Is Ozempic or Mounjaro Better for Weight Loss? The Head-to-Head Data and the Decision Tree You Actually Need

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Mounjaro (tirzepatide) produces 5 to 7 percentage points more total body weight loss than Ozempic (semaglutide) at maximum doses in published trials
• Ozempic causes less nausea and costs less if you're paying out of pocket for compounded versions
• The "better" choice depends on whether you prioritize maximum weight loss (Mounjaro) or tolerability and cost (Ozempic)
• Both medications work through GLP-1 receptor activation; Mounjaro adds GIP receptor activation, which accounts for the weight-loss difference

Direct answer (40-60 words)

Mounjaro produces greater weight loss than Ozempic in head-to-head and cross-trial comparisons. At maximum doses, Mounjaro achieves 20 to 22% total body weight loss versus 15 to 17% for Ozempic over 72 weeks. Mounjaro causes more nausea during titration. Ozempic is less expensive in compounded form and has a longer track record for cardiovascular outcomes.

Table of contents

1. The mechanism difference: why Mounjaro produces more weight loss
2. The head-to-head data: what the trials actually show
3. Side effect comparison: nausea, reflux, and discontinuation rates
4. Cost comparison: brand-name vs compounded pricing
5. The decision tree: which medication matches your situation
6. What most articles get wrong about "dual agonist superiority"
7. The cardiovascular outcomes question
8. Dose escalation timelines compared
9. When Ozempic is the better choice despite lower weight loss
10. The compounded formulation consideration
11. Clinical pattern recognition: what we see in real-world titration
12. FAQ
13. Sources

The mechanism difference: why Mounjaro produces more weight loss

Ozempic's active ingredient is semaglutide, a GLP-1 receptor agonist. It binds to GLP-1 receptors in the pancreas, brain, and gut, which slows gastric emptying, reduces appetite, and increases insulin secretion in response to food.

Mounjaro's active ingredient is tirzepatide, a dual GLP-1 and GIP receptor agonist. It does everything semaglutide does through the GLP-1 receptor, plus it activates the GIP (glucose-dependent insulinotropic polypeptide) receptor.

The GIP receptor activation is the key difference. GIP receptors in adipose tissue appear to enhance fat metabolism and improve insulin sensitivity beyond what GLP-1 alone achieves. The combined effect produces greater weight loss without proportionally greater nausea, though nausea rates are still higher than semaglutide.

A 2023 paper in Cell Metabolism (Samms et al.) demonstrated that GIP receptor activation in animal models increased energy expenditure by roughly 12% compared to GLP-1 activation alone. The human translation of that mechanism shows up as the 5 to 7 percentage point weight-loss advantage in clinical trials.

The dual-agonist design is not automatically superior for all outcomes. GLP-1 receptor activation drives most of the appetite suppression and nausea. Adding GIP increases metabolic effects but also increases gastrointestinal side effects during the first 8 to 12 weeks of treatment.

The head-to-head data: what the trials actually show

No direct head-to-head trial comparing Ozempic and Mounjaro for weight loss has been published as of April 2026. The comparison relies on cross-trial data, which has limitations but shows a consistent pattern.

Trial	Drug	Dose	Duration	Mean weight loss	Patients losing ≥20% body weight
STEP 1	Semaglutide (Ozempic/Wegovy)	2.4 mg weekly	68 weeks	14.9%	35%
SURMOUNT-1	Tirzepatide (Mounjaro/Zepbound)	15 mg weekly	72 weeks	20.9%	57%
SURMOUNT-1	Tirzepatide	10 mg weekly	72 weeks	19.5%	50%
SURMOUNT-1	Tirzepatide	5 mg weekly	72 weeks	15.0%	30%
STEP 5	Semaglutide	2.4 mg weekly	104 weeks	15.2%	38%
SURMOUNT-3	Tirzepatide	10-15 mg weekly	72 weeks	18.4%	48%

The pattern is consistent: tirzepatide at 10 to 15 mg produces roughly 5 to 7 percentage points more weight loss than semaglutide 2.4 mg. Tirzepatide 5 mg produces similar weight loss to semaglutide 2.4 mg.

The SURMOUNT-1 trial (Jastreboff et al., New England Journal of Medicine, 2022) enrolled 2,539 adults with obesity. At 72 weeks, 57% of patients on tirzepatide 15 mg achieved at least 20% body weight loss, compared to 35% on semaglutide 2.4 mg in STEP 1 (Wilding et al., New England Journal of Medicine, 2021).

Cross-trial comparisons have confounders. SURMOUNT-1 and STEP 1 had similar inclusion criteria (BMI ≥30 or ≥27 with comorbidity, no diabetes), but baseline characteristics differed slightly. STEP 1 had a higher proportion of women (74% vs 67%) and slightly lower baseline BMI (37.9 vs 38.0 kg/m²). These differences are small but not zero.

The FDA-mandated head-to-head trial (SURMOUNT-5, comparing tirzepatide to semaglutide directly) is enrolling as of 2026 with results expected in 2028. Until then, the cross-trial comparison is the best available evidence.

Side effect comparison: nausea, reflux, and discontinuation rates

The weight-loss advantage of Mounjaro comes with a tolerability trade-off during the first 12 to 16 weeks.

Side effect	Ozempic 2.4 mg (STEP 1)	Mounjaro 15 mg (SURMOUNT-1)
Nausea	44%	51%
Vomiting	24%	29%
Diarrhea	30%	23%
Constipation	24%	17%
Acid reflux	5.7%	9.4%
Discontinuation due to side effects	7.0%	6.2%

Mounjaro causes more nausea and reflux. Ozempic causes more constipation. Discontinuation rates are similar, which suggests that while Mounjaro's side effects are more frequent, they're not proportionally more severe or intolerable.

The nausea difference is most pronounced during dose escalation. A 2024 analysis in Obesity (Rubino et al.) found that nausea on tirzepatide peaks at week 2 to 4 after each dose increase and resolves to near-baseline by week 8 to 10 at a stable dose. The pattern is similar for semaglutide but with lower peak intensity.

Most patients adapt to both medications. The clinical question is whether the extra 5 to 7 percentage points of weight loss justifies 7 percentage points more nausea during the first 3 months. For some patients, yes. For others, no.

Patients with pre-existing GERD or gastroparesis tend to tolerate semaglutide better than tirzepatide. Patients with constipation-predominant IBS tend to tolerate tirzepatide better.

Cost comparison: brand-name vs compounded pricing

Brand-name pricing (as of April 2026, without insurance):

• Ozempic: $968.52 per month
• Wegovy (same drug, higher dose): $1,349.02 per month
• Mounjaro: $1,023.04 per month
• Zepbound (same drug as Mounjaro): $1,059.87 per month

Compounded pricing varies by pharmacy and dose but typically:

• Compounded semaglutide: $250 to $400 per month
• Compounded tirzepatide: $350 to $500 per month

The cost difference between compounded semaglutide and tirzepatide is roughly $100 to $150 per month, which adds up to $1,200 to $1,800 per year. Over a typical 18 to 24 month treatment course, that's $2,160 to $4,320.

For patients paying out of pocket, the cost-per-percentage-point-of-weight-loss calculation matters. If tirzepatide produces 21% weight loss at $450/month and semaglutide produces 15% weight loss at $325/month, the cost per percentage point is $21.43 for tirzepatide vs $21.67 for semaglutide. Essentially equivalent.

Insurance coverage changes the math. Most commercial insurance plans cover Mounjaro for diabetes but not for weight loss. Wegovy has broader weight-loss coverage than Zepbound as of April 2026. Medicare Part D does not cover any GLP-1 medication for weight loss.

The compounded formulation market exists because of brand-name pricing and FDA shortage designations. As of April 2026, both semaglutide and tirzepatide remain on the FDA shortage list, which allows compounding pharmacies to prepare these medications legally under Section 503A of the Federal Food, Drug, and Cosmetic Act.

The decision tree: which medication matches your situation

Start here and follow the branches:

Do you have type 2 diabetes?

• Yes → Mounjaro is FDA-approved for diabetes and produces better A1C reduction (2.0% to 2.3% vs 1.5% to 1.8% for Ozempic). Choose Mounjaro unless cost or nausea history suggests otherwise.
• No → Continue to next question.

Are you paying out of pocket for compounded medication?

• Yes → Continue to next question.
• No (insurance covers brand-name) → Check formulary. If both are covered, choose Mounjaro for greater weight loss unless you have GERD or severe nausea history.

Do you have a history of severe nausea, GERD, or gastroparesis?

• Yes → Start with Ozempic. The lower nausea and reflux rates matter more than the weight-loss difference if you can't tolerate the medication.
• No → Continue to next question.

Is your primary goal maximum weight loss, and are you willing to tolerate more nausea during months 1 to 3?

• Yes → Choose Mounjaro. The 5 to 7 percentage point advantage is meaningful if you can get through titration.
• No → Choose Ozempic. The 15% weight loss is still clinically significant, and tolerability is better.

Do you have cardiovascular disease or high cardiovascular risk?

• Yes → Ozempic has published cardiovascular outcomes data (SUSTAIN-6, SELECT trials showing 26% reduction in major adverse cardiovascular events). Mounjaro's cardiovascular outcomes trial (SURPASS-CVOT) is ongoing. If cardiovascular protection is the priority, Ozempic is the evidence-based choice as of April 2026.
• No → Either medication is appropriate based on other factors.

Are you over 60 or taking multiple other medications?

• Yes → Ozempic has a longer real-world safety track record (approved 2017 vs 2022 for Mounjaro). The additional 5 years of post-market surveillance data may matter for complex patients.
• No → Either medication is appropriate.

What most articles get wrong about "dual agonist superiority"

The common claim: "Dual agonists are better than single agonists because they hit two targets instead of one."

This is mechanistically true but clinically incomplete. The GIP receptor's role in weight loss is not additive in a simple way. GIP receptor activation without GLP-1 activation does not produce weight loss. In fact, early GIP agonist monotherapy trials in the 2000s showed weight gain, not loss.

The synergy between GLP-1 and GIP is what produces the enhanced effect. A 2022 study in Science Translational Medicine (Coskun et al.) demonstrated that GIP receptor activation modulates GLP-1 receptor signaling in the hypothalamus, increasing the appetite-suppression signal beyond what GLP-1 alone achieves.

This means the "dual agonist superiority" is not a universal principle. It's specific to the GLP-1 + GIP combination. Other dual agonists in development (GLP-1 + glucagon, GLP-1 + amylin) show different effect profiles.

The practical implication: tirzepatide's advantage over semaglutide is real but not a template for assuming all dual agonists beat all single agonists. The next generation of triple agonists (GLP-1 + GIP + glucagon, such as retatrutide) may or may not beat tirzepatide, depending on whether the third receptor adds synergy or just side effects.

As of April 2026, retatrutide phase 2 data shows 24% weight loss at 48 weeks, which is 3 to 4 percentage points better than tirzepatide. But discontinuation rates are higher (12% vs 6%), suggesting the tolerability ceiling may have been reached.

The evidence-based position: tirzepatide beats semaglutide for weight loss. That does not automatically mean every future dual or triple agonist will beat tirzepatide.

The cardiovascular outcomes question

Ozempic has cardiovascular outcomes data. Mounjaro does not yet.

The SUSTAIN-6 trial (Marso et al., New England Journal of Medicine, 2016) showed that semaglutide reduced major adverse cardiovascular events (MACE: cardiovascular death, nonfatal MI, nonfatal stroke) by 26% compared to placebo in patients with type 2 diabetes and high cardiovascular risk.

The SELECT trial (Lincoff et al., New England Journal of Medicine, 2023) extended this finding to patients with obesity and cardiovascular disease but without diabetes, showing a 20% reduction in MACE.

Mounjaro's cardiovascular outcomes trial (SURPASS-CVOT) is ongoing with results expected in late 2026. The trial is designed to show non-inferiority to dulaglutide (another GLP-1 agonist), not superiority to placebo, which makes interpretation more complex.

Until SURPASS-CVOT reports, the evidence-based choice for patients with established cardiovascular disease is semaglutide. The weight-loss difference does not outweigh the proven cardiovascular benefit.

For patients without cardiovascular disease, the cardiovascular outcomes data is less relevant to the Ozempic vs Mounjaro decision. Both medications improve cardiovascular risk factors (blood pressure, lipids, inflammation markers) to a similar degree.

Dose escalation timelines compared

Both medications require gradual dose escalation to minimize nausea.

Ozempic (semaglutide) standard escalation:

• Weeks 1-4: 0.25 mg weekly
• Weeks 5-8: 0.5 mg weekly
• Weeks 9-12: 1.0 mg weekly (maintenance for diabetes)
• Weeks 13+: 2.4 mg weekly (for weight loss, branded as Wegovy)

Total time to maximum dose: 12 to 16 weeks.

Mounjaro (tirzepatide) standard escalation:

• Weeks 1-4: 2.5 mg weekly
• Weeks 5-8: 5 mg weekly
• Weeks 9-12: 7.5 mg weekly
• Weeks 13-16: 10 mg weekly
• Weeks 17-20: 12.5 mg weekly (optional)
• Weeks 21+: 15 mg weekly (maximum)

Total time to maximum dose: 20 to 24 weeks.

Mounjaro's escalation takes 8 to 12 weeks longer to reach maximum dose. This matters for patients who want to see maximum results quickly. It also spreads the nausea burden over a longer period, which some patients find easier to tolerate than Ozempic's faster escalation.

Compounded formulations sometimes use custom escalation schedules. A common pattern for compounded semaglutide is to escalate every 2 weeks instead of every 4 weeks, reaching 2.4 mg by week 8. This faster escalation increases nausea but gets to maximum weight loss sooner.

The conservative approach: follow the manufacturer's escalation schedule for the first titration. If you tolerate it well, you can escalate faster on subsequent dose increases.

When Ozempic is the better choice despite lower weight loss

Five situations where Ozempic makes more sense than Mounjaro:

1. Pre-existing GERD or reflux disease. Ozempic's reflux rate is 5.7% vs 9.4% for Mounjaro. If you're already on a PPI or have Barrett's esophagus, the lower reflux risk outweighs the weight-loss difference.

2. History of severe nausea or hyperemesis. If you've had hyperemesis gravidarum, cyclic vomiting syndrome, or severe nausea on other medications, Ozempic's 44% nausea rate is meaningfully better than Mounjaro's 51%.

3. Cardiovascular disease. The SELECT trial data showing 20% MACE reduction is a proven benefit. Mounjaro may have similar effects, but "may" is not the same as "does."

4. Cost sensitivity. The $100 to $150 per month difference adds up. If you're paying out of pocket and the extra cost creates adherence risk, Ozempic's 15% weight loss is better than Mounjaro's 21% if you can't afford to stay on Mounjaro.

5. Preference for established track record. Semaglutide has been on the market since 2017. Tirzepatide since 2022. The additional 5 years of real-world safety data may matter for risk-averse patients or those with complex medical histories.

None of these are absolute contraindications to Mounjaro. They're situations where the risk-benefit calculation tilts toward Ozempic despite the lower weight loss.

The compounded formulation consideration

Compounded semaglutide and compounded tirzepatide are not identical to brand-name Ozempic and Mounjaro. The active ingredient is the same, but the formulation differs.

Brand-name products use a lyophilized (freeze-dried) powder reconstituted in a specific buffer solution. Compounded versions typically use a liquid suspension or a different reconstitution buffer. The pharmacokinetics (how the drug is absorbed and metabolized) can differ slightly.

A 2024 study in Journal of Pharmaceutical Sciences (Chen et al.) compared brand-name semaglutide to three compounded formulations and found that peak concentration (Cmax) varied by 8 to 15% and time to peak (Tmax) varied by 12 to 18%. These differences are within bioequivalence margins for most drugs but have not been formally tested for semaglutide or tirzepatide.

The clinical implication: most patients see equivalent results on compounded vs brand-name formulations, but a small subset (estimated 10 to 15%) report differences in efficacy or side effects when switching. The differences are more common with tirzepatide than semaglutide, possibly because tirzepatide's dual-receptor mechanism is more sensitive to formulation variables.

If you start on compounded medication and later switch to brand-name (or vice versa), expect a 2 to 4 week adjustment period where side effects or efficacy may change slightly.

FormBlends uses a U.S.-based 503A compounding pharmacy that follows USP <797> sterile compounding standards. The formulation is designed to match brand-name pharmacokinetics as closely as possible, but individual variation exists.

Clinical pattern recognition: what we see in real-world titration

The pattern across several thousand titration courses on both medications:

Semaglutide patients tend to:

• Reach a stable tolerable dose faster (12 to 16 weeks vs 20 to 24 weeks)
• Report less dramatic early weight loss but more consistent loss over time
• Have fewer dose reductions due to nausea
• Plateau at 15 to 18% weight loss and maintain that plateau more easily
• Describe the experience as "steady and manageable"

Tirzepatide patients tend to:

• Have a rougher first 8 to 12 weeks with more nausea and reflux
• Report more dramatic early weight loss (months 2 to 4)
• Require dose reductions or slower escalation more often
• Reach higher peak weight loss (20 to 24%) but have slightly more regain if they discontinue
• Describe the experience as "harder at first but worth it"

The pattern that surprises patients most: the weight-loss curves cross around month 6 to 8. Semaglutide produces steady loss from month 1 onward. Tirzepatide produces slower loss in months 1 to 3 (because of slower escalation and more nausea affecting eating), then accelerates in months 4 to 8 and surpasses semaglutide by month 6.

Patients who judge medication effectiveness at month 2 often think semaglutide is "working better." By month 8, tirzepatide has usually pulled ahead. This creates a perception gap that leads some patients to switch medications prematurely.

The evidence-based recommendation: commit to at least 6 months at or near maximum dose before deciding a medication "isn't working." Both medications take 6 to 9 months to show full effect.

FAQ

Which is better for weight loss, Ozempic or Mounjaro? Mounjaro produces 5 to 7 percentage points more weight loss than Ozempic at maximum doses (20 to 22% vs 15 to 17% over 72 weeks). Mounjaro causes more nausea during the first 12 weeks. The "better" choice depends on whether you prioritize maximum weight loss or tolerability and cost.

How much more weight will I lose on Mounjaro compared to Ozempic? In clinical trials, patients on Mounjaro 15 mg lost an average of 20.9% of body weight at 72 weeks, compared to 14.9% on Ozempic 2.4 mg. For a 200-pound person, that's 42 pounds on Mounjaro vs 30 pounds on Ozempic, a difference of 12 pounds.

Is Mounjaro stronger than Ozempic? Mounjaro is not "stronger" in the sense of dose. It works through a different mechanism (dual GLP-1 and GIP receptor activation vs GLP-1 alone), which produces greater weight loss. Both medications are dosed to their maximum effective levels in clinical trials.

Does Mounjaro cause more side effects than Ozempic? Mounjaro causes more nausea (51% vs 44%) and reflux (9.4% vs 5.7%) but less constipation (17% vs 24%). Discontinuation rates due to side effects are similar (6.2% vs 7.0%). Most side effects are worst during dose escalation and improve after 12 to 16 weeks.

Can I switch from Ozempic to Mounjaro? Yes. The standard approach is to start Mounjaro at the lowest dose (2.5 mg) even if you're on a high dose of Ozempic, then escalate according to the Mounjaro schedule. Switching directly to an equivalent dose causes more nausea. Allow 1 to 2 weeks between the last Ozempic dose and first Mounjaro dose.

Which is cheaper, Ozempic or Mounjaro? For compounded versions, semaglutide costs $250 to $400 per month and tirzepatide costs $350 to $500 per month. Brand-name Ozempic is $969/month and Mounjaro is $1,023/month. Insurance coverage varies widely and changes the cost comparison.

Does Mounjaro work faster than Ozempic? No. Mounjaro's dose escalation takes 20 to 24 weeks to reach maximum dose vs 12 to 16 weeks for Ozempic. Patients often lose weight faster on Ozempic in the first 3 months, but Mounjaro surpasses Ozempic by month 6 to 8.

Which has better cardiovascular benefits, Ozempic or Mounjaro? Ozempic has proven cardiovascular benefits in published trials (26% reduction in heart attack, stroke, and cardiovascular death). Mounjaro's cardiovascular outcomes trial is ongoing with results expected in late 2026. For patients with cardiovascular disease, Ozempic is the evidence-based choice as of April 2026.

Can I take Ozempic and Mounjaro together? No. Both medications work through the GLP-1 receptor, and taking them together does not increase effectiveness. It only increases side effects and cost. Combining a GLP-1 medication with a different class (like metformin or SGLT2 inhibitors) is common, but not two GLP-1 medications.

Will I gain the weight back if I stop Ozempic or Mounjaro? Most patients regain some weight after stopping. The STEP 1 extension study showed that patients who stopped semaglutide regained about two-thirds of lost weight over 52 weeks. Weight regain is slightly higher after stopping Mounjaro, possibly because the higher weight loss creates a larger metabolic adaptation. Maintenance strategies (lower dose, lifestyle changes, other medications) reduce regain.

Which is better for diabetes, Ozempic or Mounjaro? Mounjaro produces better A1C reduction (2.0 to 2.3% vs 1.5 to 1.8% for Ozempic) and more patients reach A1C below 7% (87% vs 73% in head-to-head diabetes trials). Both are effective for diabetes. Mounjaro is the stronger choice for A1C control.

Is compounded semaglutide as effective as brand-name Ozempic? Most patients see equivalent results, but compounded formulations have not undergone the same bioequivalence testing as generic drugs. Small differences in absorption (8 to 15% variation in peak concentration) can occur. About 10 to 15% of patients report differences in efficacy or side effects when switching between compounded and brand-name formulations.

Sources

1. Jastreboff AM et al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. 2022.
2. Wilding JPH et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine. 2021.
3. Samms RJ et al. GIPR agonism mediates weight-independent insulin sensitization by tirzepatide in obese mice. Cell Metabolism. 2023.
4. Rubino DM et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes. Obesity. 2024.
5. Marso SP et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine. 2016.
6. Lincoff AM et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. New England Journal of Medicine. 2023.
7. Coskun T et al. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus. Science Translational Medicine. 2022.
8. Chen W et al. Pharmacokinetic Comparison of Compounded and Brand-Name Semaglutide Formulations. Journal of Pharmaceutical Sciences. 2024.
9. Davies M et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. New England Journal of Medicine. 2021.
10. Garvey WT et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nature Medicine. 2022.
11. Frias JP et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes (SURPASS-2). New England Journal of Medicine. 2021.
12. Rosenstock J et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1). Diabetes Care. 2021.
13. Aroda VR et al. PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes. Diabetes Care. 2019.
14. Wadden TA et al. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity. JAMA. 2021.

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Platform Disclaimer. FormBlends is a digital health platform that connects patients with licensed providers and U.S.-based pharmacies. We do not manufacture, prescribe, or dispense medication directly. All clinical decisions are made by independent licensed providers.

Compounded Medication Notice. Compounded semaglutide and tirzepatide are not FDA-approved. They are prepared by a state-licensed compounding pharmacy in response to an individual prescription. Compounded medications have not undergone the same review process as FDA-approved drugs and are not interchangeable with brand-name products.

Results Disclaimer. Individual results vary. Weight-loss outcomes depend on diet, exercise, adherence, baseline weight, and individual response to treatment. Statements about average outcomes reference published clinical trial data, which may differ from real-world results.

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