Episode 15: Is Wegovy Weight Loss Drug Really Better than the Generic Brands?

Welcome to Inside the Cure with Dr. Charles Moak from Allure Medical. Learn what it takes to cure diseases, not just manage their symptoms. Healthcare isn't going to save itself. So let's jump right in.

Talk about a new weight loss drug that was approved by the FDA in the summer of 2021. It's called WeGovy. W E G O V Y. I'm not sure if I'm pronouncing that right. I want to kind of talk about, about what it is, what it does and maybe what are some alternatives. Now this is one of the many drugs that have been proved for weight loss and none of them have worked very well. The first one is phentermine, really doesn't work that well. It's kind of a stimulant. There's some other drugs that are related to diabetes medications that worked somewhat, but none of them were that great. This was by far the most weight loss seen, which was about 15% of the body weight. So in this study it was 68 weeks or over a year. They put the subjects on a restricted calorie diet, so they made them eat 500 calories less than they would need to maintain their weight and 150 minutes of exercise per week. So that's like 30 minutes a day, five days a week. And it was walking or something, something along those lines, not necessarily running. And they also had people that were placebo that were not given the drug. And some of the people were given the drug Wegovy, it's called a GLP agonist. So it's a glucagon, like a peptide agon. Their BMI was on average 38. That's a degree of obesity. So BMI, if you're below, say 25 is normal, 25 to 30, overweight, 30 to 35, obese, over 35, very obese. So they were very obese. On average, they lost an average of 15.3 kilograms or 15% of their body weight. 15.3 kilograms, about 35 pounds or so. And people in the placebo also lost weight, but about five pounds because they were also on the diet and exercise. They also noted that when they stopped the drug, their weight came back, at least over the next several weeks. They didn't follow for 68 weeks, 62 weeks again, or 68 weeks again. And the cost of the drug is $1,350 per month. So very expensive. And it doesn't look like it has long term effects, but it does have promise for losing weight. And this is very exciting now because we Have a drug that's the most effective for weight loss. But again, it was a very long time. Most drugs have not been studied for over a year. Very, very expensive. And works as what's called a GLP1 agonist. Well, what else is a GLP1 agonist? Agonist means it acts like GLP1. There's another drug called Metformin or Glucophage. This is one of the most common used diabetic medications over the past 50 years or so. This works by several mechanisms. It's not exactly known how or why it works, but. But it also increases GLP1 and it's not an agonist. It actually just increases the actual hormone in our body. So let's look at a study, kind of a similar study. They had a study where they had put people on no specific exercise or diet plan, but they advised them to try to cut their carbohydrate consumption in the evening. They had patients going on the active drug of metformin and patients that were the control group that were given no drug. This was a six month study, not a little over a year study like the WEGOVI trial. Their median BMI was 35, so about the same. And they were on doses from 1500mg a day to 2500mg a day based on their weight. So as they were heavier, they put them on higher doses with metformin. It causes a fair amount of gastrointestinal upset like upset stomach, maybe diarrhea. So you have to kind of start off slow, 500 a week, a day, go to 1000 a day, titrate up and actually resolves that. And they saw an average of 5.8 kg weight loss, about 13 pounds or about 5.6% of their weight. And also the control group, who was not on any drug, gained an average of 2 pounds or 0.8% of their body weight. So the control group gained weight in the metformin study because there was no diet. And then the WeGovy study, the expensive medication study, the control group lost weight. So we adjust for those CO factors. The people on WeGovy lost twice as much as the people on metformin. However, the metformin study was six months and the WEGOVI trial was over a year. So we can say that these are pretty close. Let's talk a little bit more about metformin. It's a drug used to treat diabetes. However, there's currently studies looking at metformin in people without diabetes because of a Few facts. So a 2017 study looked at the rates of age related decline or age related to d causation of men that were on diabetes and treated with metformin versus men who did not have diabetes. And what they found was men who were diabetic, which is a co founder like a variable for having heart disease and strokes if they're on metformin. There was a 40, there was a 34% reduction in all cause mortality over the period of the study. There was a reduction in cancer, better survival if they did heat cancer, less cancers overall, less neurocognitive decline and less cardiovascular disease death. So metformin, men treated with metformin that were diabetic had survived age related disease more than men who didn't have diabetes to begin with. Now this is not the same for other diabetic related diseases. Not to say you'll live longer if you get diabetes. If you have diabetes and you take metformin, you're more likely to live a longer life than if you were not taking metformin and more likely to outlive men that do not had diabetes. All very interesting. There's numerous trials, there's numerous studies looking at other decreased neurocognitive decline, Alzheimer's disease, improved outcome of strokes, reducing cancer mortality and incidence and reduces cardiovascular disease in diabetic patients. Sorry. Men and women with diabetes have lower rates of neurodegeneration such as Alzheimer's and dementia, less cancer and less mortality from cancer and less cardiovascular disease than diabetics not on metformin. That study referred to earlier showed that even reduces the rates of those conditions versus people who have diabetes in the third place or in the first place. Now there's another study called the TAME trial. Tame targeting aging by metformin. This is rolling people who are 65 to 79 putting them on, they're trying to get 3,000 people recruited. There's 14 research institutions and it's a six year trial and they're aiming to see does metformin use in people that do not have diabetes, does it reduce dementia, cancer, heart disease and Alzheimer's. So we will know that in the future. So just a recap, the WeGovy trial and the Metformin trial, which were done separately, both were treating people without diabetes and they were using these drugs as weight loss drugs. Wegovy has another name when it's used for diabetes, but it was originally approved for diabetes to copy some of the effects of metformin. Metformin works by activating GLP1 and WeGovy acts by as an agonist or something that looks like GLP1. And of course it's much more expensive. If you're a diabetic you take a lower dose. So it doesn't cost quite the 1300s, about half that. But they put people who do not have diabetes and they lost weight. The people that were on the placebo also lost weight because they're also on a 500 calorie restriction diet. You know, cut the calories by 500 calories. They're also at exercise 150 minutes a week. And in a year and a quarter they lost about 15 kg or 30, 30 odd pounds on the metformin diet. They were not encouraged to exercise or diet. They were encouraged to cut their carbohydrate use at night and they were put on metformin at a 1500-2500 milligrams a day and they lost an average of about 13 pounds in six months. So half as much as we goby diet. However, they were not on a diet, they were not exercising. It was half the amount of time. So we think about this in both cases you need to be on these medications long term to maintain it and maybe get additional weight loss as time goes by. We got a drug like WeGovy that, you know, certainly works. It works better than any other drug has been proven to work. It's not clear if it works actually better, but in terms of proof, because there's not a one year metformin trial and it's you know, $1300 a month, so you know, about 15,000 a year. So 20 years would be, you know, $300,000. Of course drug prices will probably go up. Metformin is inexpensive, costs less than a couple bucks a day and it's got a long safety record. Also, we know if you're a diabetic you have less neurocognitive decline, less cancers, less heart disease. Do we know that that occurs in people without diabetes? Definitely unknown. It is being studied. Now this is a very hot topic. They're studying this in animals and in humans to see if this has protection. However, metformin is a generic drug. There's not a big pharmaceutical company pushing this. If they could somehow get a patent on it, there would definitely be interest in studying this more extensively and rebranding and selling it again. But right now this is a generic drug and I'm not recommending you take metformin. I'm just going after the idea of taking this expensive drug. It's really hot topic. I see in my Facebook feed, a couple companies are, you know, putting people on this expensive drug. And if you're doing it for weight loss, it's probably not truly superior to metformin in the first six months. Maybe in the long term it could be. That's unknown by the study. It wasn't powered to show that. Very expensive. And, you know, I'm kind of bullish on the protective aspects of metformin since it's been around so long. We know how effective it is in diabetics, so thank you very much.

Thanks for listening to Inside the Cure with Dr. Charles Moak. See you next time.