Ozempic: The new frontier or something to fear? 

From juice cleanses to weight loss pills, to other extreme diets, it’s nothing new to see a diet or trend in the news claiming to have found the answer to help shed pounds. With almost 70% of Americans experiencing overweight or obesity, it seems like everyone is looking for a quick and convenient fix to lose weight and improve their health. Sister drugs, Ozempic®and Wegovy®, have surged in popularity recently. These drugs promise to help users lose a lot of weight and lose it fast; but are these medications safe? 

What is Ozempic®? 

Ozempic® is a once-a-week, injectable drug that was originally tested and approved by the FDA to improve hemoglobin A1C levels in patients with Type 2 diabetes, alongside diet and exercise. While it was not approved by the FDA for weight loss, doctors are prescribing it off-label due to its active ingredient, semaglutide. Semaglutide is the same active ingredient in Wegovy®, another injectable drug the FDA approved for weight loss in 2021 for patients who have overweight or obese and comorbidities related to their weight. Wegovy® has a higher amount of semaglutide than Ozempic®. 

Once demand of Wegovy® surpassed the supply, Ozempic® began to take its place for those getting it prescribed off label for non-diabetes-related use. Not only is Ozempic® becoming hard to come by for users trying to lose weight, but supply issues have also affected patients with diabetes who have been using the drug for years.  

How does it work? 

Semaglutide works by mimicking the hormone glucagon-like peptide 1 (GLP-1). Once injected, GLP-1 receptors are activated in the pancreas, which then increases insulin release to lower blood sugar. Additionally, GLP-1 receptors are activated in the brain and gastrointestinal tract causing a reduction in appetite and hunger. Some research suggests these GLP-1 receptors also cause delayed gastric emptying. 

Rapid weight loss occurs due to: 

• Reduction in appetite and hunger cues reduce food intake, making it easier to achieve a calorie deficit. 
• Delayed gastric emptying prolongs the sensation of fullness, reducing the frequency of eating, and causing earlier satiety. 
• Reduction in cravings and altered food preferences make users less likely to overeat their favorite foods.  

Risks of taking Ozempic® for weight loss 

When it comes to weight loss drugs, they can be a beneficial boost for those who have not achieved weight loss from traditional methods alone and can help improve health. But as with any pharmaceutical intervention, side effects are always a risk. Users should carefully consider and monitor potential side effects when taking a new medication, especially one prescribed for off-label use.  

GI issues are the most common side effects associated with Ozempic® and Wegovy®. 

Possible side effects include: 

• Nausea 
• Vomiting 
• Diarrhea 
• Constipation 
• Abdominal pain 
• GERD (esophageal reflux)  
• Dizziness 
• Hypoglycemia 

Symptoms tend to be mild for users and may dissipate over time. However, new cases are starting to emerge of Ozempic® or Wegovy® users experiencing sustained and severe gastroparesis, leading to severe vomiting and abdominal pain even after cessation of the drugs. With symptoms like these, users are likely to experience additional nutritional risks, such as: 

• malnutrition and nutrient deficiencies related to reduced absorption of food. 
• dehydration and electrolyte imbalances with vomiting.  
• further unintentional weight loss. 

Is this the miracle answer to weight loss that it seems to be? 

Studies have shown that participants taking semaglutide injections, combined with lifestyle changes lose an average of 15% of their original weight over 1 year, with some users losing greater than 20%. On the front end, Ozempic® works very well to induce weight loss in those taking it, however, the research also shows that most participants will regain two-thirds of the weight back after discontinuation of semaglutide. This is likely due to the return of previous eating habits as hunger cues and appetite normalize. The key to maintaining weight loss is a commitment to a healthier lifestyle and continuing healthy habits for life. 

When considering the use of a weight-loss drug like Ozempic® or Wegovy®, providers and potential users should really consider if the benefits of achieving weight loss through this intervention really outweigh the risks associated with these drugs.  

Even with adverse cases and more research to be done, it will likely take a long time for the weight loss craze surrounding these ‘miracle drugs’ to dissipate. Registered dietitians have a crucial role in providing medical nutrition therapy for those who are taking weight loss drugs, as well as continuing to educate patients, clients, and providers on healthy lifestyle choices to support weight loss journeys in achievable and sustainable ways.  

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References: 

Collins L, Costello RA. Glucagon-like Peptide-1 Receptor Agonists. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK551568/  

FDA. FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. FDA. Published June 4, 2021. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014 

Friedrichsen M, Breitschaft A, Tadayon S, Wizert A, Skovgaard D. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity. Diabetes, Obesity and Metabolism. 2021;23(3):754-762. doi:https://doi.org/10.1111/dom.14280  

Goodman B. They took blockbuster drugs for weight loss and diabetes. Now their stomachs are paralyzed. CNN. Published July 25, 2023. https://www.cnn.com/2023/07/25/health/weight-loss-diabetes-drugs-gastroparesis/index.html  

What Is Ozempic®? | Ozempic® (semaglutide) Injection 0.5 mg or 1 mg. www.ozempic.com. https://www.ozempic.com/why-ozempic/what-is-ozempic.html 

Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine. 2021;384(11). doi:https://doi.org/10.1056/NEJMoa2032183 

Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022;24(8). doi:https://doi.org/10.1111/dom.14725