Is Mounjaro the game changer when it comes to weight loss? Mounjaro, is a drug that has been created to treat Diabetes, yet it gained significant fame and still have the spot light on in making a real difference in people’s struggle with weight. But is it the right answer to everyone?
What is Mounjaro and How does it work?
Mounjaro is the brand name for Tirzepatide. Tirzepatide is a peptide molecule that is produced synthetically and activates both GIP and GLP-1 body’s receptors as receptor agonist.
GLP-1 and GIP are both hormones secreted in the intestines naturally and work in multiple ways.
GLP-1 assists in reducing glucagon secretion of the pancreas, which leads to reducing gastric emptying time, and therefore reducing appetite and intake of nutrients and eventually weight loss. Externally administered GLP-1 partly restores incretin action (GIP) in T2DM patients in which stimulates the body to release insulin which improves blood sugar status overtime.
How was Mounjaro approved by FDA for chronic weight management?
While Mounjaro use has been studied on adults with type 2 diabetes as a part of treatment high blood sugar levels, in addition to diet and exercise, it has been noted that it also caused significant weight loss in individuals who took part in the clinical trials. Therefore, it has been approved by the FDA in May 2022 as a dual therapeutic option for diabetes and obesity.
Zepbound (Tirzepatide) which is the same drug as Mounjaro with the same active ingredient has been approved for chronic weight management for adults with obesity only recently on November 2023. Zepbound (Tirzepatide) has been approved for use with adults with obesity that identifies with BMI of 30 kg/m2 or more, or overweight with BMI of 27 kg/m2 or more with at least one weight related comorbidity such as high blood pressure, type 2 DM or high cholesterol. As per FDA, Zepbound and Mounjaro have been approved for use in addition with a reduced calorie diet and increased physical activity.
An important research fact you shouldn’t skip!
Trials on Tirzepatide for obesity were for 72 weeks and were adjunct to lifestyle interventions delivered by a dietitian to help participants adhere to balanced meals with a deficit of 500 calories per day and at least 150 minutes of physical activity per week.
*Side note:
Obesity is a complex multicomponent metabolic disease of energy homeostasis that involves central and peripheral mechanisms where physiological regulatory mechanisms can work to limit weight reduction and impede weight maintenance of a biologically appropriate body weight after sometime of applying lifestyle-based approaches including diet and exercise.
What are the side effects of Mounjaro and Zepbound that you need to know about?
The most common side effects associated with Tirzepatide (Mounjaro) reported in the clinical trials included nausea, diarrhea, decreased appetite, constipation, vomiting, indigestion and stomach pain. However, as per the FDA, Mounjaro may cause serious side effects including inflammation of the pancreas (pancreatitis), low blood sugar, allergic reactions, kidney problems including kidney failure, severe stomach problems, and complications of diabetes-related eye disease like diabetic retinopathy. Meanwhile, it should not be used in patients with a personal or family history of medullary thyroid cancer or in patients with Multiple Endocrine Neoplasia syndrome type 2. It is also not indicated for use in patients with type 1 diabetes. Moreover, the clinical trials have shown low incidence rate of acute cholecystitis and hypoglycemia.
On the other hand, Zepbound’s side effects were similar to Mounjaro and included nausea, diarrhea, vomiting, constipation, abdominal discomfort and pain, injection site reactions, fatigue, hypersensitivity reactions typically fever and rash, burping, hair loss and gastroesophageal reflux disease. As per the FDA, Zepbound also contains warnings for pancreatitis, gallbladder problems, hypoglycemia, acute kidney injury, diabetic retinopathy in patients with type 2 diabetes mellitus.
A key message to healthcare providers prescribing Mounjaro regarding balancing medications and mental health:
As known, diabetes and obesity are chronic diseases that are both complex in nature combining genetic, epigenetic and lifestyle factors.
While weight loss drugs can work on reducing appetite and food intake, it may worsen restrictive food intake behaviors in some individuals. This might lead to adverse effects such as food aversions, dehydration, dietary deficiencies or low blood sugar levels that require close monitoring.
Healthcare professionals might recommend using weight loss drugs for people who are slightly overweight who seek the loss of 2-5 kgs for esthetic goals. This practice can perpetuate the idea of weight stigma, the thin ideal and the over evaluation of the body shape and weight. On the other hand, it is important to increase the patient’s awareness on the use of those medications in which they can help in adhering to helpful dietary guidelines, while fostering the importance of changing old unhelpful dietary habits prior to stopping the medication to avoid weight regain and therefore using compensatory behaviors like following extremely restrictive diets and other disordered eating behaviors.
Using weight loss drugs like Mounjaro can help in improving health outcomes, managing obesity and the overall quality of life in patients who are qualified to take it. Hence, it must be provided and used appropriately and with caution. Therefore, an interdisciplinary approach to the treatment that includes a collaboration between an obesity medicine physician, psychotherapist or a behavioral therapist if needed, and a nutrition professional to provide a comprehensive and individualized care for patients that ensures meeting adequate nutrition and maintain healthy eating patterns while promoting and building long term results.
However, it is important to carefully approach the use of weight loss drugs and GLP-1 agonists in individuals with a history of eating disorders or other forms of psychiatric disorders. Therefore, patients should be screened for current or past disordered eating behaviours prior to starting these medications in a manner that is similar to procedures applied for bariatric surgery along with close monitoring for exacerbation or triggering of abnormal eating patterns.
Moreover, it is extremely important to care for the language used about weight, to avoid weight stigma while dealing with those patients, but to focus on health outcomes and benefits rather than solely focusing on weight reduction.
Finally, to discourage the utilization of these drugs for individuals that are not in the categories of a BMI of 30 or above, and BMI of 27or above with comorbidities threatening their health as per FDA recommendations.
What do you need to ask your doctor before starting the use of Mounjaro?
It is important to note that the off-label use of weight loss drugs like Mounjaro without the supervision and monitoring of a medical doctor is very dangerous. It is necessary to know that they have been out for a couple of years only and that long term clinical experience and its data is still not available. Therefore, ask your doctor for updated data on clinical studies and trials.
Patients using Mounjaro especially for weight loss purposes need to fully understand the mechanism of how the drug works and how does it lead to weight loss. Ask your doctor to explain the importance of dietary and lifestyle changes with the support of a professional to yield desirable and sustainable results instead of falling into the risk of gaining the lost weight back after the discontinuation of the treatment. You need to understand that Mounjaro and other weight loss drugs are not the magical pill that leads to fast weight loss, different bodies react differently to those drugs, where people with higher BMIs tend to lose more weight over time than people with slightly high BMIs.
We encourage people who seek weight loss drugs to focus on health gains rather than weight focused results to maintain the drive for a healthier lifestyle change.
The role of nutrition and lifestyle changes in the use of Mounjaro
Nutrition plays a major role in obesity treatment whether it is with the use of weight loss drugs (Mounjaro) or without it. People who try to manage their weight can use extreme measures to control their eating like following extreme diets that either very restrictive and low-calorie or through using food restraints where they restrain from certain food groups like ketogenic diet or intermittent fasting. Following extreme measures that are not sustainable or doesn’t fit one’s lifestyle can result in unsustainable results and Yo-Yo weight fluctuations and changes and that may imply harm on one’s health rather than exert health benefits along with possible dietary deficiencies. Therefore, nutrition intervention must be personalized, balanced, and consistent with one’s lifestyle to meet optimum and sustainable nutrition and weight goals.
It is recommended to work on changing the mindset of fast weight loss when using weight loss drugs to the mindset of a more nourishing and a healthy lifestyle that involves balanced meals, regular physical activity, and problem-solving skills along with planning to work around lifestyle challenges.
The effect of Mounjaro use for weight loss on mental health.
Recently we have been observing an increased normalization of disordered eating behaviors while pursuing weight loss and a smaller body shape and size even if there is a cost to the physical and mental health. Hence, the increased focus on weight loss medications like Ozempic, Wegovy and Mounjaro raises a concern of the development of eating disorders for people at risk.
Since most people who develop an eating disorder declare previous weight loss attempts of dieting which put the person who is prescribed a weight loss drug at risk of developing an eating disorder. Therefore, prescribing a weight loss drug for someone who has suffered from or suffering from an eating disorder can put them at risk of triggering it.
Additionally, the significant weight loss following the use of a weight loss drug can also create an obsession and over evaluation of body weight and shape and the drive of thinness
On the other hand, many people have reported that they tend to regain most of the weight they lost after the discontinuation of weight loss drugs. It is important to know that significant weight fluctuations can have adverse effects on one’s health and metabolism. Moreover, there is a mental element to weight loss, gain or weight fluctuation that can trigger many emotions in people at risk which may contribute to a critically negative mindset causing hopelessness, increased disordered eating habits like severe dietary restrictions or restrains or compulsive eating, and maybe depressive episodes.
Finally, it is important to note that Zepbound (Tirzepatide) also contains warnings for suicidal behavior or thinking and depression, which requires prior screening and close monitoring during the time of treatment.
A call to action and a takeaway message
It’s important to admit that we don’t have enough and long-term studies on the effect of Mounjaro on weight or the metabolism in the long run or after stopping the injectable drug. Therefore, it is important to use it with caution, under the supervision of a medical professional with necessary screenings for any medical or mental health risks. Meanwhile, during the treatment with weight loss drugs, work on maximizing the benefits of its use through building helpful dietary habits and lifestyle changes that bring long lasting results. What is more important, never hesitate to reach out for the right professional help!
References:
- Chavda, V. P., Ajabiya, J., Teli, D., Bojarska, J., & Apostolopoulos, V. (2022, July 5). Tirzepatide, a new era of dual-targeted treatment for diabetes and obesity: A mini-review. MDPI. https://www.mdpi.com/1420-3049/27/13/4315
- Commissioner, F. (2022, May 13.). FDA approves novel, dual-targeted treatment for type 2 diabetes. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-novel-dual-targeted-treatment-type-2-diabetes. Accessed 20 Dec. 2023.
- Eli Lilly and Company, (n.d.) Recent your expectations with Mounjaro (https://www.mounjaro.com/hcp/a1c-weight#mounjaro-a1c). Accessed on 20 Dec. 2022.
- Jastreboff A. M., Aronne L. J., et al, (2022, July 21). Tirzepatide Once Weekly for the Treatment of Obesity. DOI: 10.1056/NEJMoa2206038. https://www.nejm.org/doi/full/10.1056/NEJMoa2206038
- Richards, J., & Khalsa, S. S. (2023, August 30). Highway to the danger zone? A cautionary account that GLP-1 receptor agonists may be too effective for unmonitored weight loss. https://doi.org/10.31234/osf.io/uxa78
- Wilding , J. P. H., & Batterham , R. L. (2022, April 19). Weight regain and cardiometabolic effects after withdrawal of Semaglutide: The STEP 1 trial extension. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725
- Wojtara, M., Mazumder, A., Syeda, Y., & Mozgała, N. (2023, September 20). Glucagon-like peptide-1 receptor agonists for chronic weight management. Advances in Medicine. https://www.hindawi.com/journals/amed/2023/9946924/
