Dear Dr. Roach: After about 10 months of being on Ozempic and working my way up to a 1-mg dose, I lost 40 pounds effortlessly. Sugar cravings disappeared as if by magic. I then noticed myself drifting backward and craving sweets again. My doctor increased my dose to 1.7 mg of Wegovy instead of 2 mg of Ozempic. I find myself continuing to crave sweets and have gained 8 pounds in around six months.
I’m wondering if any studies explain this and what’s the best way to address it. Should I increase the dose further or switch to another drug?
J.A.
Wegovy and Ozempic are the exact same drug: semaglutide. They are dosed slightly differently and marketed for different purposes, with Ozempic being indicated for diabetes and Wegovy for weight loss. The dose has to be started low and slowly raised in order to minimize side effects. My experience is that each dose leads to a certain amount of weight loss, then a plateau, but it is highly variable from person to person.
When the plateau is reached, or if the weight loss reverses, then it’s usually time to increase the dose. Wegovy can be increased to a maximum of 2.4 mg, which is given by injection once weekly, compared to the maximum dose of 2 mg of Ozempic. My preference is to go to the maximum dose, so I advise a person in your situation to try the 2.4-mg dose of Wegovy.
Some of my weight loss medicine colleagues who have more experience than I do note that some people do better with semaglutide, whereas others do better with another GLP-1 agonist, tirzepatide. Like semaglutide, it is available for diabetes (Mounjaro) or weight loss (Zepbound). A head-to-head trial found that tirzepatide was slightly better with weight loss, but each person is different. In addition, insurance will often only cover one option.
Weight loss specialists will use additional medications to augment the effectiveness of GLP-1 agonists such as metformin or topiramate. I recommend seeing an expert in weight management if single drug therapy is not giving you adequate results.
Finally, I recommend against the compounded versions of these drugs, which are not well-tested for safety and efficacy.
Dear Dr. Roach: I read your recent column on polymyalgia rheumatica (PMR) with interest. My husband was given this diagnosis after a sudden onset of debilitating headaches, neck and shoulder pain that sent him to the emergency room. He had follow-ups with his internist. The pain and inflammation continued over the course of a month, along with a low-grade fever. Prednisone tamed it, as well as ibuprofen.
After one month, he received a positive test for Lyme disease. He had been given an initial Lyme test at the onset, which came back negative. Fortunately, an astute friend who was an ER physician assistant suggested a repeat test, since Lyme antibodies can take four to six weeks to develop. Once the Lyme treatment commenced (doxycycline), all of his symptoms cleared up rapidly and permanently.
Two years later, I have learned through my research that undiagnosed Lyme disease can mimic many conditions or ailments, especially involving neurological pain in the head, neck, back and joints. I just wanted to offer this possible insight.
K.M.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
