Here’s the Skinny on The New Weight-Loss Drug, Ozempic
There’s a lot of buzz about Ozempic and newly approved prescription weight-loss medications on the market. While these GLP-1 agonists were originally created as effective ways to manage type 2 diabetes, the weight loss side effect (caused by early fullness and less hunger, leading to consuming less food), has consumers requesting these meds in droves. Several medications in this class have now been FDA-approved strictly for weight-loss for those with comorbidities of obesity. We’re seeing exciting results, but these medications are not without their issues, including a supply shortage causing diabetics to be denied access.
Ozempic (Semaglutide) is made by Novo Nordisk and is “an injectable prescription medicine used along with diet and exercise to improve blood sugar in adults with type 2 diabetes, to reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes with known heart disease…and it may help you lose some weight.” The FDA has approved a weight-loss specific version of Semaglutide called Wegovy, but when Wegovy is unavailable, Ozempic is being used off-label for non-diabetics and then we run into the supply issue.
Most GLP-1 agonist medications are injectable, requiring anywhere from twice daily to weekly shots. There are many others in the class that operate similarly including Trulicity (Dulaglutide), Victoza and Saxenda (Liraglutide), Byetta and Bydureon Bcise (Exenatide), Adlyxin/Lyxumia (Lixisenatide), Rybelsus (Semaglutide), Tanzeum (Albiglutide), and Mounjaro (Tirzepatide).
How do these meds work?
When the body is working effectively, after we eat, a hormone called glucagon-like-peptide 1 (GLP-1) is secreted from the small intestine in what is known as the “incretin effect,” which then stimulates the secretion of insulin from our pancreas. Insulin moves the glucose (sugar) from our blood stream into our tissues where it is used for energy. For those with type 2 diabetes, the body’s natural process for breaking down glucose doesn’t work properly, so these medications are there to revive insulin secretion. (Remember that type 1 diabetes mellitus is different- no insulin can be stimulated from the pancreas, so needs to be completely replaced).
These GLP-1 agonist medications (also known as incretin mimetics) have been used for patients with type 2 diabetes as an alternative to the traditional treatment of Metformin for some time. They do a beautiful job of controlling blood sugar and have been shown to decrease mortality all-around, decrease cholesterol, improve cardiovascular function and health, increase glucose uptake in muscles, protect the liver and brain, and slows gastric emptying and promotes a sense of fullness thereby causing weight loss.
That brings us to the non-diabetic utilization of these meds.
What about weight loss?
In the past few years, the FDA has approved the use of Wegovy (Semaglutide) and Saxenda (Liraglutide), both Novo Nordisk GLP-1 agonists meant as “pharmacologic treatments for obesity, prescribed to overweight patients with comorbidities.” They are always prescribed in conjunction with healthy diet and exercise. Wegovy is injected at home weekly, Saxenda daily, and they are approved for patients over age 12 with certain BMI/weight and weight-associated comorbidities. Costs vary by insurance coverage, but out-of-pocket a month of either runs $1,349.02.
According to the National Institute of Health, “This class of medications has also been shown to promote an average weight loss of 2.9 kilograms (6 lbs 6oz) compared to placebo” but the manufacturer indicates it’s reasonable to expect significantly more weight loss.
Several studies of Wegovy (both conducted by Novo Nordisk) found an average weight loss between 7.9% and 14.9% of body weight and for Saxenda, between 4-10%. Also, one study of Wegovy demonstrated significant reductions in waist circumference, hemoglobin A1C (HbA1c) levels, systolic blood pressure, total cholesterol, and triglycerides. A long-term study comparing the two drugs showed a 15.8% weight loss on Wegovy and 6.4% on Saxenda after 68 weeks. The theory is that Wegovy more aggressively decreases food cravings and hunger.
These medications are largely effective and well-tolerated. The most common side effects of GLP-1 agonists are gastric-intestinal distress like nausea, vomiting, and diarrhea. If severe enough, these side effects can lead to acute kidney issues related to dehydration but slow increases in dosing can help mitigate this, as well as not eating when there is a sense of fullness. Some people cannot tolerate the injections and get discomfort or itching at the sites. Other people note dizziness, mild tachycardia, infections, headaches, and dyspepsia. The obvious initial concern with these medications is hypoglycemia (not enough glucose in the blood), but so far studies have not demonstrated major hypoglycemic events.
Who should NOT take GLP-1 agonists?
Thyroid tumors and sometimes deadly pancreatitis have developed in some subjects, so anyone with a personal or family history of multiple endocrine neoplasia 2A, 2B or medullary thyroid cancer or pancreatitis should not use GLP-1 agonists. Also, as the medication is eliminated by the kidneys, so anyone with moderate kidney disease needs to be monitored and managed closely and those with severe kidney disease should not use them. Those who are pregnant or may become pregnant should not use them, and anyone with inflammatory bowel disease or gastroparesis should also avoid them. It is possible to build an allergic reaction to the medication which can eventually lead to anaphylaxis. Anyone with pre-diabetes or diabetes should discuss the best management course with their physician.
The benefits are clear, what are some other concerns
One of the primary concerns is misuse of the medications. The approved use of GLP-1 agonists meant for weight loss are for those who are obese with weight-related conditions. There is risk of malnourishment and disordered eating when used outside of these recommendations. Also, as mentioned earlier, prescribing diabetic meds off-label to non-diabetics has devastating repercussions.
“Weight cycling can potentially lead to serious cardiovascular events,” warns Maria Scrimenti, Certified Intuitive Eating Counselor, Health & Wellness Coach, and Eating Disorder Recovery Coach. “Individuals considering taking these medications for weight loss should be advised that, similar to any weight loss "quick fix", it is expensive, dangerous, and unsustainable. Because we do not know the long-term side effects of taking these weight loss drugs, I would proceed with extreme caution.” Maria advises a more holistic approach using intuitive eating.
“Also, this isn’t a long-term solution,” holistic dietitian, Lana Scales, MS, RD, CNSC, ACSM, EP-C, reminds us. “Patients’ weight will bounce right back when they go back to their normal GLP1 production.”
Lana is right to be skeptical. A 2022 study published by the journal of Diabetes, Obesity, and Metabolism, showed that, “One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables. Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.”
Lana advises longer-term, more sustainable solutions to weight management. “I’m a huge fan of intermittent fasting for those who can do it,” Lana says, noting that it would be unsafe in type 1 diabetics and that everyone should consult their physician before changing their eating schedule. An example of an intermittent fasting schedule would be eating from 10:00a.m. to 7:00p.m. and fasting the other hours. “It works because of something called the dawn phenomenon which is where the body naturally has higher than normal blood sugar in the morning designed to help us get up and go. We don’t need additional food right out of the gate, especially the sugary, processed foods we often have for breakfast.” Not eating late at night can also help with sleep.
For those with obesity-related conditions who feel like they have tried it all, GLP-1 agonists might feel like miracle drugs. When used properly, in addition to weight loss, we can expect other health improvements while actively taking these medications. The downside of GLP-1 agonists being widely used for weight loss is its effect on diabetic supply, the potential for misuse, the short-term effect of the treatment, and concerning potential side effects. When considering any changes in diet or medications, it is critical we consult with a healthcare provider.
Sarah Zimmerman is a freelance writer in Northern California and is working on her first novel. In past lives,, she has been a Physician Assistant in Women's Health and the owner of a vegan ice cream business. Sarah writes about marriage, sex, parenting, infertility, pregnancy loss, social justice, and women's mental and physical health, always with honesty and humor. She has written for Ravishly, Cafe Mom, Pregnant Chicken, and more and can be found at sarahzwriter.com and on Medium, Twitter, Facebook, Instagram and TikTok at @sarahzwriter.