Ozempic/Wegovy/Zepbound

I am 82 years old and obese. I have tried to lose weight, but I haven't been successful. My cardiologist writes in his office notes that I should lose weight, but he has never suggested medication. With the significant price drop of Ozempic, Wegovy, and Zepbound, is it time for me to ask my cardiologist for one of them, and which one is best?

 

COPILOT (Smart mode)

Given your age, heart history, and the fact that you’ve already been under a cardiologist’s care, this is absolutely the kind of conversation worth having directly with your doctor — and now may be a good moment to raise it, especially with the recent price changes.

Here’s a clear, side-by-side look at the three drugs you mentioned, based on current evidence:

Medication

Active Ingredient

FDA Approval for Weight Loss

Typical Average Weight Loss in Trials

Notable Benefits

Key Considerations for Older Adults

Ozempic

Semaglutide

❌ (approved for type 2 diabetes; used off-label for weight loss)

~10–12% of body weight

Improves blood sugar control; reduces the risk of heart attack/ stroke in people with heart disease.

Less studied in people over 75, GI side effects (nausea, vomiting) can lead to dehydration and muscle loss.

Wegovy

Semaglutide

✅

~15% of body weight

Same heart benefits as Ozempic; approved explicitly for chronic weight management.

Similar side effect profile; requires ongoing use to maintain weight loss.

Zepbound

Tirzepatide

✅

Up to ~21% of body weight at the highest dose

Dual-action (GLP-1 + GIP) may lead to greater weight loss; it is also approved for use in patients with obesity and sleep apnea.

Newer drug — long-term data in the 80+ age group are limited; may have more potent GI effects.

Why this matters for you:

  • Potential benefits: All three can help with weight loss and may improve cardiovascular outcomes, which is relevant given your cardiologist’s notes.
  • Risks in your age group: Older adults are more prone to dehydration, dizziness, and muscle loss from rapid weight reduction. That’s why close monitoring — especially of hydration, nutrition, and muscle strength — is essential.
  • Drug choice: There’s no universal “best” — Zepbound shows the most significant average weight loss in trials, but Wegovy has more established long-term data for weight management. Ozempic is often chosen if diabetes is also present, but it’s not FDA-approved for weight loss.

How to bring it up with your cardiologist:

  • Mention your ongoing difficulty losing weight despite lifestyle changes.
  • Note the recent price drop and ask whether a GLP-1 medication could be appropriate for you.
  • Ask which option they feel balances effectiveness, safety, and your heart health.
  • Discuss a plan for monitoring side effects, hydration, and muscle mass.

 

Here is a draft a short, focused message or talking points for a cardiologist in January, or seek an appointment sooner with my PCP?

Here’s a way to frame it so you’re prepared for either path — keeping it short, clear, and medically relevant.

Option 1 – Talking Points for January Cardiologist Visit

  1. State the challenge plainly: “I’ve been unable to lose weight despite diet and activity changes.”
  2. Reference medical context: “At my age and with my heart history, I’m concerned about the health risks of remaining at this weight.”
  3. Tie in recent developments: “The recent price drop for GLP-1 medications like Wegovy, Ozempic, and Zepbound has made them more accessible.”
  4. Ask for their guidance: “Do you think one of these would be appropriate for me, and which would be safest given my age and heart condition?”
  5. Agree on a plan: “If we start, how will we monitor side effects, hydration, and muscle strength?”

Option 2 – Requesting a Sooner PCP Appointment

If your concern is urgency — for example, if your weight, energy, or cardiac symptoms have worsened — it’s reasonable to call your PCP now rather than waiting until January. A PCP can:

  • Review your overall health and medications.
  • Determine if a GLP-1 is appropriate now.
  • Coordinate with your cardiologist if they agree to start therapy.

How to decide on timing:

  • Sooner: If symptoms are worsening, or you feel waiting could risk your health.
  • January: If your condition is stable and you’d prefer to make the decision directly with your cardiologist, who knows your heart history best.

 

I expect to end my ADT for stage 4 cancer in December. Should wait and bring up the topic with my oncologist and urologist in November before seeking advice from my PCP. Comments?

That’s a thoughtful sequencing question — and in your specific medical landscape, it makes sense to loop in the cancer‑care specialists before making a weight‑loss medication decision with your PCP.

Here’s why:

  • They know your current treatment’s impact on weight and metabolism — ADT often changes body composition, insulin sensitivity, and cardiovascular risk. Your oncologist and urologist can help determine whether these effects persist after you stop therapy.
  • Medication interactions and safety context — Some cancer treatments (even post-ADT) can influence how you tolerate GLP-1 drugs, or might make rapid weight loss less advisable without additional monitoring.
  • Coordinating the “medical narrative” — Having your oncologist or urologist document that they’ve reviewed and support the idea can make your PCP and cardiologist more comfortable initiating therapy.
  • Timing advantage — If you meet with them in November, they can flag whether it’s safe to start early in the new year or if they prefer a waiting period after ADT ends.

Practical pathway:

  1. November: Discuss with oncologist/urologist — focus on safety, cancer-specific considerations, and timing after ADT.
  2. Post‑discussion: Share their input with your PCP (and/or cardiologist) for a prescribing decision. This way, everyone is on the same page, and you avoid conflicting advice.


 

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