In recent months, we’ve seen an explosion of media coverage and social media content centered around a now-famous drug called Ozempic. Officially approved as a drug to treat type 2 diabetes, many people have used Ozempic off-label as a weight-loss medication. There’s so much information and even more misinformation swirling around the internet about the potential benefits and side-effects of these types of medications, along with plenty of judgment towards the people taking them. Let’s cut through the noise and get to the truth about these drugs.
What is Ozempic?
In 2017, the FDA approved the use of Ozempic for use in adults with type 2 diabetes. Ozempic is a weekly injection that lowers blood sugar by helping the pancreas produce insulin. It can also cause weight-loss by suppressing appetite and slowing gastric emptying. Ozempic (semaglutide) is in a category of drugs called glucagon-like peptide 1 (GLP-1) agonists, which means they mimic the hormone GLP-1. Another medication approved for diabetes treatment is Mounjaro (tirzepatide), which mimics two hormones instead of just one: GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). This makes it more effective than Ozempic, but it’s also more expensive.
It’s important to note that as early as 2010, a medication called Victoza was the first GLP-1 to be approved for diabetes care. That means that we have over a decade of data that helps us understand and affirm the long-term safety of GLP-1 drugs
Wegovy (semaglutide) and Zepbound (tirzepatide) are the only drugs that are FDA-approved for weight-loss. However, there are other GLP-1 drugs that can be used, including Ozempic, since they have similar effects:
Dulaglutide (Trulicity)
Exenatide extended release (Bydureon Bcise)
Exenatide (Byetta)
Liraglutide (Victoza, Saxenda)
Lixisenatide (Adlyxin)
Semaglutide (Rybelsus)
Revolutionizing diabetes care
In all the hype surrounding Ozempic, one thing that often gets left out of the conversation is how incredible the medication is for patients with type 2 diabetes. For many years patients had to rely solely on metformin, sulfonylureas, insulin and diet changes to control their blood sugar. Checking blood sugar levels multiple times a day and making educated guesses about how much insulin they would need before any particular meal was the daily reality for millions of people in the U.S. It can be difficult to correctly dose insulin, so hypoglycemic episodes are common and can lead to trips to the emergency room. There are also patients that are afraid to take insulin due to fear of having these episodes and this is a challenge to achieve ideal blood sugar levels.
With Ozempic and other GLP-1 agonist medications, a once-weekly injection, along with diet and exercise, can be enough to maintain healthy blood sugar levels. A lot of patients can significantly reduce their insulin doses or go off of it completely, which simplifies their diabetes care regimen and lowers the risk of low blood sugar. Some patients do continue taking insulin while on Ozempic, in which case it’s especially important to check blood sugar levels regularly because of the risk of hypoglycemic episodes.
Cardiovascular and Renal Benefits
Aside from the benefits in blood sugar these medications have shown to provide other significant metabolic benefits. There is evidence that GLP-1 agonists reduce risk of death from any cause, as well as reduce the need for blood pressure and lipid lowering medications. On March 8th, 2024, Wegovy was approved for use in patients who are overweight or have obesity and heart disease. It was found to reduce the risk of cardiovascular disease, heart attack and stroke based on the SELECT trial data. It seems that we are learning more all the time about the health benefits of these powerful medications.
Quieting the “food noise” and suppressing appetite
Ozempic and similar medications work by suppressing your appetite and slowing down your intestine. Essentially it keeps you feeling full longer so you decrease your caloric intake. Another thing my patients love best about this medication is that it quiets the “food noise,” or constant and persistent thoughts about food.
We naturally produce GLP-1 in our intestine (L-cells) which helps the gut communicate with our brain in regards to nutrients and food intake. With GLP-1 medication use we amplify this signal and send the message that we have had enough food to feel full with smaller amounts. There are theories stating that patients with obesity might have difficulty feeling full or could have genes that impair this system to respond appropriately to the hormones and signals making it difficult to achieve weight loss, which is why these medications are helping so many people feel more at peace with their food behaviors.
The danger of black market and compound versions of Ozempic
The sudden popularity of Ozempic caused a shortage of the medication which opened the door to black market activity. Products like “semaglutide powder” and compounded semaglutide-like products quickly popped up on the internet, promising customers the same benefits at a lower cost. Taking any kind of medication that isn’t FDA-approved is always risky, especially if you have no way of verifying the actual ingredients or the quality of those ingredients. Best-case scenario is that it’s just a waste of money, worst-case scenario is that you experience severe side-effects. There have been reports of these products being contaminated with bacteria or fungus and having unverified ingredients with unknown side effects.
Bottom line is, avoid these kinds of products at all costs. If you’re interested in taking weight-loss medication, it’s imperative to talk to a certified physician and to get a prescription.
Who is a good candidate for these medications?
The best candidate for Ozempic and Mounjaro are patients with type 2 diabetes. One of the consequences of so many people using these drugs off-label (especially Ozempic) for weight-loss was that it caused a shortage for people who use it to manage their diabetes.
If you don’t have diabetes but you’d like to try a weight-loss medication, Wegovy and Zepbound are safe and effective when used correctly and with the supervision of a qualified physician.
Given the relative safety of these medications with guidance of a trained specialist, any patient with a BMI >27 with metabolic comorbidities or with BMI >30 can benefit from GLP-1 use.
Common Side Effects of Ozempic and other GLP-1 Meds
One reason that a person might experience side effects when taking this medication is that they’re using it without the supervision of a physician. If your dose is too high, you’re taking it too often, you’re not eating enough, you’re eating too much, or you’re not having the right kinds of foods, you could experience significant side effects. The most commonly reported side effects are nausea, diarrhea, constipation, and abdominal pain. These effects can be managed with a personalized diet regimen emphasizing fiber intake, hydration and balanced meal intake.
Not a Magic Bullet
These drugs are life-changing for many people who take them, and extremely effective for weight-loss and diabetes management. That doesn’t mean, however, that patients don’t have to do their part.
All these drugs should be taken in conjunction with lifestyle changes. It’s important to work on your relationship with food and move your body as much as you can. Studies show that most patients regain the weight they lost after they stop taking the medications. In my clinic, I have seen patients maintain weight loss after stopping a GLP-1 but only when they’ve also made significant changes to eating behaviors and created a lifelong commitment to self-care and being mindful of their body’s needs.
Short term interventions lead to short term results, there are no magic solutions that bring long-term health benefits. When you’re ready to make lasting changes for your health and well-being, it’s crucial to find a physician who understands the complexity of these issues and who can gather an effective care team.
When we work together, I will help you figure out how you can make lasting changes that lead to optimal health, and identify when we need to bring in other specialists (dieticians, psychologists/therapists, physical activity support, medical providers) to help you learn how to achieve long-term health and weight stability.
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