Investors and the weight-loss drugs; This Drug Could Be the Next Ozempic. Bootlegs Are Already Selling Online; Beware of knockoff weight-loss drugs

Investors are finally catching on to a story I first wrote about more than 13 months ago:

I've recently become aware of three new weight-loss drugs, which appear to be nothing short of miraculous, especially Mounjaro (tirzepatide), which seems to have fewer side effects (mostly gassiness) and results in the greatest weight loss.

I know many people on these drugs and they're all thrilled with them, having lost large amounts of weight with few side effects...

With sales of these GLP-1 drugs skyrocketing, investors are trying to identify the companies (and stocks) that will be the winners and the losers – and it's really moving stock prices this year, as this chart from a friend's presentation shows:

Here are two Business Insider articles on this topic: The disruptive effect of weight loss drugs like Ozempic could have surprising impacts on the stock market. Here are potential winners and losers and Wall Street just revealed a surprising new potential winner and loser of the Ozempic craze.

In June I created a personal e-mail list to follow developments in this sector that's open to anyone, both to inform – but also learn from – my family, friends, and readers. (If you'd like to be added to it, simply send a blank e-mail to: weightlossdrugs-subscribe@mailer.kasecapital.com, and I've created a PDF of all of the e-mails I've sent and posted it here.)

Here is the most recent e-mail I sent on Saturday – investors might want to pay special attention to my friends' comment in item No. 3...

1) This exclusive story in the Wall Street Journal highlights that a drug Eli Lilly (LLY) has under development, retatrutide, which results in even greater weight loss than Mounjaro, is available right now for a fraction of the cost. I think this will literally be a life-saver for millions of people: This Drug Could Be the Next Ozempic. Bootlegs Are Already Selling Online. Excerpt:

A potential blockbuster weight-loss drug still years away from U.S. regulatory approval is already being sold online, another example of a thriving gray market for unapproved weight-loss medications, according to a Wall Street Journal review.

The Journal found hundreds of merchants offering the new drug, which is being developed by Eli Lilly and is called retatrutide. Most appear to be Chinese sellers shipping directly to U.S. consumers from sites such as Made-in-China.com. Some of the sites, including ones that appear to be based in the U.S., have marketed their products via posts on Facebook, LinkedIn, and Reddit. A handful have run paid ads on Instagram and Google. A fitness influencer has offered it for sale via his newsletter.

In August, the Journal reported that more than 50 websites were selling knockoff semaglutide and tirzepatide, the active ingredients in Ozempic and Mounjaro respectively. The Food and Drug Administration issued warning letters to two websites for "unlawful sale of unapproved and misbranded drugs" after the Journal's article. One, GorillaHealing.com, no longer lists those two drugs on its website, but does offer retatrutide. Last week, three days after the warning letter was posted publicly, the top result in a Google search for "buy retatrutide" was a GorillaHealing.com ad.

If anyone knows of a safe and inexpensive way to get retatrutide, please let me know and I'll pass the info along.

That said, here's a cautionary story from the Washington Post: Beware of knockoff weight-loss drugs. Excerpt:

Americans are so desperate to get their hands on popular weight-loss drugs such as Ozempic and Wegovy that many are turning to knockoff versions. Doing so could come with real harm.

The desire for these drugs, which are remarkably effective at treating diabetes and obesity, has been nothing short of explosive. During the last three months of 2022, health-care providers wrote more than 9 million prescriptions for them, a whopping 300 percent increase from early 2020. Demand for these medications is so high that the Food and Drug Administration placed them on its drug shortage list.

The popularity of the drugs, combined with uneven insurance coverage, has given rise to a cottage industry of online retailers and medical spas that purport to provide "generic Ozempic" at discounted prices. Some require only a cursory medical consultation. Others forgo it altogether.

Consumers should be extremely wary.

2) Here's a Forbes article about it: What To Know About Retatrutide: Unapproved Drug Boasts Greater Weight Loss Than Ozempic, Mounjaro, Wegovy. Excerpt:

A new weight loss drug from Eli Lilly has shown promising results, with participants in a new study averaging a loss of 24% of their body weight, the highest weight loss percentage from any drug in its class.

Eli Lilly, the manufacturer of Mounjaro, published results from two separate studies on Monday showing promising signs for a new injectable weight loss drug.

The drug, called retatrutide, helped patients lose an average of 24% of their body weight over the course of 48 weeks on the highest dosage, according to a mid-stage study published in the New England Journal of Medicine.

Participants lost an average of 58 pounds over the course of 11 months – every participant on the highest dose lost at least 5% and a quarter lost 30% or more of their weight.

In the second study published in the Lancet, researchers found retatrutide not only saw significant weight reductions in people with type 2 diabetes, but it made improvements in glycemic control as well.

Participants lost an average of 17% of their body weight in nine months, which is remarkable as it's typically more difficult for type 2 diabetics to lose weight compared to others with obesity or who are overweight.

The drug's side effects are similar to other medications in its class – like Ozempic, Mounjaro, and Wegovy – which are mostly gastrointestinal and include mild to moderate nausea, constipation, vomiting and diarrhea.

3) I e-mailed four friends (all men) who are on Mounjaro the following questions:

I'm curious how your diet has changed since you've been on Mounjaro. I understand that you're eating less, but has the mix changed? I've been hearing stories about how people on these drugs feel like they have a license to eat anything they want, so they actually eat MORE crap food... Is there any type of food you eat a lot more of? Less of? What about alcohol? Soft drinks?

I'm trying to think of the investment implications. If tens of millions of Americans start taking these drugs, is that good or bad for gyms? Good for dating sites and bad for makers of artificial hips and knees, I assume?

Here were their replies...

Friend 1

Definitely causes you to eat less. I seemed to fizzle out on meals much quicker and my wife says I also ate a lot slower. Another thing I noticed is that diet soda became unappealing to me. In the past, I would drink one or two diet sodas a day. On Mounjaro, I noticed I had little interest in having them or could barely finish one in a day.

My wife and I don't drink a lot of alcohol these days as we are doing IVF. I did notice that I would get really sick on alcohol if I had more than a drink or two. This almost made me scared to drink... which isn't necessarily a bad thing I guess.

As far as its impact on gyms, I would assume average gym-goers might not feel as compelled to use the gym for "aesthetics". Most people who are serious about diet and exercise know caloric-restriction is only part of the equation to being in shape. I imagine not ALL the weight lost by Mounjaro is fat and that some lean mass is lost too (especially in the absence of strength training). And yes, I agree that it would likely be great for dating sites and probably less so for medical sales.

I have been off of Mounjaro for three weeks now as I figure out if it is financially sound going forward. Have gained a few pounds back but haven't had any wild food binges or "rebound side effects". If I can figure out how to get it cheaper and fit it back into my budget, I would love to get back on it and continue my weight loss efforts. Still have a little ways to go! Thanks for flying us into this miracle drug. Sure did make it easy to lose weight while it was affordable!

Friend 2

I unfortunately have not stayed on the medications regularly. I started gaining back weight and found that the initial results didn't seem to sustain.

I gained back about half the weight I lost – I am discussing options with my doctor.

I mostly just ate less when I was on them, not so much different foods.

Friend 3

My eating has improved because I crave sweets less. I bet this is highly variable based on personality and biology.

There is definitely a group of people who take these drugs, don't exercise, and eat poorly. But there's also a group that gets motivated by the positive results, and eats better and exercises more, unfortunately I do not have a sense as to the size of each group.

Friend 4

This is a super interesting question. Keep in mind I wasn't a junk food eater but I viewed my ability to go on these drugs a blessing so I want to make sure my diet became super clean. I was a big eater though. Big portions of healthy food are still too many kcals. I am really happy that I paid super close attention to my diet because I wouldn't have the same amount of success and confidence to know that I could keep off the weight. I also learned so much from Rich and Betty over the years at FiteMeHealth that I had the knowledge and tools to be successful.

In short, I eat now like some who had bariatric surgery. I eat smaller portions and make sure I get lots of protein to maintain/build muscle and have a lot of nurturing dense food. It has been a continual learning process for me.

So to dive in...

What doesn't work:

• Food that is too rich or greasy; very much upsets my stomach. This could be a tuna salad made with too much mayo, something that has too much butter (like I ordered an avocado toast and the place butters the bread – it was greasy, I couldn't eat it) or the thought of eating something like a foie gras just makes my stomach churn now. OK. I don't eat that with any regularity but the thought of something that rich is unappealing now. 

• Too much sugar; I have found that some sugar is OK – especially natural and with fiber (dates especially), but the drug is a diabetes drug and is meant to help regulate blood sugar. I have found if I had a full desert (bowl of ice cream, slice of cake) it is too much. I don't feel well/right. A taste is sufficient (small amounts).

I was at a benefit on Monday, they served a molten chocolate cake for dessert. That would fall into the too rich and too much sugar. It had 4 raspberries and like a Tbs of whipped cream. I ate the raspberries and whipped cream. It gave me some sweetness and was the right amount that I felt fine.

• Red meat – anything that can take a long time to digest is hard on my stomach now. I have always found red meat harder to digest then other animal protein. That is really the case now. The drug causes our stomach to empty slower, so stuff that is hard to digest and sits in my stomach longer doesn't work for me. Other protein; poultry, fish, tofu are all fine.
• Too much fiber – I know this is an issue for very few people, but if I am say at 50+ grams of fiber in a day, that can also be hard on my GI system. This is a real balance for me and has taken me time to figure out as the drug can either constipate or cause diarrhea so I need fiber, but too much is hard on my stomach. In this regard, I don't eat broccoli like I used to because I have found it harder to digest. Fear not, I have switched to eating more spinach (more on that below).

• Larger meals – the drugs do make you eat less, but larger meals, if you are not mindful make you feel too full for too long and uncomfortably so. Given many people's largest meal is at dinner, I have found it can impact my sleep if I ate too much for me on the drug too late. 

• I know is this a me-ism, but too many/types of probiotics as messed with me – like many things overall keeping it simple is better. So I do yogurt (Siggi's or Fage 0%) and Kim Chi. I had added in other fermented food (sauerkraut/cabbage/fermented carrots and ginger), Kefir, etc. and it messed with my stomach. That may not even be because of the drug. So I have gone back to work I know works for me; yogurt and (not together 😊)

What does work:

• Smaller meals throughout the day; say every 3-4 hours. Even if I break up an ordinary lunch into 2 meals say at 12 and 3pm that works. I know this can vary widely based on what people actually eat, but I have found 400-500 Kcal meals for me to be a sweet spot. When I cross into 600+ kcal meals they are either too large are take too long to digest. Snacks 200-300 kcals. I was eating on average 1600 kcals a day on Mounjaro while losing. My RMR was 2350 or so (I was also exercising a lot – still am). So that was 3 meals and snack in the afternoon.

We are now ramping down my dose and I am eating closer to 2200-2500kcals by focusing on high nutrient and kcal foods, but still low volume (nuts, salmon, maybe 1.5T of olive oil instead of 1T in dressing to up my kcals to maintain but not increase volume, add an Rx bar in around 10:30am, mixing in fun ingredients like 1T of cacao powder and 2t of collegian protein into my morning latte)

• High Nutrient foods that can be smaller in volume. This is where the spinach comes in. I can steam 5oz of spinach down into a small volume. So I can get a lot of nutrients in a small amount of volume b/c I fill up fast now.
• High calorie foods that are smaller volume; nuts and nut butters.
• Smaller prepacked protein – cans of tuna, salmon or sardines (all low sodium – of course). I have found brands that are smaller portion size (King Oscar Skinless boneless, in water, no salt Sardines – 4.23 oz, Safe Catch Pacific Pink Salmon Skinless and no salt – 5oz, Vital Choice, Solid White Albacore in water, no salt added – 3.75oz). These are all approved brands on Consumer Labs. High protein, low mercury and just the right amount of protein.
• Protein bars; but for me – really Rx bars. I know the ingredients. They are the right volume and aren't sugary or too rich. I use these A LOT.
• Shakes! Blending down ingredients has made them easier to digest. Plus helps with a volume. I make both fruit based and veggie based shakes depending on what I am in the mood for. Dates come in handy for me here too as they add sweetness to the shakes
• Seeds; adding in either chia, flax or hemp seeds to meals to get protein and fiber with minimal volume
• Beans – fiber and protein and for me easy to digest, but need to be careful that I don't overdo it on fiber here so I try and limit beans to no more than ½ cup a day.
• More lacto-ovo vegetarian based diet – eggs, yogurt, beans, kefir, plant based milk . tofu all easier to digest than animal protein (I find chicken and fish OK – but I eat more vegetarian than I used too). So breakfast could be a some oatmeal, berries and 2 hard boiled eggs or 1 hard boiled egg and egg whites
• Last and certainly not least – critical to stay hydrated; water and unsweetened iced tea for me. I still drink seltzer but the bubbles can also make me feel very full on the drug.

This is what I have so far; off the top of my head. Really happy to discuss this with you. You know I love this stuff and I record everything I eat so I can retrace my journey with you... plus I am still on the journey.

As to your direct questions...

While lower weight would mean less knee/hip replacements – more exercise may mean other injuries. But if you also focus on more lower impact exercise I could see an increase in say walking shoes or brands like Hoka.

I could see a rise in smaller portion bags even for junk.

One less talked about side effect is I have lost a taste for alcohol. Just no longer appeals to me. So could see that hurting consumption. I stopped consuming artificial sweeteners many, many years ago – so no soft drinks here (have Betty talk to you about that – it's really fascinating)

In speaking with my personal trainer today; she has other clients on Ozempic and Mounjaro.

Agrees about dating sites, also people will want to travel more – people feel good and are looking good. They will be interested and able to travel (better for airlines if less weight re fuel). Clothing industry should be a boon as people will not only need but want new clothes, but especially maybe bathing suits and/or lingerie.

Also, while knee & hip replacement may go down, I think cosmetic surgery especially excess skin removal will go up. That is not covered by insurance, I believe.

Occurred to me this morning; what I do see a big market for is prepacked meals/protein bars/shakes etc. Lots of people when they go on these meds are not hungry at all. Literally do not eat. So they are losing weight and muscle mass, but it is also really unhealthy for them as they aren't getting their daily nutrients. So I see a big market for someone/company who can come out with a range of good tasting portable Meals for those on Mounjaro that are hitting daily requirements. Small, fiber, protein, easy to digest, vitamins, etc. This way if you aren't really hungry you could say have something the size of protein bar that gives you the nutrients your body actually needs. To function properly.

Thank you, my friends!

Best regards,

Whitney

P.S. I welcome your feedback at WTDfeedback@empirefinancialresearch.com.