Today we are talking about switching between weight-loss medications. In particular, GLP-1 receptor agonists such as Saxenda, Ozempic and Wegovy. I also have a small note about other classes of weight-loss medications such as Contrave!
So let’s get to it!
Unlike buying a pair of jeans or a new shirt, switching between weight-loss medications requires a bit more discussion and assessment. Or at least it should! While stopping one drug and starting another is easy enough, we want to look a bit deeper to ensure this switch is in your best interest! Now that Wegovy or Semaglutide 2.4mg once a week has been approved in the US and Canada, this is a hot topic. Many individuals who are currently taking Saxenda or even Ozempic, which is Wegovy at 1mg once weekly, are hoping to make the switch. Why might you ask?
Yes, why make the switch?
Wegovy has been shown to be considerably more effective in terms of weight-loss. If you haven’t read my other blogs, you should start here and here. In fact, in the STEP 1 trial, a majority of participants lost ~15% of their baseline body weight and nearly ⅓ of participants lost 20% or more of their baseline body weight. Saxenda and Ozempic 1mg once weekly, unfortunately, average to be in the 5-10% weight-loss range. Not that that amount is anything to turn our noses up at, but Wegovy just happens to be better!
Needless to say, people are biting at the bit to jump on Wegovy and lose more weight! And based on the data, that is what would likely happen for a majority of people. For example, in my clinical experience of switching people from Saxenda to Ozempic (Wegovy) 1mg once weekly, we have seen a greater amount of weight-loss! However, to my knowledge, they have not done a specific trial looking at switching from one to the other, ie. Saxenda 3mg daily to Wegovy 2.4mg once weekly, but if I am wrong, please send me a link!
Anywho, it can be done and likely, you will see further weight-loss. However, in my opinion, we should be doing a more in-depth assessment to determine if switching is the right choice.
Why bother? Let’s just get to it!
Why am I being a pain in the a*s?
The reason being is that these drugs are not increasing an individual’s metabolism; they are lowering the barrier and making it easier to step over in choosing the apple over the apple pie. It helps to reduce appetite, increase satiety, and decrease wanting and food-seeking behaviours, which is fantastic! This can be a game-changer for many people that have obesity.
However, there is always a concern about reducing your appetite so much that you are eating <1200 or even <1500 calories per day. When we start to venture into this territory, we run the potential risk of malnourishment and a lack of sustainability. Why? Because <1500 calories per day is just way too low for most people except for small toddlers. We also need to look at the processes of metabolic adaptation, which I reviewed in detail in this lecture here. It becomes increasingly difficult to lose weight with metabolic adaptation, and many people ultimately stall. Combine that with a ridiculously low amount of calories most people will start eating more out of frustration and, well, biology. And biology always wins. They then gain weight more quickly due to metabolic adaptations until they go onto their next diet.
So… get on the medication, right?
Medications like Saxenda and Wegovy can make the process of staying at a low-calorie intake more easily, but eventually, things will stall, and biology will strike. Therefore, before we make any jumps to another medication, we need to ensure optimized dietary and activity patterns. In particular, eating enough calories and protein consistently! As well as achieving as much activity as we can that we honestly enjoy! Sounds easy enough, right?
You would think so, but when it comes to eating in particular, I find many people are often not consuming enough food and protein. This is partly due to the medication and partly due to years of dieting and restriction. We need to ensure we are providing enough fuel to support further weight-loss and adequately fuel your body and, ultimately, your life!
I say all this because your weight-loss has stalled if you are currently on Saxenda, Trulicity, Ozempic, etc. You are either so metabolically adapted your body will not allow you to reduce your calorie intake any further consistently to lose weight, OR you have reached your Best Weight – the weight when you are eating the amount of calories you are happy with and doing the most amount of activity you can that you honestly enjoy.
Yes, switching to a more potent medication may help you reduce your calorie intake further; however, we run the risk of eating too few calories and eating a calorie amount that you are not happy with. If that happens in both cases, you will likely start reverting to old patterns and behaviours of eating more and, ultimately, gaining some weight back despite the more powerful medication being present.
What about Contrave?
The same can be said for switching from a GLP-1 to Contrave. It can be done easily enough, and for some people, GLP-1s provide no benefit, and Contrave produces amazing results. In some situations, I have added Contrave to a GLP-1 regimen to see if we can obtain more benefits that way as well. Certainly, there is some additional benefit that is seen for some!
So, in summary, we sure can switch you from one medication to another. Some clinicians will make the switch quite abruptly. However, I recommend doing a full review and assessment with your clinician to ensure it is appropriate to switch. Have we optimized all of your lifestyle parameters? Otherwise, we run the risk of not obtaining any additional benefit and possibly even some weight regain if the process to lose weight is not sustainable! I by no means want to discourage you from making the switch but just want you to look at a few considerations before you do!
I hope this helps! Always remember small tweaks lead to massive peaks.
Until next time,
Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Feb 10. doi: 10.1056/NEJMoa2032183. Epub ahead of print. PMID: 33567185.