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5 things you should know about Ozempic from a dietitian

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A registered dietitian’s deep dive into the truth about Ozempic. Let’s dive into the science to look at how effective at weight loss it actually is and just how bad the side effects actually are. We also cover implications of the medication shortage and considerations for those with a history of an eating disorder or disordered eating. image with white bottle and various medications with text that says "5 things you should know about Ozempic (from an RD)"Trigger warning: discussions of weight loss numbers, eating disorder behaviors

Ozempic and other weight loss medications like Wegovy, Mounjaro, Trulicity and Rybelsus are a hot topic right now.

Celebrities are publicly attributing their weight loss to these medications (Oprah being the latest one as I’m writing this). Doctors are prescribing them left and right for weight loss (and any other ailment you might bring to the doctor that they think is correlated to your weight). Patients with diabetes (for whom these medications were originally developed) can’t access these meds because there are shortages across the country and their health is suffering as a result.

From news headlines to TV advertisements to water cooler talk, Ozempic is everywhere. As a non-diet, weight-inclusive dietitian, I want to make sure that I am empowering my clients and my community with all the evidence-based information we have (and highlight what we don’t have) so that you can make an informed decision on whether or not to take these medications. It’s not my role to persuade you (because I believe in your agency and body autonomy) but it is my role to educate and inform, which I hope to do here.

I would never, ever shame or judge someone who decides to take these medications. It would make sense if you choose to take them or are thinking about taking them given the anti-fat culture we live in and the pressure from medical providers to “do something about your health, aka your weight.”

So I compiled what I’ve learned about these medications in this post and am highlighting what the research shows us on weight loss (how much weight you’re actually likely to lose – hint: it’s not as much as you might think), what the known side effects are, and why you should be careful about where you’re accessing these meds from.

What is GLP-1?

These weight loss medications fall into a class of medications called GLP-1 agonists. GLP-1 is glucagon-like peptide, also known as an incretin. Incretins are secreted in the small intestine and help to increase insulin, decrease glucagon and slow down gastric emptying (i.e. digestion), all of which help to manage blood sugar. With incretin, glucose can slowly enter the bloodstream instead of being flooded with it.

It also stimulates satiety and fullness and helps you stay full longer, which is why the medication is now being used to control appetite and produce weight loss.

What is semaglutide?

Semaglutide is the generic name for the active ingredient in Ozempic and Wegovy. Ozempic and Wegovy are just the brand names. Ozempic is FDA-approved for the treatment of diabetes, and in 2021, Wegovy became FDA-approved for the treatment of weight loss. Both are essentially the same medication only Wegovy has higher doses of semaglutide. 

Once Wegovy became FDA-approved for weight loss, it quickly went into shortage and then doctors began prescribing Ozempic off-label (meaning prescribing it for something other than what it is FDA-approved for) for weight loss. And then Ozempic shortages quickly followed suit.

The problem with this is Ozempic and other GLP-1 and GIP agonists FDA-approved for diabetes treatment aren’t getting to the people who need them the most and can have serious health ramifications for those with diabetes.

Semaglutide is still in shortage as of writing this blog post in December 2023.

How do GLP-1 agonists help those with diabetes?

In folks with diabetes, incretin’s effects are reduced (by about 30%), which leads to higher blood sugars and poorer blood sugar control. GLP-1 agonists help control blood sugar and lower A1c levels, which measure your average blood sugar levels over the last three months. Studies show these medications can help lower A1c levels by 1 – 2.4 percentage points and can reduce the risk of cardiac events, regardless of weight changes.

5 things you should know about Ozempic and Wegovy (and other GLP-1 agonists)

1. You may or may not lose weight with Ozempic and once you stop taking it, you will likely gain the weight right back.

Not everyone loses weight taking these medications, which is important to note, otherwise people who don’t lose weight on these meds are left feeling like failures. 

The research on semaglutide for weight loss largely comes from the STEP trials, randomized controlled trials (RCTs) which are funded by, you guessed it, the pharmaceutical company that makes this drug, Novo Nordisk.

When looking solely at the STEP trials, results show that 80% of people taking these medications lose some amount of weight. So about 20% of folks who take these meds won’t lose any weight. For those who do lose weight, at the very least, they are losing about 5% of their body weight (that’s about 10 lbs for someone who weighs 200 lbs).

Roughly half of the folks who took this medication saw a more moderate weight loss, about 10-15% of body weight (about 20-30 lbs for someone weighing 200 lbs) and roughly one third of folks taking this medication saw a pretty substantial weight loss of 20% or more body weight (about 40 lbs weight loss for someone weighing 200 lbs). This more substantial weight loss is of course what is driving all the hype and media coverage on these medications.

But let’s keep in mind that these trials were not only funded by the maker of the medications but also had a lot of exclusion criteria. People couldn’t join these studies if they were depressed, had any existing cardiovascular issues, and if they were females of childbearing age without a highly effective birth control method, just to mention a few.

When you look at other trials on semaglutide, without the pharma funding and extensive exclusion criteria, the results are less impressive. Only 40% of folks are losing at least 5% of body weight. Looking at a meta-analysis (review) of RCTs, most weight loss totals hovered around an average of 8-10 lbs, with a few studies showing more significant weight loss, around 25-40 lbs.

If your goal is to lose about 5-10% of your body weight then these medications might help you get there but if you are looking for more dramatic weight loss, these meds probably won’t help you meet your goals. 

It’s also important to recognize what happens when you stop taking the medications. Because maybe your insurance will stop covering it, or you can no longer afford it, or there’s a shortage, etc.

Studies have looked at what happens when you take someone off semaglutide and replace it with a placebo and found that weight regain happens very quickly. Within a year, people regain almost all of their weight lost, even while still doing behavioral interventions like nutrition, exercise, and cooking classes.

Sounds very similar to all the research on what happens to your weight once you stop doing a diet (you gain it back).

Graphic with quote: "Studies have looked at what happens when you take someone off Ozempic (semaglutide) and replace it with a placebo and found that weight regain happens very quickly. Within a year, people regain almost all of their lost weight. Even while still doing behavioral interventions like nutrition, exercise, and cooking classes."

2. Ozempic comes with very unpleasant side effects.

Studies show that a range of 60% up to 93% of people taking these medications will experience some side effects – the most common being gastrointestinal distress. These side effects may include nausea, vomiting, diarrhea, constipation, GERD, and abdominal pain. For most people, severe GI symptoms should resolve within a few days and more mild GI side effects usually resolve within 8-12 weeks.

These medications also come with a black box warning that they can increase the risk of thyroid tumors. This is based purely on studies done in rodents so we don’t know how that extrapolates to humans, yet. There are human studies being conducted now but we won’t know the results until 2035 at the earliest. Because of this these medications are contraindicated for those with a family history of thyroid tumors. 

There are other very rare side effects like pancreatitis, gallbladder disease, kidney injury, and suicidal ideation. The FDA also recently added ileus to the list of side effects on the label, which is when your bowel stops functioning and you can’t remove waste – it can only be treated with surgery and can be fatal.

And then there’s the aesthetic reported side effect people are talking about, “Ozempic face”. As a result of rapid weight loss (for some) and likely not getting adequate nutrition, people report having loose skin on their face and a hollowing under the eyes and near the temples. This appearance is also seen in those suffering from malnutrition.

3. There is a shortage of these weight loss drugs, which is leading compounding pharmacies to create versions that are not approved or regulated.

When a drug goes on the FDA drug shortage list, the FDA allows compounding pharmacies to mix up their own version of the drug without any FDA approval or screening.

But, here’s the catch. Novo Nordisk has a has a patent on the semaglutide molecule and only they can produce it until 2032 so compounding pharmacies don’t have access to this active ingredient. 

So these pharmacies are selling medication and calling it semaglutide but it’s really something else. It might be a watered down version of it or it might be something called semaglutide sodium or acetate, the salt forms of semaglutide, which have not been shown to be safe or effective in humans, or it might be something else all together.

If you want to take a weight loss medication, get a prescription from your doctor and secure it from a licensed pharmacy. Stay far away from wellness centers, spas, or telehealth providers touting these medications at a low cost.

Graphic with quote: "If you want to take a weight loss medication, get a prescription from your doctor and secure it from a licensed pharmacy. Stay far away from wellness centers, spas, or telehealth providers touting these medications at a low cost."

4. There’s no long-term data on Ozempic.

Let’s not forget that we have NO long term data on these drugs. Semaglutide was approved by the FDA for diabetes treatment in 2017 and the longest study I found was follow-up with a little over two years. We just don’t know if there are any long-term side effects. We also don’t know if you maintain your weight loss when you stay on this drug long-term.

It’s an eerily similar picture to past weight loss meds like Fen-Phen and Ephedra, both of which were hailed as miracle weight loss drugs with no long-term data and were eventually taken off the market because of irreversible serious adverse side effects like fatal hypertension, heart valve problems, heart attack, stroke, and death.

It’s important to weigh this when deciding to take the medication – you simply can’t know what the safety or efficacy is of taking Ozempic long-term. What we do know is that if you want to have a shot at maintaining your weight loss, you will have to stay on it long-term.

5. Ozempic can be dangerous for those with a history of an eating disorder or disordered eating.

This medication ultimately puts you out of touch with your body’s natural hunger and fullness cues, which is counterproductive to eating disorder recovery and the intuitive eating framework. It causes you to eat less, which can exacerbate and fuel already restrictive eating patterns, and lead to potential nutrient deficiencies.

Graphic with quote: "Ozempic ultimately puts you out of touch with your body's natural hunger and fullness cues, which is counterproductive to eating disorder recovery and the intuitive eating framework. It causes you to eat less, which can exacerbate and fuel already restrictive eating patterns, and lead to potential nutrient deficiencies."

For those with binge eating disorder or who struggle with episodes of binging, coming off the medication can result in significant upswings in hunger, which may make you more susceptible to binges.

And then there’s the impact of weight changes on your mental health. If you don’t lose weight taking the medication, you may go to extremes to restrict your food intake. Or losing weight may trigger you to want to lose even more, fueling more restriction. Or if you lose significant weight and then gain it all back once you come off the medication, that change in body appearance may cause emotional distress and lead to disordered eating.

In the same way I wouldn’t recommend a diet or intentional weight loss to folks with an active eating disorder, a history of an eating disorder, or disordered eating, I wouldn’t recommend these weight loss medications either. It reinforces the idea that thin is best and results in inadequate nourishment and nutrition.

If you are struggling to get adequate nutrition while taking one of these medications or are debating on taking one of these medications and would like more individualized nutrition support, our team would love to help you. Book a nutrition assessment today.

References:

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss

https://pubmed.ncbi.nlm.nih.gov/32441473/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840940/#:~:text=Semaglutide%202.4%20mg%20is%20to,greater%2C%20received%20FDA%20approval%20in

https://pubmed.ncbi.nlm.nih.gov/33567185/

https://dom-pubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.14863

https://pubmed.ncbi.nlm.nih.gov/35441470/

https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic

https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full

Eating Disorders & Diabetes: A Focus on Diabetes Medications Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Pro

For more blog posts like this check out:

How to Set Sustainable Health Goals For the New Year that Are Actually Sustainable

Am I Eating Enough? 8 Signs You’re Undereating 

Is Intuitive Fasting Really Intuitive or Is It Just Another Diet?

What Is Orthorexia? When Healthy Eating Becomes Obsessive

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