Dear Dr. E,
I’m doing really well following your recommendation to try Ozempic. Lost some weight, cut my insulin in half, staying 98% time in range, and sporting an A1c of about 6.4. But I’d still like to lose that old diabetic man’s belly, maybe another 10 pounds. I’m doing fine, but could I do better and lose some more weight on the new Lilly drug Mounjaro?
Dr. Edelman: Thank you very much for that excellent question. People with type 2 diabetes – both men and women – have a typical body habitus of a “beer belly”, and it has very specific physiologic meanings. What’s causing the stomach to protrude is not subcutaneous fat, which is the type of fat you can pinch between your fingers, but it’s a certain type of fat below the stomach muscle (rectus sheath) that separates your body organs (i.e. intestines, pancreas, liver) from the subcutaneous fat above. This intra-abdominal fat, also called visceral fat, is very different than subcutaneous fat. It’s yellow and oily and associated with several serious conditions such as type 2 diabetes, cardiovascular disease, fatty liver, hypertension, abnormal cholesterol levels, etc.
This special type of intra-abdominal fat is almost impossible to lose and it does not come off with weight loss, which is why people with T2D who lose weight on drugs like Ozempic and Mounjaro reduce their subcutaneous fat. Their arms and legs look pretty darn good, but it’s just that protuberate abdomen that bothers a lot of people like yourself.
The best thing to do is to get down to the best body weight that you can, and try not to worry too much about the protuberant abdomen, which most likely will not get better over time. Stay healthy and do all the things you need to do to protect your heart and your kidneys, and you will do fine. And use the upper part of your belly to store your six-pack when you go to a party!
Additional Resources:
Ozempic: What Is It and How to Use It
Say “Buongiorno” to Mounjaro, a New Blockbuster Diabetes Medication
New Blockbuster Type 2 Medication Mounjaro Gets FDA Approval
Concerned about Needles? Try the Simplicity of Once-Weekly Trulicity
I have been on Mounjaro for one month and now there is none available.
Is there anything I can do about this?
The best thing to do is to call around to different pharmacies to see if any of them have it, and even pharmacies that are mail order. Unfortunately you’re not the only one in this situation. Ozempic is low as well as Mounjaro…they’re both very popular medications.
Wegovy is also out. Has been for many months, and they keep moving back the date of availability. They say that when it returns, it will be available first only for those who were on it when it ran out, and not for new patients. Latest info is that it will be back by the end of the year. Well, it IS the end of the year now (December), but they mean literally the end of December (which probably means early 2023).
It’s best to call other Pharmacies,even different locations.
It’s best to call other Pharmacies,even different locations. Remember the grocery stores pharmacies too.
I just wanted to point out that this article is incorrect. Both Mounjaro *have* been shown to decrease visceral fat.
Hello…my impression from the studies was that it was primarily subcutaneous fat? Would love to see the data/paper on that. Can you send please to steve@tcoyd.org.
I would really like to hear more about this if in fact it does help shrink the ‘apron’ of fat in the belly. That’s the area l am on Ozempic for in the 1st place.
SAME my body has reacted as the article described but I still have an apron and belly. How can we get rid of it ?
Intra-abdominal fat, or visceral fat, is deep in your stomach and harder to lose. It’s very frustrating, and we feel your pain!
See beyondtype1.org.
Study showed a 37% decrease in visceral fat. Even more than subcutaneous fat (24% if I remember correctly).
Zuzana, that data seems correct. You lose both belly fat and intra-abdominal or visceral fat as well.
I just stared back on Mounjaro,stop due to constipation,but didn’t tolerate Ozempic well,so 3rd week with Mounjaro,so far no constipation.
That’s great! 🤞
I’m so confused. First Dr. Edelman stated: This special type of intra-abdominal fat (visceral fat) is almost impossible to lose and it does not come off with weight loss. Then he agrees with Zuzana’s data that you lose both belly fat and intra-abdominal or visceral fat as well.
I was under the impression that visceral fat is tough to lose, but I appreciate the reference information that was sent, and it looks like you can lose both.
For many people what the article said is correct. Lost about 70 LBs with ozempic. Arms and legs are showing muscle and some viens nows. Lower belly went down about 6 inches. However Upper belly has almost no change at all.
Belly fat is really a lay term for what we call intra-abdominal fat or visceral fat, which is the fat tissue under the stomach muscle that is around the different organs like the pancreas, liver, and small intestine. Typically that type of fat does not go down with weight loss with Ozempic (or other types of weight loss). What you lost was subcutaneous fat, and good for you! I would not worry about that, and just do as much cardio and weight lifting as you can that’s appropriate for you.