Alternative To Ozempic For Weight Loss: 10 Options In 2023

Over the past year, medications traditionally used to regulate blood sugar levels, like Ozempic, have become increasingly popular among individuals seeking to lose body weight. Glucagon-like peptide-1 medications, like Ozempic, have become a major topic of conversation for weight management strategies including diets and supplements.

In addition to managing blood glucose levels, glucagon-like peptide-1 medications, or GLP-1s, have shown significant weight loss potential.^[1] There are many potential benefits associated with weight loss, but there have also been some barriers.

As always, it is important to consider risk factors and ensure safe use. Ozempic may not be available to people due to high cost, lack of availability, or fear of needles. So, what makes for a good alternative to Ozempic for weight loss? We will discuss some options and things to consider before seeking alternative options.

Alternative To Ozempic For Weight Loss: 10 Options

There are a number of alternatives to Ozempic for weight loss. Some are in the same class of medications called GLP-1 agonists. Others include alternative prescription medications that typically carry a lower cost. They are also oral medications, rather than injectables. Each medication has its own safety considerations that are important to understand. Finally, there are also several over-the-counter supplements offering a natural alternative for weight loss.

If you are uncertain, consult with a doctor before use to ensure that the supplement is safe and fits for your individual needs.

The first five options are different versions of semaglutide, the active ingredient in Ozempic, or other GLP-1 agonists. Note that Ozempic is not FDA-approved for weight loss. However, one of the versions of semaglutide, Wegovy, is approved for weight loss.

The FDA-approved indication for weight loss using semaglutide^[2] are as follows: 

• Obese: Adults with a BMI > 30 kg/m² . 
• Overweight: Adults with a BMI > 27 kg/m² AND a weight-related comorbidity, such as:
  • High blood pressure. 
  • High cholesterol. 
  • Diabetes. 
• Pediatric patients with a BMI in the 95th percentile or higher.

Prescribers are likely to follow this approach when identifying good candidates for therapy when considering other options like exenatide, liraglutide, and dulaglutide.

Option 1: Semaglutide (Rybelsus Or Wegovy) 

Semaglutide is the active ingredient in Ozempic, but it is also available in other forms. Rybelsus is a prescription medication of semaglutide in tablet form. The oral form of semaglutide is fairly new and has been studied in people with diabetes. Interestingly, although both therapies resulted in significant weight loss among individuals with diabetes, oral semaglutide^[3] showed greater weight loss than liraglutide (Victoza).

Wegovy is approved specifically for weight loss. It provides the same active ingredient, semaglutide, at a higher dose of 2.4 mg; the maximum dose of Ozempic is 2 mg. Wegovy is most like Ozempic, but for weight loss.

A commonly used definition of clinically significant weight loss is 5% of baseline body weight. This number is significant because it provides a better prediction of benefits related to weight loss. Wegovy gained FDA approval for weight loss in 2021. This was due in part to its average weight reduction of nearly 10% of baseline weight. Also, over 8 out of 10 individuals in the study achieved a weight loss of 5% or more.^[4]

Option 2: Exenatide (Bydureon Or Byetta)

Another alternative is exenatide. This is available either as a twice-daily injection, Byetta, or a once-weekly injection, Bydureon. Byetta was the first GLP-1 available on the market, with an initial approval date in 2005. Although it has primarily been used to help lower blood sugar levels, some research has shown weight loss effects in individuals without diabetes. On average, individuals using exenatide lost 4.47 kg (9.85 pounds)^[5] compared with placebo.

Option 3: Liraglutide (Saxenda Or Victoza)

Saxenda was actually the first GLP-1 medication approved specifically for weight loss, back in 2014. Weight loss associated with liraglutide has been shown across many studies.^[6] In one study comparing the effects of liraglutide and semaglutide directly,^[7] liraglutide resulted in an average weight loss of 7.8%, compared with 6.0% to 13.8% with semaglutide across different doses.

Option 4: Dulaglutide (Trulicity)

Trulicity has been studied for blood sugar control. However, these studies also assessed its potential as for weight loss in people with diabetes. In patients using 4.5 mg, 51%^[8] achieved a weight loss of 5% or more after one year.

Option 5: Tirzapetide (Mounjaro)

Mounjaro is a newer GLP-1 medication. It was introduced in 2022 to help individuals with diabetes improve glycemic control.

In a recent review, Mounjaro was associated with an average weight reduction of 9.81 kg^[9] (21.6 pounds). Like other GLP-1 medications, the most likely side effects were gastrointestinal, like nausea, vomiting, and diarrhea.

Option 6: Metformin

Metformin is a very common medication for blood sugar management. It has an established role in diabetes management. It improves insulin sensitivity, but it has also displayed some weight loss potential.

Metformin’s weight loss potential is somewhat modest with an average drop in BMI of about one unit^[10] in an obese population. This amount of weight loss may not justify the risks for side effects for some, but it is an excellent choice for managing diabetes or prediabetes. Metformin is a fraction of the cost of GLP-1 medications, which can be too expensive for many individuals.

Option 7: Naltrexone-bupropion (Contrave) 

Contrave can help manage weight similarly to how it is approved to manage addiction, by targeting reward centers in the brain. It can help manage food cravings, which can benefit weight loss. Naltrexone has been used to help individuals manage alcohol and opioid dependence,^[11] and bupropion has been applied to efforts to stop smoking.^[12]

One trial^[13] suggests over 8 out of 10 individuals using Contrave lost over 5% of their baseline body weight. The most common side effects were nausea, constipation, dizziness, and insomnia.

Option 8: Phentermine-topiramate (Qsymia)

Qsymia leverages the stimulant properties of phentermine with an appetite-suppressing effect of the anti-epileptic medication topiramate. There are several caveats associated with Qsymia^[14] that are helpful to be aware of:

• Topiramate is known to cause birth defects. 
• Pharmacies must be certified through a REMS (Risk Evaluation and Mitigation Strategy) program, so not all pharmacies may carry the medication. 
• Individuals who can get pregnant are advised to:
  • Use effective contraception.
  • Take a pregnancy test before starting therapy and once monthly during therapy. 

In studies, about 25% of patients^[15] using Qsymia achieved a weight loss of 5% or greater. 

Option 9: Orlistat (Xenical Or Alli)

Orlistat^[16] can help with weight loss by limiting the absorption of fats from the digestive tract. This does not provide a free pass to eat fatty foods as dietary fats are retained in the digestive tract and can cause diarrhea. It can also cause stools to become more fatty, also known as steatorrhea.

Some may recognize the alternative brand name for Orlistat, Alli, which is available over-the-counter. It has a strength of 60 mg, compared with the 120 mg contained in prescription-strength Xenical.

Option 10: Nutritional Supplements

Various nutritional supplements could be considered a natural alternative to Ozempic for weight loss. Many are often marketed as fat burners. These supplements include an array of ingredients, but many share similar ones:

• Stimulants, like caffeine.
• B vitamins. 
• Guarana. 
• Garcinia cambogia. 

Individual ingredients often have some backing research, but blends are rarely evaluated directly for safety or efficacy in clinical research. It is crucial to consult your doctor to ensure safe use before starting a fat-burning supplement.

How To Choose An Alternative? 

The decision comes down to weighing the benefits and risks when deciding on any therapy. There are benefits with losing weight, but it is also essential to be aware of the potential risks. Your doctor can help you identify any potential concerns and help ensure your weight loss goals are reached using both safe and effective means.

Benefits Of Weight Loss

For individuals with a BMI that is considered overweight or obese, there are clear benefits of weight loss. A weight loss goal of 5% to 10% of baseline body weight is associated with several benefits:^[17] 

• Improved self-image.
• Reduced insulin resistance. 
• Lower cardiovascular disease risk:
  • Elevated high-density lipoprotein (i.e., beneficial cholesterol).
  • Decreased low-density lipoprotein (i.e., harmful cholesterol).
  • Decreased triglycerides.
• Lower risk of developing sleep apnea.
• Lower incidence of knee and joint pain.
• Improved mobility. 

Regardless of whether you choose to use a medication or supplement promoting weight loss, staying hydrated, a healthy diet, and physical activity remain important to your overall health and well-being.

Risks Of Weight Loss Medications

GLP-1 Agonists

While GLP-1 medications have produced some results, they also carry risks. Fortunately, despite their use for diabetes, they have not been associated with symptomatically low blood sugar. Discuss your medical history with your doctor, as there are some precautions^[2] and potential reasons to avoid therapy:

• Individual or family history of thyroid cancer. 
• Individual history of pancreatitis. 
• Pregnancy or breastfeeding.

Your doctor may also review your kidney function before starting the medication.

A primary limiting factor for increasing the dose of GLP-1 medications is gastrointestinal side effects. Many who stop using the medications are unable to continue because of an upset stomach, nausea, or diarrhea. Slowly lowering the dose can be helpful.

Metformin

The most common side effects of metformin are gastrointestinal. These include nausea, stomach discomfort, and diarrhea. The risk of these side effects can be lowered when using an extended-release formulation or taking metformin with meals.

A rare but serious side effect is lactic acidosis.^[18] This is a metabolic imbalance that can require hospitalization. The risk of lactic acidosis increases for patients with:

• Reduced kidney function.
• Reduced liver function. 
• A history of alcohol abuse.
• Age 65 or older. 
• Other medications that modify blood glucose. 

Contrave

The combination of naltrexone and bupropion should be used with caution or avoided^[19] by individuals with:

• A history of seizures.
• Current opioid use.
• Uncontrolled high blood pressure.
• A history of manic episodes.

Qsymia

In addition to concerns related to pregnancy and birth defects, it is important to consider^[14] that lower doses are needed for impaired kidney and/or liver function and that longer-term effects related to heart health have not been evaluated.

Overweight individuals may carry a higher risk of heart-related diseases. Talk with your doctor if you may have risks or concerns about heart disease.

Xenical Or Alli

Xenical is a prescription strength version of orlistat, a medication that helps prevent the absorption of a portion of fats from the diet. Some individuals may also be familiar with the brand name Alli, an over-the-counter alternative with the same active ingredient.

Orlistat works by keeping fats confined to the digestive tract. This can increase risk for gastrointestinal side effects,^[20] like diarrhea. Side effects can be minimized by limiting dietary fat while using the medication.

Nutritional Supplements

Many fat-burning supplements contain caffeine, which is a stimulant also found in coffee and most teas. Some side effects are more likely to occur with higher doses. Individuals managing anxiety^[21] and high blood pressure should exercise caution with caffeine supplements. The relationship between caffeine and blood pressure is complicated,^[22] with some research pointing to temporary increases but no overall increase in the risk of cardiovascular events. But, with the right dosage, nutritional supplements can be a good alternative to Ozempic.

Conclusion

There are many alternatives to Ozempic available on the market. Consult with your doctor to help determine which treatment works best for you. Medications or supplements aside, lifestyle habits like healthy eating and physical activity are important and should be a priority.

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