MounJaro Weight Loss
A New Miracle Weight Loss Drug? UNDERSTANDING MOUNJARO, Tirzepatide, and Zepbound
Tirzepatide is an anti-diabetic and weight-loss medication sold under the brand names Mounjaro® for diabetes and Zepbound® for weight loss. Tirzepatide (the generic name for the medication) is a gastric inhibitory polypeptide (GIP) and a glucagon-like peptide (GLP-1) receptor agonist. Originally developed to treat diabetes, tirzepatide is safe and highly effective for long-term weight loss and weight management. We have been successfully using GIPs and GLP-1s for years at our clinic in conjunction with our metabolic health program focusing on hormone health, food, sleep, and exercise.
HOW DO Tirzepatide, MOUNJARO, and Zepbound WORK?
Tirzepatide, most widely known as Mounjaro, is a GLP-1 agonist and a GIP agonist, meaning it mimics these two peptide hormones. These peptides are naturally occurring hormones produced by the gut that affect messaging associated with glycogen, sugar, and lipid metabolism. The dual-action peptides send signals to the brain, affecting metabolism and appetite, making weight loss significantly easier for patients who have historically struggled. Below are some details of the pharmacology of the medication that makes it such an effective weight-loss drug:
GLP-1s stimulate the secretion of insulin and slow the release of glucagon, thereby keeping blood sugar low. This effect on blood sugar facilitates lipolysis or fat-burning.
Studies have suggested that Mounjaro increases lipolysis and fatty acid synthesis. In simple terms, this means you have an easier time breaking down and using stored fat for energy.
GLP-1 agonists work on leptin and ghrelin, impacting hunger and satiety signaling. Patients generally experience a significant reduction in cravings and find it much easier to manage choices around food (i.e. chronic snacking or obsessive food thoughts that often accompany a calorie-restricted diet). The addition of GIP in tirzepatide enhances the satiety effect of GLP-1s (i.e. increased appetite suppression).GLP-1s slow stomach emptying, which helps patients feel fuller faster and leads them to eat a much lower volume of food.
GLP-1s and GIPsmay work to lower your set point. Your set point is the weight your body naturally gravitates towards due to the interaction between metabolic health, genetics, and environment. When you restrict calories, your natural biology will resist weight loss to defend its set point. Research has shown that overweight patients who have more difficulty losing weight may have a functional deficit in GLP-1 signaling. GLP-1s may help resist the metabolic slowdown that happens in response to weight loss and calorie restriction.
Terzepatide can reduce leptin levels. Leptin mainly acts on your brain stem and hypothalamus, inhibiting or preventing hunger and regulating energy expenditure. When you are well-fed, leptin levels should be high, signaling your body to suppress appetite and burn off fat cell energy as fuel. Overweight or obese people can become leptin-resistant, meaning the brain does not respond as sensitively to leptin. Leptin resistance can lead to feelings of excessive hunger and sluggish use of stored energy (i.e., fat). The moral of the story is that tirzepatide may improve leptin sensitivity by regulating leptin and preventing resistance to this powerful satiety hormone.
Mounjaro BENEFITS AND WHAT TO EXPECT
In our clinic, for patients being prescribed Mounjaro, we target around one-half to one pound of weight loss per week.
Food cravings will diminish, making strategic food choices (i.e., a high protein, low carbohydrate diet), portion control, and time-restricted eating easier.
Ideally, GLP-1s/GIPs not only lead to weight loss and improved metabolic health, they also enable patients to cement healthy habits gained in the process.
Studies have shown that Mounjaro reduces cardiovascular events in Type 2 diabetics and reduces cardiovascular disease.
Our clinic’s goal when prescribing Mounjaro is to keep our patients on the lowest dose while equipping them with the tools to maintain the food, exercise, sleep, and emotional wellness habits required for long-term success.
Mounjaro can help reduce inflammation and metabolic dysfunction (i.e., insulin and leptin resistance) and has been associated with a reduction in blood pressure and improved cardiovascular health.
GLP-1s and GIPs have been shown to regulate cholesterol and triglycerides in Type 2 diabetics by modulating key enzymes of lipid metabolism in the liver.
WHAT’S THE DIFFERENCE BETWEEN Mounjaro, Tirzepatide, Zepbound and Semaglutide?
Tirzepatide
This is the generic drug that makes up Mounjaro and Zepbound. a first-in-class drug that works as both a GLP-1 and a GIP agonist. This drug has now been approved as both a weight-loss drug (Zepbound) and a diabetes medication (Mournjaro). This dual-action peptide drug has been shown to have slightly more effect than semaglutide. Tirzepatide is the effective ingredient utilized in the compounded versions of these medications. The benefit of using the compounded version of Mounjaro or Zepbound is more easily tailored dosing or micro-dosing for sensitive patients. The compounded versions of Mounjaro have been safe and more readily available alternatives to the expensive commercial versions.
Zepbound
This version of tirzepatide is branded and FDA-approved for weight loss. This is a first-in-class drug that works as both a GLP-1 and a GIP agonist. This dual-action peptide medication comes as a pen-injector to make it easy for the patient to administer. However, we often prescribe a compounded version for more tailored dosing or “microdosing” for sensitive patients. In clinical trials, patients taking Zepbound lost a significant amount of weight (more than patients on Ozempic or Wegovy). According to one study, after a year and a half, patients taking the highest dose or Zepbound lost 21% of their body weight compared to around 15% for patients on Wegovy after one year and five months.
Semaglutide
This is a GLP-1 agonist and is the active ingredient or drug in Ozempic and Wegovy (read more about these drugs here). The benefits of Ozempic or semaglutide are blood sugar management and weight loss. Semaglutide is FDA-approved for weight loss and Type 2 diabetes. In clinical trials, after a year and a half, patients lost an average of 15% of their body weight. In a randomized control trial, Type 2 diabetics achieved a mean hemoglobin A1-C of 6.4% (starting A1-C of 8.3%). Additionally, unlike Mounjaro, Ozempic is FDA-approved to reduce the risk of major cardiovascular events in patients with Type 2 Diabetes and established heart disease. Commercial versions of semaglutide are expensive. We frequently work with specialty pharmacies to use a compounded, generic form of this medication. The advantage of using this generic form is greater dosing adjustability and greater affordability.
Mounjaro
This is a first-in-class drug that works as both a GLP-1 and a GIP agonist (the generic name is tirzepatide). This drug was FDA-approved for Type 2 diabetes in May 2022. Mounjaro comes as a pen-injector to make it easy for the patient to administer. However, we often prescribe a compounded version for more tailored dosing or “microdosing” for more sensitive patients. In head-to-head studies, Mounjaro lowered hemoglobin A1-C levels more than Ozempic. In general, Mounjaro, while more expensive than Ozempic, is more effective at managing Type 2 diabetes and resulted in greater weight loss.
WHAT DOES THE RESEARCH SAY?
Studies show that there is a direct correlation between GLP-1 agonists and weight loss. In clinical trials of Wegovy as an adjunct to lifestyle modification, participants lost an average of 15 percent of their body weight – with more than half the people treated with Wegovy losing more than 15 percent of their starting weight - up to five times the average weight loss seen with traditional diet and exercise plans.
Those who took tirzepatide lost a greater percentage of body weight each month, compared to semaglutide: Mounjaro led to the most significant weight loss of the GLP-1s with patients losing approximately 20% of their body weight after a year and a half of using the medication. Over a similar period of time, patients on Ozempic lost approximately 15% of their body weight.
We have treated countless patients over the past five years - with the majority of them reaching their goal weight and keeping the weight off. We assess every prospective patient to determine if tirzepatide (i.e., Mounjaro or Zepbound) is the right path to weight loss for them. Patients joining the program begin with an in-office consultation and body composition analysis on our SECA Scale (the gold standard for medical body comp analysis).
The program includes the medication, weekly B12 or MIC Fat Burner injections, dietary recommendations, an Intermittent Fasting Guide (for those who are interested), and ongoing clinical support. Patients continue with the program in 90-day increments for as long as they find it necessary and beneficial to achieving or maintaining their goal weight. We offer the following programs: Mounjaro Seattle, Mounjaro Bellevue.
OUR CLINIC’S PROGRAM
FREQUENTLY ASKED QUESTIONS
Q. WHAT IS MY BMI, AND DOES MY BMI NEED TO BE OVER 30 TO USE tirzepatide?
A. You can use the BMI Calculator below to determine your BMI. Tirzepatide is used on-label for people with a BMI over 30 or overweight with accompanied co-morbidities (i.e. high blood pressure, high cholesterol, etc.). This medication can be used off-label in patients wanting to lose weight without comorbidities based on the clinical judgment of the provider.
BMI Values for Women and Men 18 and Older
Underweight < 18.5
Normal weight 18.5–24.9
Overweight 25–29.9
Obesity > 30
Q. HOW MUCH DOES THE MEDICATION COST?
A. The average monthly cost of Mounjaro at a commercial pharmacy is around $1,000 to $1,300 per month. (It is difficult to get insurance to cover the cost of this medication for weight loss.) Ozempic is approximately $935 for a one-month supply.
Q. IS Mounjaro or Zepbound APPROVED BY THE FDA?
A. Mounjaro was approved by the FDA on May 13, 2022 to treat Type 2 Diabetes. The FDA approved Zepbound (tirzepatide) for chronic weight management on November 8, 2023.
Q. DOES INSURANCE COVER Mounjaro or Zepbound?
A. Most insurance companies do not have great coverage for these medications for weight loss. If a patient has Type 2 Diabetes, they generally need to fail other diabetes medications before being covered for Mounjaro. If you have Type 2 Diabetes, your chances of getting coverage for Ozempic are slightly higher (Mounjaro is slightly more difficult).
Q. WHAT ARE THE MOST COMMON SIDE EFFECTS?
A. Common side effects include nausea, changes in bowel habits, acid reflux, and, more rarely, abdominal pain or vomiting. If you are experiencing severe abdominal pain or vomiting, it is important to contact our clinic or, in severe cases, report to the Emergency Room. That said, very few patients report severe side effects. For more information about side effects, please see our blog post “Side Effects of Semaglutide for Weight Loss.”
Q. HOW MUCH WEIGHT CAN I EXPECT TO LOSE?
A. Those who took tirzepatide lost a greater percentage of body weight each month, compared to semaglutide: an average of 5.9% of their body weight after 3 months; 10.1% after 6 months; and 15.3% after 12 months. When managing patients on tirzepatide, our target is for patients to aim for approximately one pound of weight loss each week. Weight loss might be faster in the beginning for some patients and may slow as patients get closer to their target weight.
Q. DO I HAVE TO SIGNIFICANTLY CHANGE MY DIET?
A. In our experience, a diet focused on high-quality proteins, vegetables, and slow-burn carbohydrates tends to be a healthy and sustainable diet for most patients. We like to leave flexibility for patients’ personal or cultural preferences (i.e. pescatarian, vegetarian, dairy-free, etc.). General tenants that most medical professionals can agree upon include focusing on whole foods and avoiding highly processed foods and sugar, and at least some consciousness around white, starchy carbohydrates. We also introduce people to the concept of intermittent fasting, which, for some patients, can be an effective tool and made easier when on Tirzepatide. Below are some general dietary recommendations that may help enhance weight loss efforts:
Focus on high-quality proteins. A general goal is to consume one gram per pound of body weight per day to avoid substantial muscle loss when losing weight.
Eat a fibrous diet. Focus on vegetables that are high in fiber and low on the glycemic index.
It is okay to consume slow-burn carbohydrates such as legumes, lentils, or quinoa.
Avoid fried foods or highly processed or fatty foods as they take longer to digest.
Limit or avoid simple, fast-burn carbohydrates such as rice, breads, bagels, and pasta
Limit alcohol intake.
Drink at least 32 oz of water a day to avoid constipation.
Q. IS EXERCISE NECESSARY?
A. While exercise isn’t as important as what you eat for weight loss, sustainable exercise habits have been proven to keep the pounds off. According to the National Weight Control Registry (a database of people across the U.S. who have lost at least 30 pounds and have kept it off for at least a year), the number one thing these people have in common is a daily exercise routine. Also, remember, while exercise may not be required for weight loss - it is imperative for optimizing your health and well-being.
Q. CAN I LOSE WEIGHT FAST WITH Mounjaro?
A. Literature suggests that patients lose an average of 15% of their body weight. Our goal is to have most patients lose approximately one pound each week. The speed with which you lose weight will depend on the amount of weight you need to lose as well as the dedication you put into supporting the medication’s effects with healthy lifestyle choices (food, exercise, emotional health, and sleep).
Q. WHAT IS THE AVERAGE LENGTH OF THE PROGRAM?
A. The duration of your program will depend on the amount of weight you want to lose as well as how effective the drug and your individual lifestyle changes are. A Wegovy study, which boasted an average of 15% body weight reduction, was a 17-month study at the maximum dose of 2.4 mg of semaglutide.
Q. WHERE CAN I BUY Tirzepatide or Mounjaro?
A. Tirzepatide or Mounjaro are not available over the counter and must be prescribed by a physician. Tirzepatide is not a supplement - it is a prescription medication. We highly recommend you work with a doctor who is familiar with GLP-1s and GIPs, understands the intricacies of their use for weight loss, is effective at personalizing dosing, and is well-versed in helping patients integrate dietary and lifestyle interventions.
Q. DOES Tirzepatide HAVE ANY SERIOUS SIDE EFFECTS?
A. In rodents, Mournaro medications and medications that work like Mounjaro, caused thyroid tumors including thyroid cancer. It is not known whether or not semaglutide will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma in humans. Other serious but rare side effects include pancreatitis, gallbladder problems, bowel obstruction or gastroparesis. Rarely, low blood sugar, kidney problems, allergies, increased heart rate and depression or thoughts of suicide may occur. The more common and less concerning side effects include nausea, changes in bowel habits, heartburn, bloating, belching, and fatigue. In our clinic, focusing on the lowest possible dose for weight loss helps to mitigate these side effects. For more information about side effects, please see our blog post “Side Effects of Semaglutide for Weight Loss.”
Q: Where can I get Mounjaro in Seattle?
A: KPM offers medical weight loss programs in the greater Seattle area that include the use of Mounjaro.
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