Should I take OZEMPIC or MOUNJARO?

GLP-1S: WHY MOST PEOPLE DON’T NEED OZEMPIC OR MOUNJARO—AND HOW TO USE THEM SAFELY WHEN THEY DO

Fast Results, Slow Regrets

Over the past two years, I’ve watched otherwise thoughtful people treat Ozempic (semaglutide), Wegovy (semaglutide 2.4 mg), and Mounjaro/Zepbound (tirzepatide) like they’re shortcuts to a new identity. Shots first; habits later. It’s the modern health parable: outsource discipline to a syringe and hope physiology doesn’t notice.

Here’s the reality we teach at CAPPA Mind & Body: these medications can be powerful tools for the right, medically appropriate patient inside a structured program—but they are not cosmetic hacks. Used casually, they too often trade speed for stability: disproportionate lean-mass losses, GI/biliary complications, low real-world persistence, and rapid weight regain after stopping, with cardiometabolic risk drifting back toward baseline. The trials show what’s possible; behavior determines what’s durable.

Impact of the Problem: What Happens When We Medicalize a Shortcut

• Weight comes off—but muscle too. Analyses show a meaningful share of total loss is lean mass unless you actively protect it with resistance training and adequate protein. Some reports estimate ~20–40% of the loss can be lean mass, depending on cohort and method. Wiley Online Library+2PMC+2

• Stop the drug, weight returns. In STEP off-treatment extension data, participants regained ~two-thirds of lost weight within one year of stopping semaglutide; cardiometabolic markers drifted back toward baseline. PubMed+1

• Real-world persistence is weak. Outside RCTs, adherence and 12-month persistence are far lower, and 3-year persistence can be ~8% in commercially insured cohorts—one in twelve still on therapy at three years. PMC+2Jmcp+2

• Safety signals matter. Meta-analyses link GLP-1 RAs with gallbladder/biliary events, especially at higher doses/longer duration for weight loss; U.S. labeling for semaglutide now includes “ileus” as an adverse reaction. Markel Insurance+3PubMed+3BioMed Central+3

Bottom line: Without a program that builds capacity (muscle, habits, monitoring), these drugs can become a revolving door: on-drug improvement, off-drug relapse.

What the Big Trials Actually Show (And Don’t)

• STEP-1 (semaglutide 2.4 mg): ~15% mean loss at 68 weeks with lifestyle co-intervention; BP and lipids improved on treatment. PubMed

• SURMOUNT-1 (tirzepatide): ~15–21% loss at 72 weeks in adults with obesity without diabetes. New England Journal of Medicine+1

• SELECT (semaglutide 2.4 mg): In adults with overweight/obesity and established CVD but no diabetes, semaglutide reduced major adverse CV events (MACE) vs placebo (median ~40 months). New England Journal of Medicine+2PubMed+2

Missing from the headlines: what happens after discontinuation and how often people stop in the real world (see above). Trials prove efficacy on drug; they don’t guarantee durability off drug.

Biomarkers Beyond the Scale: What Improves, What Rebounds

• On treatment: Many trials and reviews show improvements in triglycerides, non-HDL-C/LDL-C, and blood pressure while patients remain on therapy; SELECT adds hard CV outcomes in a high-risk group. New England Journal of Medicine+1

• After stopping: STEP off-treatment data show ~⅔ weight regain in 1 year with cardiometabolic variables sliding toward baseline—unless lifestyle changes are locked in. PubMed+1

• Lean mass risk: DEXA-based analyses and reviews report substantive lean-mass declines accompanying total weight loss with GLP-1–class therapy—necessitating resistance training + protein. Wiley Online Library+1

Safety Signals to Treat With Respect (Plain-Language)

• Gallbladder/biliary problems: Higher risk of cholelithiasis/cholecystitis vs controls—especially at higher doses/longer duration and when used for weight loss. Report right-sided abdominal pain, fever, or jaundice promptly. PubMed+2JAMA Network+2

• Ileus / severe GI issues: Semaglutide labeling now lists “ileus”; counsel on persistent vomiting, severe abdominal pain, no bowel movements. FDA Access Data+2CGH Journal+2

• Eyes (diabetes): Rapid A1c drops (e.g., in SUSTAIN-6) have been associated with early worsening of retinopathy; screen and monitor where relevant. PMC+1

• Peri-operative: Multi-society guidance now indicates most patients can continue GLP-1s before elective procedures, with individualized risk assessment (e.g., 24-hour clear liquids prior to endoscopy in higher-risk patients). ASA+2CGH Journal+2

• Regulatory notes: FDA cautions against compounded/unapproved products and continues to review safety signals; stick to approved products and clinical oversight.Drugs.com+1

My Position (and How We Operate at CAPPA): Program-Based Use—Not Casual Scripts

We are health management specialists, not a prescription kiosk. When GLP-1/GIP therapies are appropriate, we coordinate with the client’s physician, embed them in a high-touch program, and validate outcomes with physician follow-up and labs. Most people don’t need these agents; many who want them are seeking speed instead of structure.

Eligibility (illustrative—not medical advice):

• BMI ≥35–40, or BMI ≥30 with high-risk comorbidities (e.g., T2D, established CVD, OSA, NAFLD) after an earnest trial of intensive lifestyle therapy.

• Demonstrated readiness to change and agreement to monitoring.

Non-negotiables if on therapy:

• Progressive resistance training 2–3×/week.

• Protein targets individualized to lean mass.

• Quarterly labs & adverse-event surveillance.

• Dose titration with side-effect coaching (nausea/constipation plans; dose holds if needed).

• Exit plan from day one to prevent relapse (nutrition coaching, relapse-prevention skills, scheduled follow-up).

Why strict? Because safety, muscle preservation, and long-term outcomes demand it.

What Patients Must See in Bold

• These medicines are not cosmetic; they’re chronic therapy. Stop abruptly → weight regain and biomarker relapse are common. PubMed

• Protect your muscle. Lift 2–3×/week and hit protein targets; track strength and lean mass. Wiley Online Library

• Report red-flag symptoms early. Severe/constant abdominal pain, persistent vomiting, fever/jaundice, or visual changes. PubMed+2CGH Jour

Practice Box: Monitoring We Require (Coordinated With Your Physician)

Quarterly

• Weight, waist, blood pressure

• Fasting lipids (TC, LDL-C, HDL-C, TG)

• A1c/fasting glucose

• CMP (liver enzymes, creatinine), eGFR

• Vitamin D/B12/iron studies if intake is poor

• Gallbladder symptom screen

Baseline & 3–6 months

• DXA (or high-quality bioimpedance) for lean mass

• Retinal exam for patients with diabetes or rapid A1c drop risk

Peri-operative

• Follow multi-society guidance; consider 24-hour clear liquids before endoscopy in higher-risk patients. CGH Journal

CAPPA CASE STUDY (Composite; Physician-Verified)

Profile: 47-year-old executive; BMI 37, hypertension, hepatic steatosis; prior failed diets and brief, self-funded semaglutide with GI side effects.

Program (24 weeks): Staged Wegovy® initiation inside a resistance-training + protein-target protocol; diet quality upgrades; hydration and sleep coaching; weekly accountability; quarterly labs coordinated with his physician.

Outcomes (Week 24): −12.4% body weight; ALT normalized; triglycerides −26%; BP controlled; DXA showed preserved appendicular lean mass (<1% change). Patient elected to continue at a maintenance dose with a 12-month relapse-prevention plan. Results confirmed by physician follow-up and hospital lab testing.

Our perspective: The success belonged to the program structure (training, protein, monitoring, behavior change) plus appropriate medication—not the injection alone.

Where the Evidence Is Nuanced (and Where I Might Be Wrong)

• SELECT shows on-treatment CV benefit in high-risk patients; some individuals may reasonably prioritize those gains despite cost or side effects. New England Journal of Medicine+1

• Persistence can improve with coverage, supply, and side-effect management; data from 2024–2025 suggest some upward trend at 12 months, though long-term use remains limited for many. Reuters+1

• Lean-mass losses vary across cohorts/methods; structured training and protein mitigate risk. Wiley Online Library

The Bottom Line

GLP-1/GIP drugs are powerful but unforgiving. Without behavior change + monitoring, they often backfire—on the scale and in the lab. Used inside accountable programs for the right patients, they can be life-changing. Used as a shortcut, they become another yo-yo.

At CAPPA Mind & Body, our stance is consistent:

• Most people don’t need these drugs; they need precision coaching and discipline built into habits.

• When medications are appropriate, we collaborate with your physician and confirm progress with follow-up testing.

• We protect muscle, metabolism, and long-term health—not just the next weigh-in.

What’s your biggest question about these medications—muscle loss, safety, or long-term planning?

Compliance note: This article is educational and not individual medical advice. GLP-1/GIP agents may help some adults with obesity and high cardiometabolic risk as part of a comprehensive, physician-supervised program. Outcomes vary. Discuss medication, nutrition, and exercise decisions with your physician; choices should reflect your history, labs, and goals.

If you found this Valuable, I’d truly appreciate your feedback. I invested significant time reviewing primary studies and real-world data to make this as clear and useful as possible. Tell me what helped most, what you’d like clarified, and which topics you want me to tackle next. If you want more articles at this level of depth and quality, let me know in the comments—or message me directly—and I’ll prioritize them in upcoming editions.

References & Key Resources

• Weight regain after stopping semaglutide (STEP extension): ~⅔ regained in 1 year; cardiometabolic drift toward baseline. PubMed+1

• SURMOUNT-1 (tirzepatide 72 wks, non-diabetic): ~15–21% loss. New England Journal of Medicine+1

• SELECT (semaglutide 2.4 mg): reduced MACE in overweight/obese adults with established CVD and no diabetes. New England Journal of Medicine+2PubMed+2

• Lean-mass change with GLP-1 RAs: DEXA-based analyses; substantial lean-mass share of total loss without countermeasures. Wiley Online Library+1

• Gallbladder/biliary risk (meta-analyses): increased relative risk with higher doses/longer duration. PubMed+1

• Label update—ileus added (semaglutide): review current labeling and safety communications. FDA Access Data

• Peri-operative multi-society guidance: most patients can continue GLP-1s pre-procedure with individualized assessment. ASA+1

• Real-world persistence/adherence: low 1-year persistence and very low 3-year persistence; evolving 12-month trends. PMC+2PR Newswire+2

• https://doi.org/10.3390/gastroent15010014