There are 4 drugs that are less expensive than Ozempic and Wegovy
How do they compare?
In my last post, “Curious about the new blockbuster weight loss drugs?” I discussed the pros and cons of Ozempic, Wegovy (semaglutide), Mounjaro and Zepbound (tirzepatide). In this post I’ll compare these new medications with several older meds and non-medical approaches to weight loss.
In addition to semaglutide (the top selling drug in the US) and tirzepatide, four older medications are approved by the Food and Drug Administration (FDA) for weight loss. Although they don't produce as much weight loss, you might consider them since they're less expensive and don't require weekly injections.
I'll briefly describe all the meds and the average weight loss they produce. For good measure I'll also include the results of behavioral programs like Weight Watchers and Noom.
The medication that produces the most weight loss is Zepbound. One study found that after 72 weeks, the average weight loss was 21 percent of body weight. That’s close to the results from bariatric surgeries, which typically result in 25 to 30 percent weight loss after one year. Wegovy is almost as effective as Zepbound, with a 14.9 percent weight loss at 68 weeks.
Here are older medications that are administered orally (no weekly injections) and may produce significant but less dramatic weight loss.1
Qsymia is a combination of phentermine, an appetite suppressant, and topiramate, an antiepileptic that reduces appetite. A 56-week follow-up found a 10.9 percent weight loss.
Contrave, a combination of naltrexone, an opiate antagonist, and bupropion, an antidepressant, was found to produce a 6 percent weight loss after 56 weeks.
Xenical (orlistat) decreases the absorption of fats but frequently has negative gastrointestinal effects (flatulence, diarrhea). The mean weight loss is between 2.8 to 4.8 percent of body weight. Alli is an over-the-counter medication that is a lower dose of orlistat.
Phentermine (Adipex-P, Lomaira) is a stimulant that suppresses appetite. It's FDA-approved for short-term (12 weeks) use. It is the least expensive and most widely used anti-obesity medication. Despite the FDA caution, phentermine is often prescribed for more than 12 weeks. It shouldn't be used by patients with a history of hypertension, glaucoma, heart disease, or substance abuse. After 28 weeks, the average weight loss is 4.4 percent of body weight.
Compared to these medications, a typical behavioral intervention lasting six months, which includes self-monitoring, dietary counseling, and physical activity recommendations, typically results in a 5 to 10 percent weight loss. For example, Weight Watchers participants average 5.9 percent weight loss after 12 months. Noom, an online behavioral lifestyle intervention program, averages a 5.2 percent weight loss.
You’ll notice that these studies report weight loss after a little more than a year, but what happens after that? Unfortunately, there's no long-term magic that guarantees permanent weight loss. You probably know this from your own experience. After any weight loss, whether it’s from medications, behavioral, or online programs, even surgery you’ll regain weight when you go off the medication or program.
But it's not hopeless, there is one strategy that will minimize regaining weight. Can you guess what it is? Go ahead, put your guess in the comment section below and check back next week for help maintaining weight loss with or without medications.
Reference
Elmaleh-Sachs, A, Schwartz, J. L., Bramante, C. T., et al. (2023). Obesity Management in adults: A review. JAMA, 330, 2000-2015.