244. Ozempic, Wegovy, and Mounjaro: The Truth About Weight Loss Drugs No One Tells You

What if I told you that weight loss drugs like Ozempic, Wegovy, and Mounjaro are not just about shedding pounds—but can also reduce the risk of heart attacks, strokes, and even improve sleep apnea?

And what if I also told you that while these medications are powerful tools, they’re often misunderstood, misused, and surrounded by myths from self-proclaimed “gurus”?

In this episode, Dr. Adrienne Youdim, triple board-certified internist and obesity medicine specialist, breaks down everything you need to know about GLP-1 medications. From how they work, to who should actually use them, to why “compounded” versions can be dangerous—you’ll finally get the truth about these drugs and how they fit into the bigger picture of health.

Don’t forget to share this episode with anyone considering these medications or feeling confused by the hype.

What You’ll Learn From This Episode:

• How GLP-1 drugs work: Understand why they’re more than “diet drugs” and how they affect appetite, gut function, and blood sugar.
  
  
• Side effects explained: Learn about common gut-related issues, rare but serious risks, and how to minimize discomfort.
  
  
• The truth behind “Ozempic face” and “Ozempic butt”: Why weight loss naturally changes body fat distribution—and why it’s not unique to these medications.
  
  
• Who should (and shouldn’t) take them: Clear guidelines on BMI, comorbidities, and why these drugs aren’t for losing just 5–10 vanity pounds.
  
  
• Why compounding is a red flag: Discover why cheaper compounded versions pose major health risks.
  
  
• What’s coming next: From oral GLP-1s to triple agents and even potential uses in conditions like Alzheimer’s, alcohol use disorder, and fatty liver disease.
  
  

“These drugs are powerful—not just for weight loss, but for improving overall health. But they must be used with medical oversight, not as quick fixes from unqualified sellers.” — Dr. Adrienne Youdim

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Transcript

Have you noticed that all of a sudden everyone is a weight loss medicine specialist? All of a sudden, your butcher, the dermatologist, your gardener, your mother-in-law—everyone is a guru in obesity medications.

Well, I'm here to set the record straight. My name is Adrienne Youdim. I'm a triple board-certified internist, obesity medicine, and physician nutrition specialist. I have been boots on the ground working with weight loss and obesity medicine for almost 20 years, and you're listening to Health Bite, the podcast that explores the physical, emotional, and spiritual hungers that drive us to soothe.

Each week I will offer you the essential nutrients that help you support your physical, mental, emotional, and spiritual health and well-being. And today we are going to set the record straight on obesity medicine and weight loss drugs.

We're going to talk about what's available and how they work. What are the side effects? What are the scary side effects? We'll talk about Ozempic face and Ozempic butt. Who needs these drugs and why do we need drugs anyway?

We'll talk about why I'm a hard no on compounding medications, what's coming down the pike—oral GLP-1s, as well as triple agents, muscle-building agents. And finally, we'll talk about the evidence of what else is available to us with the use of these drugs. What other conditions might we be able to treat?

We're going to cover all of that in today's episode. So let's get started.

What Are GLP-1 Drugs?

So first things first, what are these drugs, these injectable GLP-1s? You've heard them now for years. Celebrities are taking them. Your friends are probably taking them. You've probably heard that they're scary—maybe they'll cause blindness, they'll kill you. But then again, everyone's using the drug.

These medications are a class of hormonal mimics. There are hormones in our bodies that we produce when we consume food. One of those hormones is called GLP-1, glucagon-like peptide 1.

GLP-1 gets released from your gut, from your intestine when you eat food, and it does a few things.

Number one, it sends a message to your brain to say, woohoo, we've received food. You can shut off that hunger signal. So it acts as an appetite suppressant. It acts as a satiety or fullness signal. It literally tells your brain that you're full.

The second thing that it does is that it slows down the gut. It reduces what we call gut motility. So food is going to hang out in the gut longer. That makes people feel fuller longer because the food is hanging out there. But as you can imagine, that is also what contributes to some of the GI side effects.

Finally, this gut hormone sends a signal to the pancreas, the organ in our body that creates insulin, and tells the pancreas to send more insulin. That makes sense, right? Because if you've eaten food, you've eaten carbs, you have sugar that needs to be managed in the bloodstream. So this molecule is telling your pancreas: give me more insulin so you can manage my blood sugar.

And that is why these drugs are currently FDA approved for two things: type 2 diabetes and obesity or excess weight.

Classes of Medications

So what are the classes of medications? There's a couple right now that I'm going to focus on.

We started out back in the day with the daily injectables. Those came under the name of Liraglutide, Victoza when it comes to diabetes. But these injectables were daily and they didn't really catch on.

Number one, because people weren't really into injections back then. They hadn't gotten accustomed to it. Number two, the weight loss was not as effective as the weekly agents, the weekly GLP-1s like Semaglutide, Wegovy, Ozempic.

The second generation of these drugs was Semaglutide. That is the chemical name or the active ingredient in Ozempic. Ozempic was approved first for type 2 diabetes and then a few years later we got the approval in 2021 for Wegovy. Same ingredient as Ozempic but approved for weight loss.

When you hear about Ozempic, Ozempic-face, Ozempic-butt, Ozempic-whatever, they're really just referring to GLP-1 agonists called Semaglutide. And Wegovy is one of those things. So those three names are kind of interchangeable. You can replace them, swap them, because they're all essentially the same thing.

And then finally, the newest agent, which is not so new anymore, is Tirzepatide. You probably know it as Mounjaro. That is the name given to the approval for diabetes or ZepBound. Same ingredient, same chemical, approved for the treatment of obesity.

The difference between Wegovy or Semaglutide and Tirzepatide or ZepBound is that Wegovy only has one active ingredient. It only mimics one gut hormone, GLP-1, whereas Tirzepatide mimics two hormones, GLP-1 and another hormone by the name of GIP.

What probably matters more is the fact that Wegovy has shown about 15 to 17% weight loss in clinical trials. With Tirzepatide, it's about closer to 20 to 24%, 25% weight loss. I think average is 21% weight loss. So Tirzepatide is slightly more effective in terms of weight loss.

However, it's not just about weight. It's about cardiometabolic health. Both Semaglutide and Tirzepatide have shown benefits to metabolic risk factors, cardiometabolic health problems. They reduce blood sugar, reduce blood pressure, reduce cholesterol, and they've also shown to reduce major cardiac events.

Specifically, Wegovy has been shown to reduce heart attack, stroke, vascularization like PTCA. So, hard endpoints in improving cardiovascular health.

All of this to say that these drugs are approved for weight loss. They also have benefits to cardiovascular and cardiometabolic health.

For that reason, they're now getting other indications. So Wegovy is approved also for cardiovascular risk reduction. Tirzepatide has been approved for obstructive sleep apnea.

And then finally, there's also a new indication for Wegovy and MASH. MASH is a metabolic condition you may know as fatty liver.

Side Effects

So the next question is, what are the side effects of these drugs?

Yes, there is no drug that comes without a side effect. All drugs have adverse effects, and everything comes with a cost—even inaction, right? Someone who has obesity has risk factors or metabolic diseases. Not doing anything also comes at a cost.

So what are the side effects?

Remember that these are gut hormone analogs or mimics. It makes sense that the side effects are going to be primarily in the gut.

Food is going to stay in the stomach longer. That can cause bloating, reflux, nausea, vomiting, diarrhea, or constipation.

Usually, people who are already constipated, I ask them to get on something like Benefiber, MiraLAX, or psyllium husk to prevent constipation. Hydration is also really important.

Most of my patients actually do pretty well. I don't deal with a lot of side effects, number one, because I counsel my patients on how to eat. Don’t eat super heavy. Don’t eat highly prepped foods. Reduce portion sizes. Don’t eat big meals. Don’t skip meals either, because long periods without food can increase nausea.

Eating adequate protein is so important in order to preserve muscle mass. Protein also helps manage nausea.

Scary but Rare Side Effects

There are also potentially scary side effects.

We’ve worried about pancreatitis—inflammation of the pancreas. It usually presents with severe nausea, vomiting, and abdominal pain. That is a reason to reach out to your doctor.

Another potential scary adverse effect is thyroid cancer in animal studies. Animals who were given excess amounts of this drug developed thyroid tumors. So it's contraindicated in anyone with a personal or family history of a specific type of cancer, medullary carcinoma, or a syndrome called MEN.

Studies in humans are not showing this to really come out to play. Same with pancreatitis. Still, it’s on the packaging, and it is on our minds in terms of what to look out for.

This medication is cleared through the kidneys, so I check chemistries to make sure kidney function is not affected.

There are some recent reports for optic neuritis and retinopathies. These are both very rare forms of blindness, more likely in diabetics.

And then finally, gastroparesis. This is severe slowing of the gut. Thankfully, I haven’t had anyone in my practice experience this. It tends to happen when the drug is misused—like when doses are escalated too quickly or when significant vomiting is ignored.

Side effects are real, but most can be mitigated. The scary ones are rare.

Ozempic Face and Ozempic Butt

When an individual loses weight—no matter how—you’re going to lose fat everywhere. That includes the face and the butt.

So they're calling it Ozempic face, they're calling it Ozempic butt. It’s just skin laxity and sagging that happens when body fat is reduced.

It’s not unique to Ozempic; it’s just part of weight loss.

Who Is a Candidate?

There are professional guidelines that determine who is a candidate for this drug.

If you have a BMI of 30 or greater, you are a candidate. If you are overweight with a BMI of 25–27 and have a comorbidity like high blood pressure, high cholesterol, degenerative joint disease, reflux, or sleep apnea, you are also a candidate.

This is not meant for losing just 5 or 10 pounds. It’s for scenarios in which excess weight is causing or will cause problems.

These drugs are intended for long-term use. They are not diet drugs.

Why? Because when we lose weight, our body does everything in its power to regain it. Hunger hormones go up. Metabolism drops. The body becomes more efficient at storing fat.

This is a physiologic response, not a lack of willpower.

Why I’m a Hard No on Compounding

I am a hard no on compounding.

So many so-called gurus of weight loss are compounding their own drugs and trying to sell them. That should raise a red flag.

Compounding means pharmacies not FDA-approved are creating these compounds and selling them. There is no regulation, no oversight, no guarantee of quality or consistency.

Studies have shown compounded versions come with higher risks of abdominal pain, diarrhea, nausea, gallbladder issues, contamination, and manufacturing errors.

Yes, it’s cheaper. Yes, access is a real issue. But compounding is not the safe solution.

What’s Coming Down the Pipeline

This is an exciting area of medicine.

Oral agents are coming. Novo Nordisk and Eli Lilly are both developing oral GLP-1s.

More effective agents are coming. Retarutide is a triple agent showing 24% weight loss in trials.

There’s also research into combining GLP-1s with muscle-preserving agents like Bimagrumab, though Eli Lilly recently paused this work.

Other uses are being studied too: Alzheimer’s disease, alcohol use disorder, kidney disease, heart failure, osteoarthritis, psoriasis, PCOS, breast cancer, colorectal cancer.

Closing Thoughts

These drugs are powerful—not just for weight loss, but for improving overall health. But they must be used with medical oversight, not as quick fixes from unqualified sellers.

I hope this has given you a thorough but helpful rundown of GLP-1 drugs, what they do, how we use them, what we should be careful of, and what is the proper way for them to be used.

I also hope it gives you pause when listening to self-proclaimed gurus. There are people out there selling snake oil. They have no training, no understanding, and no care in treating obesity with compassion.

I am here and open to answering your questions. Feel free to find me on Instagram @DrAdrienneYoudim. You can also go to www.dradrienneyoudim.com and sign up for my newsletter.

I love to talk about all things nutrition, and hunger—physical hunger, emotional hunger, spiritual hunger—and to teach you the nutrients, mind and body, that will help you live well and thrive.

This is Dr. Adrienne Youdim signing off. I'll see you next week right here on Health Bite.