of the endocrine system. 

What are the side effects of weight-loss drugs? 

They act directly on the digestive system by slowing gastric emptying. Food sits in your stomach longer before it travels to the intestines. That’s how they make people feel fuller sooner and stay full longer, but it’s also where their side effects come in. Because food is sitting in the stomach longer than usual, it can cause reflux, nausea (a sense of over-fullness), diarrhea or constipation.  

The injectable medications are most potent the first few days after the injection, and that’s when their side effects can be most evident.  

The vast majority of people tolerate the medications well. It’s also important to reduce portions and eat slowly to mitigate side effects.  

What is “Ozempic face” and why does it occur?

When we lose weight, we can’t target where we lose it. Sometimes, it’s in the face, where it might be more noticeable. 

And when we lose weight, we lose both fat and muscle. That’s why it’s important to increase protein intake and do resistance training to hold on to muscle mass as much as possible while taking these medicines. 

How can I get a prescription? 

“We require a comprehensive medical evaluation, including your vitals, blood work and a complete medical history. We tailor individual plans for our patients, based first and foremost on diet and physical activity, and we select appropriate weight-loss medications to support their goals,” says Dr. Aras. 

I’ve heard about Mounjaro. Is that medication different from Ozempic and Wegovy? 

Mounjaro, currently FDA-approved for the treatment of type 2 diabetes, may soon receive approval as an anti-obesity medication. It could lead to even more weight loss than Ozempic or Wegovy, because it activates two gut hormones instead of just one. 

How about cost? Are they covered by insurance? 

Anti-obesity medications can be quite expensive, especially when they aren’t covered by insurance, but “the Comprehensive Weight Control Center has an entire pharmacy team dedicated to processing authorizations required by insurances in an effort to obtain these medications for our patients. Regrettably, Medicare and Medicaid don’t cover anti-obesity medicines,” she says.  

How should I communicate with my doctor at Weill Cornell Medicine’s Comprehensive Weight Control Center? Should I use the portal system (“Connect”)? 

See the following guidelines for messages and phone calls to your provider: