Is Zepbound (tirzepatide) 2.5 milligrams ineffective in suppressing appetite for weight loss: what are the next recommendations?

From the Guidelines

If Zepbound 2.5 mg is not suppressing your appetite effectively for weight loss, the next recommendation would be to continue with the standard dose escalation protocol, as most patients require higher doses (10-15 mg) to achieve significant appetite suppression and weight loss results 1. When considering the next steps for weight loss, it's essential to prioritize morbidity, mortality, and quality of life as the primary outcomes. The current evidence suggests that dose escalation of Zepbound is a viable option, but it's crucial to weigh the potential benefits against the risks of medications 1. Some key points to consider when evaluating the effectiveness of Zepbound 2.5 mg for weight loss include:

• The medication's mechanism of action, which involves slowing gastric emptying and acting on brain receptors that control hunger and satiety 1
• The importance of individualized dosing, as patients may respond differently to the medication based on genetics, metabolism, and other factors 1
• The need to maintain a calorie deficit through portion control, increasing protein intake to 25-30% of calories, staying hydrated, and incorporating regular physical activity while waiting for medication adjustments 1
• The potential benefits and risks of alternative medications, such as Wegovy (semaglutide), Saxenda (liraglutide), or combination approaches, if dose escalation is not effective 1 It's also important to note that the 2.5 mg starting dose of Zepbound is primarily intended to minimize gastrointestinal side effects rather than provide maximum weight loss benefits 1. Therefore, dose escalation to 10-15 mg weekly may be necessary to achieve significant appetite suppression and weight loss results. If dose escalation doesn't help after reaching 10-15 mg for several weeks, discussing alternative treatment approaches with a healthcare provider is recommended 1.

From the Research

Next Recommendations for Weight Loss

If Zepbound 2.5 mg is not suppressing appetite, the following options can be considered:

• Consult a healthcare professional to discuss alternative treatment options, such as adjusting the dosage or switching to a different medication 2
• Consider a multidisciplinary approach to weight loss, including dietary strategy, physical activity, and behavioral modification 2
• Explore other FDA-approved anti-obesity medications, such as phentermine, orlistat, phentermine/topiramate ER, naltrexone SR/bupropion SR, liraglutide 3.0 mg, semaglutide 2.4 mg, and tirzepatide 2

Comparison of Semaglutide and Tirzepatide

Studies have compared the efficacy and safety of semaglutide and tirzepatide for weight loss:

• Tirzepatide has been shown to be superior to semaglutide in reducing body weight and waist circumference in adults with obesity but without type 2 diabetes 3
• Tirzepatide has also been shown to be noninferior and superior to semaglutide in reducing glycated hemoglobin levels in patients with type 2 diabetes 4
• However, the cost-effectiveness of tirzepatide and semaglutide is a concern, with high costs and uncertain value for money 5, 6

Cost-Effectiveness Considerations

The cost-effectiveness of anti-obesity medications, including semaglutide and tirzepatide, is an important consideration:

• The cost of these medications can be high, with estimated costs of $1845 and $985 per 1% weight loss for semaglutide and tirzepatide, respectively 6
• The annual Medicare costs for treating obesity with semaglutide could exceed $2.6 billion, $13.3 billion, and $26.8 billion for 1%, 5%, and 10% of the population, respectively 6
• However, the cost-benefit ratio of these medications may ultimately be favorable, considering the potential health benefits and cost savings from reduced obesity-related complications 6