Weight loss medications have been shown to be effective in losing weight and maintaining weight loss to prevent weight gain. This in turn can help to reduce the effects of excess weight on your metabolic health.

Each medication works in a different way.

Saxenda: increases fullness, reduced hunger, reduces gastric emptying
Contrave: increases fullness, reduced hunger, reduces cravings
Wegovy: increases fullness, reduced hunger, reduces cravings
Mounjaro: increases fullness, reduced hunger, reduces cravings

Contrave, Wegovy and Mounjaro all work to increase the feeling of fullness, reduce hunger, and reduce cravings; some may also slow gastric emptying. This means the stomach will slowly empty so that you feel the sensation of fullness longer by means of the stomach physically being fuller for a longer period of time. This can be interesting for people who feel that they need the physical feeling of being fuller for longer in addition to appetite control. 

People with a BMI above 30 kg/m2 or between 27 kg/m2 to 29.9 kg/m2 and with health problems related to their weight are eligible to be considered for weight loss medications. 

All medications are to be avoided in women who are pregnant, attempting conception, and breastfeeding. 

Saxenda, Wegovy, and Mounjaro are to be avoided if you have a personal or family history of medullary thyroid cancer or a personal history of MEN2 syndrome. 

Contrave is to be avoided if you have uncontrolled hypertension (high blood pressure), using opiods, history of or risk of seizures, if you are abusing alcohol, if you are currently taking medications classified as MAO inhibitors, if you save severe liver impairment, and if you have end-stage kidney failure. 

The weight loss documented in the literature to achieve optimal success is always combined with medical nutrition therapy, exercise, and/or behavioral modifications. A healthy diet can be tailored for you with the help of a registered dietitian and behavioral modifications from a psychologist can further optimize outcomes.

The average weight loss is difficult to put into numbers because every individual has a different height, weight, and BMI in addition to countless other factors. However, the evidence presents the following expected weight loss outcomes as a percentage of body weight loss. 

Saxenda: 8.6% vs 2.6% with placebo

Contrave: 6.1% vs 1.3% with placebo

Wegovy: 14.9% vs 2.4% with placebo

Mounjaro: 5 kg at 12 weeks vs 0.5 kg with placebo

From these outcomes we can see that Wegovy appears to result in more weight loss than Saxenda. However, weight outcomes vary from person to person; if a friend claims to have lost 25 lbs on one medication, there is no guarantee that you will lose the same amount of weight. Expectations should be tempered as a percentage of your total body weight. 

Saxenda: Injection, 1x/day

Contrave: Pills, 4x/day

Wegovy: Injection, 1x/week 

Mounjaro: Injection 1x/week

Some people may not want to be injecting themselves at all, or perhaps only willing to do so once per week. The form of the medication may affect your choice based on your preference.

Saxenda: Nausea, constipation, diarrhea, vomiting

Contrave: Nausea, constipation, headache, dry mouth, dizziness, diarrhea

Wegovy: Nausea, diarrhea, constipation, vomiting 

Mounjaro: Nausea, constipation, diarrhea, vomiting

Common side effects are classified as occurring in as much as 10% of people. 

Side effects can vary from person to person. One person may experience mild forms of these side effects, while others choose to stop the medication altogether due to experiencing a severe form of the same side effects. The most common reason for stopping these medications is due to the side effects. Some of these side effects can be managed with some modifications to your dietary habits. A dietitian can help personalize some of the adjustments for you to improve your comfort. 

Weight loss medications are currently not covered by most public healthcare in Canada. In some cases, there are private insurance companies who may cover some of these medications. It’s important to verify with your private insurance if there are any of these medications that will be covered to help guide your choices with your doctor. 

Assuming that you do not have private insurance that would cover these medications, the following is the monthly expense that you can anticipate:

Saxenda:  ~ $350 CAD / month

Contrave: ~ $90 CAD / month

Wegovy: ~ $400 CAD / month 

Mounjaro: ~ $400 CAD / month

Making a decision about weight loss medication is one that should be had alongside your prescribing doctor. Trying a medication that a friend tried may not be the best medication for you. 

Dr. Chow has been prescribing weight loss medication to consulting patients. As a bariatric surgeon he prescribes weight loss medications where indicated to previous patients, new patients, and patients having had bariatric surgery, or who are not yet ready or interested in surgery at this time. The door is open for those looking to have a personalized consultation in choosing the right weight loss medication for them to lose weight and most importantly improve their health in the process.