Ozempic, Mounjaro and the Truth About Weight Loss

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Ozempic, Mounjaro, and the Truth About Weight Loss

Fasting vs Weight Loss Medications – Which Works Best

You’ve seen the headlines. You’ve heard the chatter. Maybe you’ve even spotted that friend or coworker who suddenly dropped 20 pounds and casually mentioned they’re on Ozempic. Or Mounjaro. Or that new “miracle shot.”

But behind the weight loss glow-ups and viral TikToks, what’s really going on? Are these medications a breakthrough in fighting obesity—or just the latest hype? And how does something as ancient and natural as fasting compare? Which path leads to sustainable weight loss that doesn’t rebound the moment the prescription runs out?

Dr. Dean Mitchell recently sat down with endocrinologist Dr. Philip Rabito for a brutally honest conversation on The Smartest Doctor in the Room podcast. Let’s dive into what they had to say, and unpack the science, strategies, and straight-up truths behind this new wave of weight management.

Discover what these popular drugs actually do, who should consider taking them, and the key to sustainable, healthy weight loss.

Dr. Rabito shares:

• Why fasting works better than calorie counting

• How GLP-1 medications like Ozempic and Mounjaro suppress appetite

• Hidden dangers (like gastroparesis and gallstones)

• How to avoid gaining the weight back

• When surgery is still necessary—and when it’s not!

You’ll walk away with a practical, science-backed plan for losing weight and feeling better—for life.

The Rise of GLP-1 Medications: Powerful or Problematic?

Originally developed for managing type 2 diabetes, Ozempic (semaglutide) and Mounjaro (tirzepatide) – drugs known as GLP-1 agonists – gained traction for their unintended “side effect” – significant weight loss.

“These medications,” Dr. Rabito explains, “suppress appetite by working on the hunger centers in the brain. Patients don’t feel as hungry. Some of them go 10 hours without even thinking about food.”

In fact, one of the things individuals on these medications love the most is that it quiets “food noise” or the persistent and intrusive thoughts about food which often leads to constant thoughts or preoccupation with eating. While not a clinical diagnosis, it describes a feeling of continuous hunger or a strong preoccupation with what, when, and how much to eat. “Food noise can make you feel like you’re hungry all the time. And if you don’t feel full, you end up eating much larger meals,” notes Dr. Reena Bose, MD. For individuals suffering from food noise, it can be hard to lose weight because of these thoughts. Using medicatiosn such as Ozempic or Mounjaro can help curb these thoughts and make it easier to lose weight.

It’s part of what makes these different than your grandma’s diet pills. GLP-1s have a different mechanism.

They regulate insulin, slow gastric emptying, and reduce cravings. Harvard Health Publishing breaks down how this class of medication helps you eat less and feel full longer.

Sounds ideal, right? But, like any pharmaceutical solution, there’s a catch—or a few.

Dr. Rabito warns: “Patients need to be prepared for side effects. Nausea, reflux, sometimes constipation or diarrhea… and we’ve seen cases of severe gastroparesis when the medications are not managed properly.”

More concerning? These drugs can cost upwards of $1,000 a month without insurance. And once you stop taking them? Weight often creeps back. Currently, many people are finding more affordable options with compounded versions of the medications, but with lawsuits recently filed by pharmaceutical companies like Eli Lilly, who knows how long the more affordable compounded versions will be available.

“If you haven’t changed your habits,” he says, “you’ll just gain the weight back.”

Fasting: Free, Ancient, and Surprisingly Effective

If a thousand bucks a month feels… excessive, you’re not alone. That’s why so many people are revisiting something humans have practiced for millennia: fasting. Instead of being about what to eat, fasting focuses on when to eat.

“Two 24-hour fasts a week,” says Dr. Rabito, “can be just as powerful—if not more so—than medication. It’s not just about eating less, it’s about giving your body a hormonal reset.”

What does he mean by that?

During extended fasting, insulin levels drop, which helps unlock stored fat for energy. Without insulin circulating, the body shifts from storing fat to burning it. That metabolic switch is a game-changer. Intermittent fasting improves metabolic flexibility, insulin sensitivity, and cellular repair. It also produces additional benefits such as a longer life, a leaner body, and a sharper mind.

According to Johns Hopkins neuroscientist Mark Mattson, “our bodies have evolved to be able to go without food for many hours, or even several days or longer. In prehistoric times, before humans learned to farm, they were hunters and gatherers who evolved to survive — and thrive — for long periods without eating. They had to: It took a lot of time and energy to hunt game and gather nuts and berries.”

The best part? It’s free.

But is it easy? Not necessarily. “At first,” Dr. Rabito admits, “patients feel like they’re chewing their own arms. But after a few weeks, the body adapts. Hunger lessens. Energy goes up.”

He’s also quick to note that fasting isn’t a crash diet. It’s a structured lifestyle. And unlike calorie-counting or obsessive food logging, it doesn’t demand constant micromanagement.

“I’m not a fan of counting calories. Study after study shows it doesn’t work long term. People get exhausted,” he said.

When you adapt your lifestyle around intermittent fasting, you don’t have to count calories or carbs. You simply don’t eat during certain hours or certain days. It’s still preferable to select healthy foods for your non-fasting periods so you don’t undermine the benefits of your fast.

So, Which Works Best?

That depends on what you mean by works.

GLP-1s can accelerate initial weight loss, especially for individuals with obesity-related health risks. But without a long-term plan, the weight will likely return when the medications are stopped. They’re powerful tools – but not standalone solutions.

“None of my patients go on medication without a plan. You have to have skin in the game,” Dr. Rabito insists. “You have to be willing to change how you eat, how you move, how you live.”

Fasting, on the other hand, demands discipline but teaches the body to regulate itself. It cultivates metabolic resilience—a concept that Cleveland Clinic has highlighted as essential to long-term wellness.

Where fasting shines is in sustainability. Once your body adapts, it becomes easier to maintain. And there’s something powerful about relying on your biology rather than a pharmacy.

Dr. Rabito adds, “This is not about perfection. My patients eat pizza and drink wine. I tell them—life is short. Just don’t do it every day.”

The Real Enemy: Lack of Structure

Whether you fast, medicate, or mix both approaches, one thing is clear: structure is everything.

“We’ve known for years that structure beats willpower. It’s why Weight Watchers, despite its flaws, helped so many people—it gave them a system,” Dr. Rabito points out.

He prefers longer fasts over points systems or low-carb-only diets. “Counting macros, weighing food—it’s exhausting. Most people can’t do it forever. Fasting simplifies things.”

Still, he doesn’t push one-size-fits-all plans. “If fasting isn’t for you, fine. But pick something. Find a lifestyle you can actually live with.”

And that’s where a coach—or a great doctor—comes in.

“The most important thing?” he says, “Find someone who can be your advocate. Your partner. Someone who checks in, who holds you accountable.”

So… What Should You Do?

Start with your why. Do you want to lose 10 vanity pounds? Or reverse prediabetes, sleep better, and feel confident again? Your goals should guide your methods.

If you’re struggling with obesity or metabolic issues, medications, such as Ozempic or Mounjaro, might help kickstart the journey. But don’t mistake the shot for a solution. Pair it with structure. Support. Self-honesty.

If you’re ready to rely on biology instead of Big Pharma, structured fasting could be your path. It’s natural, inexpensive, and when done right—shockingly effective.

Whatever you choose, know this: long-term weight loss isn’t about punishment. It’s about empowerment. It’s not about being perfect. It’s about being consistent.

And as Dr. Rabito said best: “Just don’t eat broken glass. Everything else? We can work with.”

Don’t forget to check out podcast episode 14: The Benefits of Time-Restricted Eating with Dr. Mark Mattson, a leading neuroscientist.

About the Author – Dr. Dean Mitchell, M.D.

Dr. Dean Mitchell M.D. is a Board-Certified Immunologist and Allergist based out of NYC. He graduated from the Sackler School of Medicine and completed training at the Robert Cooke Allergy Institute in New York City. He is also a Professor of Clinical Immunology at Touro College of Osteopathic Medicine, a fellow of the American Academy of Allergy, Asthma, and Immunology, and the author of Allergy and Asthma Solution: The Ultimate Program for Reversing Your Symptoms One Drop at a Time. Dr. Dean Mitchell, M.D. has also been featured in The New York Times, The Huffington Post, Fitness Magazine, Dr. Oz, and News NY 1. Dr. Mitchell also hosts the podcast The Smartest Doctor in the Room – a combination of lively, personal, and in-depth interviews with top healthcare specialists.