Wegovy vs. Zepbound (+ What You Need to Know BEFORE Switching)

It’s an exciting time to be practicing in obesity medicine, with groundbreaking tools like Zepbound and Wegovy helping people achieve their weight loss goals in ways that were once unimaginable. Plus, with new medications like retatrutide (the triple agonists) on the horizon, the future of weight management is looking even brighter.

But with so many options available, it can be overwhelming to figure out which medication is right for you. How do Zepbound and Wegovy compare? Can you switch between the two? Is one more effective than the other? In this episode, I’ll dive into the key differences between Zepbound (Mounjaro) and Wegovy (Ozempic), comparing doses, effectiveness, and answering all your burning questions about how these medications stack up against each other. 

References

The Top 5 Mistakes People Make When Starting GLP-1 

Season 1 of the Premium Podcast: The Obesity Guide: Behind the Curtain

Audio Stamps

00:30 - Dr. Rentea sets the stage for a back-to-basics breakdown of Wegovy vs. Zepbound, which touches on key topics like switching, dosing, and access.

01:58 - A comparison of Wegovy (GLP-1) and Zepbound (dual GLP-1 and GIP), discussing their average weight loss effects and varying response rates.

05:19 - Dr. Rentea discusses the reasons someone might consider switching medications.

06:45 - Switching medications shouldn’t involve restarting titration, and working with a knowledgeable physician to manage transitions effectively is key.

11:45 - Medication can be a helpful tool, but long-term success depends on working with a skilled physician and staying focused on sustainable progress.

Quotes

“Within the first few months, it's going to become very clear. Do you need an additional tool? Do we need to tweak things? Do we need to change things?”

“These are medications, but they're not everything. You still have to do the heavy lifting on the lifestyle aspect behind the scenes. But you have the ability to switch from one to the other.”

“You really should be working with someone who is very familiar with these medications, with switching medications, with adding other things to it, with changing things. There is always something else that can be done.”

“We do sometimes see higher results with ZepBound, but there's going to be other medication that comes out that's potentially higher than that. At the end of the day, it's what helps me to keep doing all the other things.”

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

Premium Season 1 of The Obesity Guide: Behind the Curtain -Dive into real clinical scenarios, from my personal medication journey to tackling weight loss plateaus, understanding insulin resistance, and challenges with GLP-1s. Plus, get a 40+ page guide packed with protein charts, weight loss formulas, and more. 

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Transcript

0:28

Hey, welcome back to another episode of the podcast. How's your week going? I am so excited for us to be back. We're just going back to a one on one episode where we're going to talk about just complete basics and comparison between what Govi, which again, the other name would be Ozempic or semi glutide. And then Zep Bound, the other name being Monjaro, Terzapatide. So we're going to compare these two medications. We're going to talk a few different aspects about, can you switch from one to the other? What's the dose in comparison? Is one better than the other? We're just going to go ahead and answer all of this. Cause I see this all day long talked about. And I think it's really timely because when this episode comes out, we're kind of going to date ourselves because I feel like these things are changing all the time. But right now, at least in the U S. Both of these companies have a cash pay option. Now it's still completely unreasonable for majority of people. It's 4. 99, let's say a month for medication, but they are capping it and saying, look, as long as you order every 45 days, we're going to keep it at this price. Now, people that are living in other countries, they're just going to gasp when they hear that price because that is outrageous. Yes. In the U S we get gouged on the medications, but compared to a thousand plus dollars, this is actually. an improvement for some people to get name brand medication. So I want to just kind of start out with the basics. Let me just start here. The fact that you get any medication is better than nothing. So I want to start with this. If what Govi let's say is, so keep in mind what Govi and Zepound are FDA approved for weight management. That's why you're going to hear me say these names so often. If your insurance plan, if you are lucky enough to get coverage for what Govi, hallelujah. Great. Let's go with that. So just because you hear me say, look, Wagovi, which is semaglutide, is quote unquote just a GLP 1, meaning it's one agonist, what it's doing, versus Zep Bound, which is terzepatide, it's a dual agonist, meaning it's two things that it's doing. GLP 1 plus GIP, gastrointestinal protein. So you have one function versus two. But a GLP 1 is still absolutely incredible. So I'm going to give you average numbers. Again, we're talking on average. And a lot of this varies based on what study you're looking at, or what time frame, or what population. But on average, people will lose about 14 to 15 percent total body weight. And if you look over at ZepBound, it's about 20 plus percent body weight loss. And again, there's a big variety in these studies of who is losing what. Some are not losing that much. Some are losing more than that. So you can bust out these studies. You can really stratify it down. So just because you go on these medications doesn't mean that you're guaranteed to have those results. But you will usually within the first few months, it will declare itself. So here's the beauty with these medications. Let's say that you get on one and you start to titrate up the dose. So these are weekly subcutaneous injections, meaning underneath the skin. You take these medications once a week, unless it's daily. We are a glutide. Again, that is an option as well. I just don't prescribe it as much, but that's definitely an option. Again, the price point is pretty darn high. So I'm thinking if we're going to pay the price anyway, we're going to go with something that. provides a little bit more total body weight loss if we're going to pay the price anyway, but the point is that these are weekly subcutaneous injections and what becomes very clear over the first few months is whether you are going to be responding as we would expect or even more than we would expect, or if you are what we call a hypo responder, meaning you're just losing at a slower rate. Now, this isn't necessarily a bad thing. Okay. So take this out of your mind where. Oh my gosh, I'm a hypo responder. Stop. I find it's very, very, very rare that I have someone that truly is not able to have fat loss. That's incredibly rare, but everyone's journey doesn't look the same. I'm going to take my own. Oh my Lord, was it helpful when I got on a JLP one, but I still needed additional help down the road. I still needed all the help in the world with nutrition and movement and all of it. So don't let that get you down. Okay. But on this one, about maybe 15%, the other one, 20 plus percent. But within the first few months, it's going to become very clear. Do you need an additional tool? Do we need to tweak things? Do we need to change things? And sometimes, let's say you started out with Wagovi. What I will notice is we'll get to that four months in. So it starts 0. 25, 0. 5, 1, 1. Those are the five doses for Wigoby and Ambryon. Let's say we get to the 1. 7, and I just see, wow, it's only a few percentage points of total body weight loss. Now, many insurances will say, hey, you need to have reached 5 percent total body weight loss by six months in, or we're not continuing it because it's not clinically significant. Okay? So that just kind of keep that in mind. But if you are going through that and you notice, Hey, I'm not seeing the results that I would expect, then it might be time to either add a different, for example, like an oral medication or do something else or lifestyle changes. There are so many different things you can change. or switching over to another medication. So I will sometimes have people where we go all the way up on the titration with Wigovi, we've seen maybe, I don't know, 6, 7, 8 percent total body weight loss, which is something, and that's incredible, but it's not the same as Maybe they would get un ZEP bound. So then we go over to ZEP bound because it's potentially a little bit stronger. Maybe they lose more weight on it. They're more responsive. And so that might be a reason to switch over. So why would you switch over? First reason I see is insurance change. Second reason, one is just not providing the results that you would expect. Third reason, side effect profile. So there are people, for example, that will not tolerate We'll go V, but they will do just fine on Zep bound. So this is an interesting thing. So this is why we really want to play around with what are you on? Why are you on it? Are we getting the results that we would expect now? You still have to be doing all the heavy lifting behind the scenes and we know this right that these are medications, but they're not everything. And so you still have to do the heavy lifting on the lifestyle aspect behind the scenes, but just know that you can switch things, okay? You have the ability to switch from one to the other. Now, here's the really important thing. If you're working with a physician and they make you restart the titration over, you are not GLP 1 naive at that point. So, meaning, you've already, your body's already used to that. So, yes, we do decrease the dose down when we transfer over to the other medication, but we don't go back to the starting dose. Now, I've heard some pharmacies or some insurance plans saying no, they have to restart over. To me, that is so, I don't, I just want to use the word inappropriate because how are they deciding what the correct medication thing is when a physician is all day long prescribing this, looking over the safety of their patient and really taking care of them. So I want to tell you the example. I've had this happen actually with several friends and it's so devastating. This person will have been working so hard on their weight and lifestyle change and fat loss and all these things. And then they get switched over from max dose Wigovi to starting dose Zep Bound. They struggle for months with increased hunger. And this makes sense because they, if they had come over, they should have started a few doses up or maybe even the second dose, the five milligram dose, but to bring them to a 2. 5 when they were on a 2. 4 milligram of Wigovi. So you were five doses up in Wegovy, and now you're coming to the starting dose of ZepBound. I just find that either the titration's gonna need to be quicker, or they have to start at a higher dose. And again, this is very. dependent on the patient in front of me. This is why I'm not giving you equivalency charts. Number one, we don't practice medicine with people that are not under our medical care. So again, I always say this, nothing here is medical advice. Everything here is just general education, but really your physician needs to be helping you because I know I have discernment with some people. They are so unresponsive that I know when we switch over, they're going to need a higher dose. And then I have other people where I say, you know what? I'm going to go way down on the dose for them because I don't know. It's a wild card. And so I am so super cautious, but to entirely restart over with someone that for two years has been on max dose Wagobe, it just feels like insanity to me. So this is something that I want you to, to know that you really should be working with someone where they're very familiar with these medications, with switching medications, with adding other things to it, with changing things. There is always always something else that can be done. Okay. So I just wanted to start with stressing that. So yes, you can switch over. Sometimes people will say, well, is there like a washout period? Is it okay for a month? I'm off of it. And then you start the other one. No, in fact, we want to completely the opposite. So if you are taking this medication weekly, The prior week, let's say your injection day is Monday, you will have taken your injection, and then the next Monday, instead of taking Wagovi, you will take ZepBound. Okay, so now you know the expected percentages, you know what the mechanism is, you know that you could switch between one or the other. A lot of the time, sometimes, let's say someone's on ZepBound, but then their formulary will now cover Wagovi, someone might switch to the opposite. because it's covered. Or ironically, everyone's always thinking that sounds better, but that's not necessarily true. So some people will do better on Wigovi. So this is just a matter of how are things working for you? What is best for you? Side effect, profile wise, results wise, tolerability, all of it. So these are all things that we keep in mind. And then with switching over that you wouldn't necessarily restart. But again, working with someone that really understands this, because once the titration has been set in place, you can't change it. Is everyone hearing me? This is really important to understand. If you have a doctor that restarts the titration, it's not like, Oh, well, now I heard Metane, I realize that that's wrong. You can't change it then because then you can't suddenly skip doses. Now that is a problem. So let's say you started out at you were on max dose Wegovia 2. 4 milligrams weekly. And then let's say your doctor inappropriately changes in my estimation, not the right move again, everyone can practice however they feel fit, but let's say that they then switch you to the starting dose of that bound 2. 5 milligram and you are hungry as can be and you're thinking, Oh my Lord, this is not enough medication. I need more help. You then can't jump to a 7. 5 or a 10. You have to each month and slowly go up on the titration. So oftentimes, I will sometimes have people in my clinic where they're seeing me, but they're in a healthcare system where their primary care doctor actually has to write the medication for it to be covered. So this is then a scenario where you're going to have to titrate up monthly. So a lot of times, if the primary care doctor has done that, I'll tell the patient, okay, unfortunately, we know now for the next four months, you're going to have increased hunger, and we're going to have to go back to volume based eating and really change XYZ. And we already know the approach we're going to have to change. And again, a lot of the time, it's not that that doctor is trying to do that. Maybe The pharmacy is in the way or the insurance company like there's unfortunately there are so many external factors And so this is something that Unfortunately, we have to contend with. So again, if that happens, that's okay too. This is something that I talk about in my mini course, the top five mistakes that people make when starting a GLP 1, is that sometimes when that happens, then you just need to change your approach that you're going to have to do the next few months. It just requires though, it's like it requires so much more of you than was actually necessary if it would have been. been treated correctly to begin with. All right, let's see some other things I want to talk about. Again, I think that any medication is good if you get access to it and that I don't really like this kind of like superiority game. At the end of the day, we do sometimes see Higher results with ZepBound, but again, there's going to be other medication that comes out that's potentially higher than that. I think at the end of the day, it's what can I use that gives me a tool that helps me to keep doing all the other things. So I think that's really the important thing to focus on here. So again, people switch from one to the other or vice versa. The other question becomes, I'll look at when someone is losing, at what point do we maybe add something else on, whether it be Contrave, Metformin, different tools like that. If you look back, I've talked in other episodes about this. I also on my premium podcast, the obesity guide behind the curtain season one. I talk about what are these other options and when do we add them in to a journey like this. And so I'll make sure to, we'll put that link in the show notes for you for that if you wanted to get that. But this is something where you should really work with a physician that's used to what the numbers look like. Cause I can already tell within the first three to four months, likely what the entire trajectory is going to look like for you. Now I want to stress something just because you're losing on the slower side does not mean that you will not still be able to reach your goal. Okay. So don't get fooled by this where you're sitting there and you're thinking, Oh my gosh, I'm not following the patterns. And you start to freak out. You're getting really desperate. You're making moves that don't help you long term. Don't go into desperateness. Okay. Stay level and focused. What can I sustain long term? What's the next thing I can add in? You will be in a radically different place in one to two to three years when you just keep making steps forward compared to focusing on this week, this month, what's going to happen. Okay. It's a very different journey. All right, I think I'm going to end the episode there, but I hope that this gave you a little bit of perspective with these different medications, what you can expect. I know a lot of people have been now talking about RETA TrueTide, so now the triple agonists that are coming down the road, I think it is such an incredibly amazing time to be practicing in obesity medicine, and honestly, I can't wait for all these medications to come out. I think that they're just such incredible tools. For the hard work that's already going in. All right. I hope this was a great episode. If you have questions, make sure that we can always answer those for you. I would love for you to, comment on one of my videos on social and let me know what kind of questions you have everywhere. I'm a tear and TMD most active on Tik TOK, but you can find me on Instagram and everywhere else. All right. Have a great rest of the week.