Obesity is a growing epidemic in the Western world, especially in the United States. Statistics show that 69 percent of US adults are overweight or obese.1 An excess of fast-food options, less availability of healthier food choices, and modern sedentary lifestyles are all contributing factors to the obesity epidemic. Lifestyle changes, such as regular exercise and healthier food choices, remain the most effective solution for reversing obesity.
Consuming fewer calories from more nutritious foods and engaging in regular exercise can help individuals both reduce their weight and maintain it. However, weight loss is difficult for most people. Making lifestyle changes requires a significant amount of discipline, time, and effort. Many Americans are unable to stick to a weight loss program long enough to see changes. Furthermore, those that do manage to lose weight, often gain it back.
Doctors and specialists have been searching for an alternative solution to weight loss for years. The weight loss industry is a multi-billion-dollar industry inundated with diet foods and supplements that deliver false promises.2 On top of being largely ineffective, some of them may cause more harm than good.
Fenfluramine-phentermine, also known as fen-phen, was a weight loss drug discontinued in 1997 due to its serious negative side effects. Fen-phen combined appetite suppressants with amphetamine to curb hunger and increase metabolism. However, the powerful duo led to dangerous heart valve problems in close to a third of individuals who took the drug.3
Today, there is still no “magic pill" for weight loss that is both safe and effective. But there are medications that supplement weight loss efforts and make losing weight easier for many people. These medications work by focusing on hormone regulation. Two of the most notable hormone-regulating medications include semaglutide and tirzepatide.
Hormones are natural substances in the body that play a role in numerous bodily functions, including growth, development, and metabolism. When hormone levels become imbalanced, it can affect normal bodily function, like weight management. By controlling hormone function, doctors and scientists believe medications like semaglutide and tirzepatide can help aid in weight loss. Both drugs work to help regulate the hormones GLP-1 and GIP, two important hormones for blood sugar and weight management. Although, semaglutide is more selective for GLP-1, while tirzepatide targets both GLP-1 and GIP.78
GLP-1 hormone, also known as glucagon-like peptide 1, is a form of incretin hormone found naturally in the body. It helps regulate blood sugar levels by stimulating the release of insulin while at the same time slowing gastric emptying and suppressing appetite. It has been used to successfully aid in weight loss and treat type 2 diabetes for many years.4
In addition to these benefits, GLP-1 hormones have been shown to improve beta cell function and help prevent further beta cell damage or destruction. Furthermore, GLP-1 may even be beneficial for cardiovascular health due to its ability to reduce inflammation and platelet aggregation. As such, it is gaining increased attention as an important target for potential therapeutic interventions for metabolic diseases.
GIP (gastric inhibitory polypeptide) is a hormone secreted in response to food consumption. It helps regulate the absorption of nutrients from meals, as well as signaling satiety and inhibiting gastric acid secretion. Additionally, GIP may contribute to the regulation of blood glucose levels and insulin sensitivity. Studies have suggested that GIP plays an important role in controlling hunger, body weight, and energy balance. However, more research is needed to fully understand the role of GIP in metabolic health.
Semaglutide and tirzepatide are two new drugs that are both GLP-1 agonists, meaning they stimulate the release of glucagon-like peptide-1 (GLP-1) from cells in the digestive system. Both medications have been used in the management of type 2 diabetes to improve blood sugar control. However, they have also been shown to be effective in promoting weight loss and weight management.
Semaglutide and tirzepatide aid in diabetes and weight management by promoting insulin secretion, suppressing glucagon secretion, reducing appetite, and slowing gastric emptying. In terms of side effects, both medications may cause nausea, vomiting, diarrhea, and constipation, as well as a risk for hypoglycemia or weight gain. However, due to its higher potency, semaglutide carries an additional risk of pancreatitis compared to tirzepatide.
Semaglutide is a type of drug known as glucagon-like peptide-1 receptor agonists, or (GLP-1 RAs). It works by mimicking the human hormone GLP-1, which is released in the gut while eating. Semaglutide was developed to improve glycemic control in people with type 2 diabetes. It was approved in 2019 and sold under the brand names Wegovy®, Ozempic®, and Rybelsus®.
Currently, Wegovy® is the only semaglutide drug approved for weight loss in individuals without diabetes who are overweight or have other health problems. Wegovy® is administered by a once-weekly subcutaneous injection. Wegovy® works by binding to and activating receptors on pancreatic beta cells, which are responsible for producing insulin when needed. As a result, it increases glucose-dependent insulin secretion from these cells and reduces glucagon secretion. This helps regulate blood sugar levels and improves overall glycemic control.
In addition, Wegovy® also delays gastric emptying, which reduces hunger, regulates appetite, and increases satiety, further helping to reduce calorie intake for weight loss. A study was conducted on just under 2,000 obese adults to compare the effectiveness of semaglutide (Wegovy®) combined with a diet and exercise program, versus the same lifestyle changes without semaglutide.5 After 68 weeks, half of the participants using semaglutide lost 15% of their body weight, while nearly a third lost 20%. Participants who only made lifestyle changes lost approximately 2.4% of their weight.
In clinical trials, semaglutide has been found to be significantly more effective than other glucose-lowering medications in terms of reducing glycated hemoglobin (HbA1c) levels, a measure of long-term blood sugar control.6 It has also been associated with greater weight loss compared to other anti-diabetic drugs.7
Overall, semaglutide as Wegovy® provides an effective solution for people with or without type 2 diabetes who are looking to both improve their glycemic control and reduce their body weight. As it is available as a once-weekly injection, its convenient dosing schedule can help patients stay on track with their treatment regimen, leading to better long-term health outcomes.
Tirzepatide is a long-acting GLP-1/Glucagon dual agonist that has been shown to be effective in the treatment of type 2 diabetes.8 It works by stimulating both insulin and glucagon release from the pancreas, thus helping to regulate blood glucose levels and reduce the risk of cardiovascular complications associated with diabetes.
This means it works by imitating two hormones instead of just one: GLP-1 and GIP. Tirzepatide triggers GLP-1 production, leading to more insulin production when necessary. GIP has been proven to reduce food intake and boost energy expenditure, resulting in weight loss.9 When combined with GLP-1 receptor agonism, it may have greater effects on metabolic markers such as body weight, glucose, and lipids.
Tirzepatide was approved under the brand name, Mounjaro®), in May 2022. Mounjaro®) is administered via subcutaneous injection once a week, with the dosage being adjusted as necessary to achieve desired blood sugar levels. Mounjaro®) has been clinically proven to improve glycemic control, significantly reduce body weight, and lower HbA1c levels when compared with other anti-diabetic medications.
The effectiveness of Mounjaro®) was assessed in five clinical trials, where three different doses (5mg, 10mg, and 15mg) were administered either alone or in combination with other diabetes medications.10 This was compared to a placebo, a GLP-1 receptor agonist (semaglutide), and two long-acting insulin analogs.
Mounjaro®) was shown to be effective in lowering HbA1c levels when used as a stand-alone therapy or in combination with long-acting insulin. Compared to the placebo, patients who received the maximum recommended dose of Mounjaro®) had a 1.6% reduction in HbA1c levels. When compared to other diabetes medications, Mounjaro®) resulted in a greater reduction of HbA1c levels, with a 0.5% greater reduction compared to semaglutide, 0.9% greater reduction compared to insulin degludec, and 1.0% greater reduction compared to insulin glargine.11
Many study participants were obese, with an average body mass index of 32 to 34 kilograms/height in meters squared. Patients who took the maximum recommended dose of Mounjaro®) lost an average of 15 pounds more than those who took a placebo without insulin, and 23 pounds more than those who took a placebo along with insulin. The maximum recommended dose of Mounjaro®) resulted in an average weight loss of 12 pounds more than semaglutide, 29 pounds more than insulin degludec, and 27 pounds more than insulin glargine. Patients who only received insulin tended to gain weight during the study.11
Due to its dual action on both hormones, tirzepatide helps to create a more normalized, balanced response to glucose levels in the body. This helps to reduce swings in glucose levels that can lead to complications associated with diabetes, such as hypoglycemia and hyperglycemia. Additionally, tirzepatide may help lower cholesterol levels and improve overall heart health.
Below is a comparison chart between the 3 most common semaglutide and tirzepatide medications highlighting their differences in results.
Nutrition is an important factor in any weight loss program, and this is especially true when using GLP-1 agonists like semaglutide or tirzepatide. Though both medications aid in weight loss for people who are overweight or obese, they are not a “magic pill”. Implementing lifestyle changes such as reducing calorie intake and engaging in regular physical activity are both necessary to achieve the best results from taking semaglutide or tirzepatide.
Individuals taking either medication with the intent to reduce body weight should consider a holistic approach to their health and fitness routine. Eating a well-balanced diet with plenty of fresh fruits and vegetables, whole grains, lean proteins, and healthy fats can help to support weight loss and promote overall health. The type of food you eat, how much you eat, and when you eat are all contributing factors to your weight loss or weight maintenance program.
Eating right for weight loss while taking semaglutide or tirzepatide means focusing on nutrient-dense, low-calorie foods that are high in protein, fiber, and healthy fats. Paying attention to your macronutrients in each meal as well as timing your meals strategically throughout the day may also be beneficial for weight management. For example, eating frequent small meals rather than several large meals may help stimulate metabolism and help keep hunger at bay while controlling blood sugar levels and preventing overeating later in the day.
There is no set diet plan to follow while on either weight loss medication, but it is suggested to follow some kind of structured eating plan to maximize weight loss results. Individuals should consult with their doctor to determine what kind of diet program would be most beneficial for them.
Ultimately, weight loss can only be achieved through creating a calorie deficit. You must burn more calories throughout the day than you consume. The ideal diet plan for individuals taking semaglutide or tirzepatide medications should be low in calories to help them achieve a calorie deficit. A low-calorie diet is easier to implement while taking semaglutide or tirzepatide due to their appetite-suppressing benefits. With these medications, overweight or obese individuals feel less hungry, and thus find eating fewer calories less difficult.
Individuals taking semaglutide or tirzepatide injections are required to follow a low-calorie diet for the best results. On average, women should consume 1600-2400 calories per day, while men should consume 2000-3000 to maintain a healthy weight. However, losing 1 pound requires burning 3500 calories. For example, to achieve an 1800 calorie deficit, an individual that burns 3000 calories daily would need to consume 1200 calories per day.
Following a 1200 calorie diet, individuals that burn approximately 3000 calories daily may experience a weight loss of approximately 3.6 pounds per week. Combining this low-calorie diet plan with regular exercise and semaglutide or tirzepatide medication can assist patients in achieving their desired weight.
Semaglutide and tirzepatide injections promote blood glucose management, which can lead to prolonged feelings of fullness, decreased hunger and cravings, and delayed digestion. To maximize the benefits of this weight loss medicine and achieve your weight reduction objectives, it is important to follow certain dietary advice:
Following these guidelines can help overweight or obese individuals lose more weight while on either medication and may help them develop healthier habits for long-term weight loss and weight maintenance.
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