Should I try tirzepatide/semaglutide?
May 8, 2024 8:17 AM   Subscribe

I'm one of those insufferable people who has always been "naturally thin" but since having my first child a few years ago, I am still 20-25 lbs over my normal weight and I've tried changing my diet and exercise level and it will not come off. I have also developed prediabetes, with an A1C of 5.8.

I actually have not talked to my doctor about it because I'm not sure if my case is severe enough but I have heard that compounding pharmacies are an option if you can't get a prescription. I have also been looking into tirzepatide, which may be more effective and with fewer side effects than semaglutide. The medication also seems relatively safe, from what I've read, but I'm just wondering if anyone else has tried the medication in order to lose this amount of weight? Is it pretty safe? How bad are the side effects? Would it help my A1C levels? I guess I should say I'm 5'1" and 140-145 pounds. This is the heaviest I've ever been. My frame is small so I feel like the weight has made a pretty big difference in my appearance and is starting to really affect my self image.
posted by Forty-eight to Health & Fitness (27 answers total) 3 users marked this as a favorite
Reddit has both a tirzepatide and ozempic community. I have been pondering using ozempic or equivalent for a while, so I have been following the ozempic community. My two primary takeaways are that ozempic works startling well for many many people and that many many people get pretty unpleasant side effects. You might want to read more about that on reddit.
posted by jcworth at 8:25 AM on May 8

Been on sema for about 20 months. Onboarding is rough for a lot of people, was worth it for me for all the secondary health benefits (joint stuff, blood pressure, etc. ) and getting rid of food noise. After getting up to dose I stayed at things got a lot easier with side effects.
posted by creiszhanson at 8:29 AM on May 8

I would try metformin before a GLP-1 drug: it’s way cheaper, and has quite a long history on the market with little risk of much besides GI upset, which can be mitigated with the extended release version. It has various other potential benefits such as lowered risk of cancer, dementia, stroke, and long COVID. I posted for advice here a while back before deciding to start taking it and I’ve been happy with my decision. I am T2 diabetic but in normal to pre-diabetic ranges with my A1C.

The new GLP-1 agonist drugs have not been on the market long enough for long-term safety data. You may need to stay on them indefinitely to sustain benefits. They are expensive and hard to obtain. They have an increased risk of not just basic GI upset, but gastroparesis, thyroid cancer, pancreatitis, gallbladder disease and intestinal obstruction. This all might be worth it if you are at a higher risk for other weight or diabetes-related issues, but if I were considering it for your particular set of factors as you describe them, I probably would not pull the trigger.

Also, what kind of diet and exercise changes have you made? There may be approaches that would be more effective for you without the use of drugs at all. Eg HIIT vs strength training vs cardio, cutting out carbs vs going vegan vs intermittent fasting, etc. Do you have a continuous glucose monitor? You could try getting one for a few months, eating to minimize glucose spikes and seeing how your A1C looks at the end of that.
posted by music for skeletons at 9:00 AM on May 8 [3 favorites]

You are barely overweight. Like hardly at all. I am also about as overweight as you are, percentage-wise. It would never even occur to me to seek out powerful drugs with unpleasant side effects in order to lose 15% of my body weight (which I'm currently in the middle of doing).

When you say you've tried to change your diet, does that include strict (with a kitchen scale, logging literally everything you ingest and being honest about it) calorie counting? It can be hard and frustrating, but if it were me, I would take a very serious, honest stab at that before seeking medical intervention.
posted by uncleozzy at 9:01 AM on May 8 [15 favorites]

At 5'1" / 140 lb, your weight/height is below the criteria used to prescribe tirzepatide/semaglutide (less than 27 BMI). At 5'1" / 145 lb, your weight/height is barely above the criteria that applies if you have a weight-related health issue like blood pressure/diabetes/sleep apnea, which you don't indicate in your post.

You may have a tricky time getting a doctor from a place that isn't a prescription mill to prescribe it to you, regardless of cost/interest. Personally, for a drug that has significant side effect issues, I would want it prescribed by a local doctor I'm familiar with as opposed to a prescription mill.
posted by saeculorum at 9:18 AM on May 8 [9 favorites]

Yeah, see if you can get on Metformin for both prediabetes and weight loss -- Metformin does help with weight loss but it's not a drastic loss, but for the little amount you're overweight it should help. It's also very cheap and side effects are minor.
posted by AzraelBrown at 9:29 AM on May 8 [5 favorites]

I am seconding the notion that you are not at a body weight that justifies significant interventions for general health purposes. And: while the drugs have mild side effects + some risks to watch out for, the problem with using them to suppress appetite when you are in a healthy weight range, against medical advice, is that you can very easily push yourself into bad health by trying to cut body weight by eliminating appetite.

You really should talk about this with a general practitioner during a physical check-up and should not try to obtain these through non-diagnostic channels.

In your case, the dietary and physical conditioning that you would need to reduce your body fat percentage may be challenging, and I sympathize. Mostly, food is a broken system that works against you, and particularly does so if you do not have active hobbies and you're not tall and/or broadly-framed. For someone who is 140 and would like to be 110 or 120, every last bit of convenience food is engineered and portioned to work against you (really, to make you crave it constantly & endure huge portions of very cheap ingredients). It takes a lot of exceptional behavior to compensate for that, including ignoring hunger pangs, breaking some customary habits & in some cases doing socially unusual things like always asking for a to-go container at the beginning of a meal (since they're not going to let you order half of an oversized entree).

If the pandemic has taught us anything, it's that we have a lot of range when we break out of everyday routine and commit to the unusual in order to survive. So you have the same capabilities to focus on a project of adjusting your diet to meet your body sculpting goals. This stuff is always 80-90% diet. These drugs make that slightly easier from a digestive-signaling perspective but you would have to do the same things anyway. I'd suggest trying to commit to those dietary changes first, and then discussing with your doctor if, after a month or two, you're dealing with an insane-making complete failure of appetite control.
posted by brianvan at 9:37 AM on May 8 [5 favorites]

How old are you? What diet and exercise changes have you tried?
posted by Kwine at 9:44 AM on May 8 [1 favorite]

My experience recently:

--Doctor: Your A1C is slightly high. Let's try Ozempic.
--Me: Sure, why not.
--Doctor: I'll get it approved.
--Insurance company: Why are you trying to hack the system to get a weight-loss drug??
--Me: Who said anything about weight-loss? Doctor wants my A1C to go down.
--Insurance company: Forget it, we won't approve it.
--Doctor: We can still prescribe it, if you're willing to pay out of pocket.
--Me: Holy buckets, that's expensive.
--Doctor: Well, okay, let's try Metformin.
--Me: Sure, why not.

A few weeks later:

--Doctor: Your A1C is down.
--Me: And I'm not having side-effects. This is great.

And a couple of weeks after that:

--Pharmacy: Your clinic didn't approve your Metformin refill yet. We can give it to you but...(dramatic pause, and a serious scowl, ominous thundery noise in the background)'ll have to pay out of pocket. (Quotes tiny number, like $2 and change)
--Me, surprised: That's all? That's cheaper than Skittles, and probably better for blood glucose. (I got the refill the next day.)

End scene. Thanks for listening. Your experience may vary, do consult with your own doctor about your specific needs.
posted by gimonca at 9:51 AM on May 8 [34 favorites]

One thing you will learn if you go on sema or etc is that everyone has an opinion about it. I don't think that prediabetes or a 27 BMI will qualify you. In my experience, semaglutide has been helpful but not nearly as magical as it's described. I still have to be conscious of what I'm eating, and the side effects do require constant management. Wegovy, which I take, is not indicated for people with a 27 BMI and prediabetes; you'd have to have "actual" diabetes to qualify or a BMI over 30. Henrymeds or the other reputable-ish services can help with supply issues but won't subscribe it to someone without the medical indications.
posted by chesty_a_arthur at 9:56 AM on May 8

Please investigate peoples experiences trying to go off the drug once they have succeeded in losing the weight. What I have read suggests that the body will naturally regain a high percentage of the weight lost very quickly. Yes, most people who lose weight regain it over the course of a year but this is much faster and comes with a sense of hunger that is very hard to manage.

It is also very , very expensive and your insurance is unlikely to pay for it for the purpose of a moderate weight loss.
posted by metahawk at 10:02 AM on May 8 [2 favorites]

My understanding is that off-label, weight-loss-focused use has led to shortages of these drugs for people who have a real medical need for them. I can't make an ethical call for you but it may be worth spending some time considering whether that's something you want to participate in/contribute to.
posted by wormtales at 10:12 AM on May 8 [6 favorites]

I can see how at 5’1” an extra 25lbs would be very uncomfortable!

In your place I would still hesitate to bring out the big guns. I would start traditional - use a food tracker app to count calories because with a baby and breastfeeding I got used to eating more and as it turned out I needed some retraining to feel as full on less food. Having a kid is a huge lifestyle change. I was snacking their left over food for example. I’ve personally had good success eating a balanced fat/carb/protein diet. If you go to the meds the weight will just come back after you stop (over time) with no underlying changes. I found I didn’t really lose the baby weight till she was 3 and it did take some effort.
posted by St. Peepsburg at 10:27 AM on May 8 [4 favorites]

And I’m sorry if you feel you’ve lost the magic “eat anything stay skinny” dust, I lost it too ! There is some reality shock / grief there as well whenever we have a new identity thrust upon us. I now have to diet and exercise like a mere mortal. Such as it is.
posted by St. Peepsburg at 10:32 AM on May 8 [14 favorites]

Prescribed for diabetes, and due to shortages I have had to repeat the "onboarding" process numerous times, meaning, for me, a good 3 weeks of nausea, diarrhea and vomiting. I've only once been able to get it for multiple months in a row. Something to add to your mathematics.
posted by Iteki at 10:35 AM on May 8 [2 favorites]

Please don't, at least not for the weight-loss. There are SEVERE side effects that are NOT talked about enough, up to death due to pancreatitis and acute kidney injury. You need to have a FULL check-up before starting it, as well as a whole network of doctors and dietician who can monitor your progress and modify the regimen as needed. There are people who developed gastroparesis (paralyzed stomach) from taking it too. When I see that 25% of people who take suffer from side effects, I consider that way too much risk (but then, my own medical problem had dropped me from 290# to 220# in less than a year, so who am I to judge?)
posted by kschang at 2:02 PM on May 8 [1 favorite]

Speaking with the bias of someone with a lot of T1 & T2 diabetes in my family, I would do whatever it takes to get you A1C where it should be sooner, rather than later. The range of "not okay but not di-beet-us is small."

Not much you do for T1 except manage it. T2 can often be nipped in the bud.

"lifestyle changes" can make a huge difference for you. However, having kids can awake a slumbering diabetes demon lurking in your pancreas, as can COVID.
posted by Lesser Shrew at 4:43 PM on May 8

Another thing you can change is your diet. Some diet changes, such as switching to a higher protein content style cooking can help, along with some exercise. There are thousands of videos on Youtube about high protein / low-carb cooking and a lot of them can be done through meal-prep (do it on Sunday, save time all week), or make one batch, repurpose for multiple meals. Effort that goes into it will help you in other areas, not just your weight.
posted by kschang at 5:01 PM on May 8

People your height often say they have to be pretty strict with diet, very precise (weighing food and tracking calories and macros). It’s a pain to do for a while until you figure out which meals to get into rotation. A pattern some do sometimes is skipping breakfast or having a small one (eg a couple boiled eggs with 1 small piece of grainy toast, or Greek yogurt and berries), then for lunch and dinner doing a protein + fibrous veg. Probably have to limit beverages to water and coffee or tea (no or very limited sugar). No desserts except maybe a small one on special occasions, no trash food. Not too much fruit either, 1 small apple or orange or whatever would be ok. With this, a 30 min walk a day. Later add another 30 mins, get it in chunks if needed.
posted by cotton dress sock at 9:20 PM on May 8 [1 favorite]

I am 100lb overweight (not prediabetic) and I used semiglutide for weightloss until shortages made off-label use of the Novo Nordisk supply (as opposed to chemical copy by compounding chemists) unavailable. I won't go back to using it. Even though the acute side effects were tolerable, the overarching fatigue that most users experience is quite profound. Not worth it. I am happier to live with the weight than feel so enervated. YYMV regarding prediabetes.
posted by Thella at 4:33 AM on May 9 [2 favorites]

I'd probably start with metformin but compounded semaglutide isn't contributing to shortages and if you can afford it and want to try it you shouldn't feel bad for doing so. And if your insurance will prescribe it then you shouldn't feel guilty for taking the name brand because clearly you meet their diagnostic criteria for needing it.
I know people who have taken it, the side effects seem to vary but most of them seem very very happy on it. The reason to go on it is I think articulated well in cotton dress sock's post above: who wants to think about and plan food that much every day?
posted by ch1x0r at 6:24 AM on May 9

Overweight plus prediabetic would make you a candidate for Wegovy or Zepbound. I have been on both and for me it had been life changing, but how effective it is and what side effects your experience really vary from person to person.

These are not magic weight loss drugs, they mimic a hormone your makes. For me personally, I have always struggled with weight because I am pretty much always hungry and only felt full when I had eaten way too much. The advice to "eat when you're hungry and stop when you're full" was ridiculous to me before starting the drug; now I can actually trust those hunger cues and I am slowly losing weight without changing anything else (same foods, same exercise).

I had constant nausea on Wegovy, but so far have not had any side effects on Zepbound. When I first started I had some constipation and heartburn but that went away over time. The most important advice is to follow the manufacturer titration schedule and to never ever jump to a higher dose, if you look at the reddit subs for the drugs you will see this advise often as well as what happens when people ignore the advice.

The big however is that these drugs are hard to get and expensive. I have really nice insurance but I had to get pre authorization for Wegovy, and had to try Wegovy before I could get Zepbound. Wegovy was costing me $90/month, and Zep is currently $470 (with insurance and the manufacturer coupon! I am applying to my insurance to get the price down). Then there is actually getting the drug. Zepbound is currently impossible to get aside from the lowest dose. Wegovy is easier now. If you go without the drug more than 14 days you have to start over from the lowest dose so you see lots of stories of people calling dozens of pharmacies or driving hours away to get doses. A lot of us have used compounded medicine--either permanently or as a stopgap--but you have to do your research on the compound pharmacies to make sure they are reputable.

For me, these drugs have been absolutely worth it, even with the side effects and the stress/work of getting it filled. YMMV.
posted by jessica fletcher did it at 6:44 AM on May 9 [1 favorite]

Semaglutide has been lifechanging for me, and the side effects minimal. I do have some concerns about long-term safety of a relatively new medication, but also serious concerns about long-term safety at the weight and glucose levels I was at when I started it, so in my case the math was relatively easy. I don't know that I would make the same choice given the numbers you've presented here, unless I had already tried other options like metformin that weren't working for me. I think it's definitely worth having a conversation with your doctor about your options.
posted by Stacey at 7:15 AM on May 9

The Maintenance Phase podcast on this topic is interesting.
posted by slidell at 8:29 AM on May 9 [2 favorites]

I currently take Ozempic as a Type II. I also take Metformin. The side effects have not been pleasant in many regards, although they have faded. I'm also currently on a low dose and will only bump up when necessary. The biggest effect is that it's brought my A1C, which wasn't terrible, down into a pretty great range, and I hope it will be even lower at the end of the month when I get it checked again. I have also lost roughly thirty pounds, although I'm still very firmly in the fat category.

From what I can tell, the intensity of the side effects can vary wildly. I'm always prone to nausea so I wasn't surprised when that's how it hit me the worst. My husband gets the sulphur burps. Basically, be prepared for things at either end of your digestive system to go a bit haywire.

I'm also likely to stay on it very long-term, which wasn't an issue for me as many of my other meds are like that. Some people have a harder time getting past that.
posted by PussKillian at 8:48 AM on May 9 [1 favorite]

I was about 160 lbs and 5'1" and was interested in getting on, at the very least, metformin, but when I spoke to my doctor, she suggested that instead I first try one more thing in addition to general eating healthy and working out, and that one thing was to eat WAY more protein. She said that women tend to really underestimate how much protein they need.

I don't like fish or eggs so but I've been getting creative with beans, peas, and cottage cheese as well as sirloin steak, Greek yogurt, Oats Overnight and various protein smoothies and wouldn't you know it. I am no longer nearly as hungry and I don't eat as much as I used to. I also wanted to be stronger in general so I ended up joining a gym that specializes in small classes in a variety of formats. I am losing weight at a slow but steady pace so far while gaining muscle. So my advice is no matter what you end up doing add more protein.
posted by jenjenc at 3:43 PM on May 9 [2 favorites]

Watch the interview with Johann Hari by Diary of A CEO on Youtube. You will find valuable information there.

Perhaps also check out his new book (just out on May 2nd) called Magic Pill. He's been taking Ozempic for the past year or so, and he says it's the right thing for him... but was very conflicted initially, and even after doing all the research and writing his book, he says that he's still conflicted about it.

He says in the interview at one point, that one person came up to him after reading his book and said, "now I realize that Ozempic is definitely for me!"... and another came up to him after reading his book, and said, "I now know for certain that Ozempic is NOT for me!"... so there ya go.
posted by itsflyable at 4:53 PM on May 10

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