Ozempic. Wegovy. Zepbound. Xenical.

If the hype is to be believed, these medications are wonder drugs, solving the crisis of obesity. And for some people, the results speak for themselves, with dozens, in some cases 100 or more pounds lost.

Local medical professionals “weighed in” on the pharmaceutical panaceas that have helped hundreds of Wyomingites achieve better health.

The Obesity Crisis

Obesity in America is more than just on the rise — according to the latest statistics, around 43% of Americans are overweight, with 9.2% considered severely obese. That’s compared to 35 years ago, when just 20% of the population faced weight issues. Here in Wyoming, one-third of the population has Body Mass Index (BMI) numbers that put them in the obese category. 

That’s why the emergence of these GLP-1 drugs — which help the pancreas produce more insulin and lower blood sugar, as well as reduce appetite and slow digestion — have seemed to some to be a miracle cure.

Ken Ferbrache is living proof of the effectiveness of GLP-1 therapy. The Lovell resident, himself a medical professional, lost 45 pounds after he was prescribed Ozempic. 

“My mom died of every complication associated with diabetes,” said Ferbrache, a physician’s assistant at North Big Horn Hospital in Lovell. “So when my doctor told me I was a diabetic, for me, it was an all time low.”

Ferbrache said his A1C numbers, a blood test that measures average blood glucose levels, were high enough that traditional diabetes drugs like Metformin and Pioglitazone weren’t working. But after he was prescribed Ozempic, the 45 pounds he had put on over the years almost literally fell off his frame.

“It was the craziest thing in the world,” said Ferbrache, “because when I started with the Ozempic, I was 204 pounds, and over six months to a year, I now reside at 160.”

How Does It Work?

“The pathophysiology of diabetes is when your sugars are too high, which causes inflammation in the distal microscopic blood vessels — the arteries, specifically,” Ferbrache explained. “They become so inflamed that they die, and then the nerve endings don’t get blood flow.”

Those microscopic blood vessels feed the eyes, brain, kidneys, and the extremities, which is why diabetic patients often risk the need for amputation of limbs if their condition becomes out of control. 

GLP-1 receptor agonist medications, the class of medications that Ozempic belongs to, were first approved by the Food and Drug Administration (FDA) in 2005, primarily to treat diabetes. The drug Ozempic has been prescribed since 2017, and researchers soon discovered that use of that medication had a positive side effect — weight loss.

Dr. Adair Bowlby is a family physician with Billings Clinic. She explained that Ozempic is a GLP-1 drug, which mimics the hormone in the upper intestines and stomach that regulate blood sugars and regulate the hunger “switch.” 

“The two drugs in the class that work for weight loss are semaglutide and tirzepatide,” she said. “It basically acts in your body like GLP-1, which regulates appetite. It tells you you’re full. It slows your digestion, and increases your feelings of being satiated.”

That was Ferbrache’s experience.

“I just found that I wasn’t hungry,” he said. “It’s not that I didn’t crave foods, because I did. My wife’s a phenomenal cook, but like, for Thanksgiving, you’re sitting at the table, and here comes the pumpkin pie. You take two bites, and it’s like, I’m satisfied. I just get up and walk away from it. So for me, Ozempic was miraculous, just unbelievable.”

Ozempic vs. Wegovy

When researchers realized that people were losing weight on the semaglutide drugs, Bowlby said the drug companies, in particular, Novo Nordisk for Ozempic, went back and tweaked things a bit, and came up with Wegovy.

“It’s exactly the same chemical, but they tweaked the dosing regimen,” said Bowlby. “The maximum dosing is higher to get that weight loss indication from the FDA.”

She clarified, however, that Ozempic can only be prescribed for people who have been diagnosed with diabetes.

“You can’t get Ozempic for weight loss,” said Bowlby. “If I put ‘weight loss’ or ‘obesity’ as the diagnosis for a prescription for Ozempic, I get a big old ‘nope.’ It may give me a yes for Wegovy, depending on the patient’s insurance coverage.” 

Beware the Side Effects

Despite the reported success of the semaglutide drugs, with all medications comes the potential for negative side effects. In the case of Ozempic or Wegovy, Bowlby says that the vast majority of those are related to delayed gastric emptying, or emptying of the stomach. 

“People will complain of reflux, they’ll complain of nausea, of vomiting, of constipation, because it just slows down the whole gut,” she said. “If somebody’s going in for surgery, say, a knee replacement or anything, they have to stop their GLP-1 medication two to three weeks in advance to decrease that risk of aspiration, because their stomach doesn’t empty.”

There are more serious side effects that occur on rare occasions, which Bowlby said include pancreatitis, allergic reactions, kidney injury (related to dehydration from nausea and vomiting), and sometimes, especially for patients on insulin, low blood sugar.

“The reflux, nausea, vomiting, constipation, are very, very common,” said Bowbly. “A third of patients. The other ones are very rare.”

Who Qualifies?

Bowlby has prescribed semaglutide drugs for literally hundreds of patients. She said the best results happen for people who can tolerate the side effects.

“Of the people who can tolerate them, most people lose weight,” said Bowlby. “80-plus percent lose weight.”

With either drug, however, comes a caveat — the effects only last as long as the patient is on the medication.

“If you take them off their medicines and their lifestyle changes, they’re right back where they started,” said Ferbrache.

That is the whole paradigm of obesity as a chronic disease, Bowlby pointed out. 

“The management becomes chronic and lifelong,” she said. “The medications are long term. They’re not a quick fix.”

Bowlby said that one study she reviewed showed that two-thirds of people who went off of the semaglutide drugs regained the weight within one year.

“I have a really good friend who has lost 140 pounds on this medication,” she said. “He knows he’s on it for life, because he has no control of his food.”

Financial Burden

Bowlby pointed out that many insurance plans do not specifically cover weight loss medications, which means if someone is just pre-diabetic, which, if untreated, becomes diabetes, they will not qualify for either Ozempic or Wegovy.

But without insurance, the price is a significant hit to the pocketbook.

“If you are cash pay, Ozempic at the maximum dose is about $1,000 a month,” she said. “And Wegovy, because of the higher dosing, is about $1,300 a month.”

But the success of the drug can create a paradoxical situation.

“I have a patient that has a similar story to mine with obesity,” Ferbrache said. “We’ve got his sugars down, and his insurance won’t pay for the Ozempic anymore because he’s not obese anymore. So when we stop this, he’s going to gain it back.”

A Solution For Many

Bowlby said that in her experience, those who are successful with weight loss on Ozempic or Wegovy have the right mindset. 

“When a patient comes to see me and says, ‘I’ve had it, I’ve done all the other things, and it’s this or surgery,’ I really have a conversation with them, assessing their readiness to change,” she said. “Because this isn’t a quick fix. So I look at, how willing are they to change?”

But Bowlby has seen the benefits for those who are willing to commit to the lifestyle changes that result in significant weight loss.

“People are more involved in life, people can get off their couch, can keep up with their kids, can keep up with their grandkids, who are more involved in their community, in their churches, in doing the social things because they hurt less,” she said. “I have seen people come off of their CPAP machines. Their moods are better because they feel accomplished. They feel like they have had success in an area where they have not had success before.”

For Ferbrache, the reminders of how far he has come, thanks to Ozempic, occur often.

“When I go buy dog food, it’s a 40-pound bag, and every time I lift it I go, ‘I can’t believe I was carrying that around,’” said Ferbrache. “It’s the craziest thing. I am amazed and awe stricken and every nice thing you can say about Ozempic, because I could see the changes that were happening for the positive.”