Ozempic - Too Good to be True?
Photo Credit: The Zoe Report
With the rapid advances in technology and 'on-demand' access to information, we are bombarded by ads and images of the current beauty standard. Lately, the standard that has taken off on social media is everyone wondering if their favorite celebrities and influencers posting their "new, slimmer" bodies are taking Ozempic. There is a difference between losing weight for one's health and losing weight to conform to an image influenced by social pressure. However, people seem to have gotten them mixed up due to the current trend of using Ozempic and Wegovy injections to achieve their weight loss goals. What was once used to specifically lower glucose levels and HbA1c in people with type 2 diabetes has now become a weight loss drug, aka “magic injection,” for healthy influencers. But while this buzzy drug is taking over, as is often the case, the downsides are often overlooked amid the fervor. Our dietetics team tells all.
So, just what is Ozempic?
Ozempic is a brand name for the injectable drug semaglutide. It is mainly used for people with type 2 diabetes due to its ability to reduce glucose levels, decrease risk of heart disease, and induce some level of weight loss1. The injection pen comes in 3 different holding capacities: 0.5mg, 1mg, and 2mg, and the dosage can range from 0.25mg to a maximum of 2mg2. This means that people can use the pen multiple times if their prescribed dosage is small. Wegovy is another brand name for semaglutide, but it only comes in a 2.4mg dose and is advertised for weight loss3. Essentially, they are the same thing: semaglutide, but just come in different dosages.
How does Ozempic work?
Your body releases a hormone called glucose-like peptide-1 (GLP-1) when you eat4. It increases insulin and makes you feel less hungry. Ozempic amplifies the effects of GLP-1 by slowing down stomach emptying, meaning that food stays in the stomach for a longer period of time, prolonging the feeling of fullness. This is important for people with type 2 diabetes because they need the additional insulin, and they need a way to control the amount of food that enters their bodies.
Why are people using this drug for weight loss?
If you’ve made it this far in the post, you can probably see why this has been such a “miracle drug” for weight loss. It’s obviously not due to the fact that it reduces blood glucose, or to the possibility of it “melting the fat away.” It’s because it suppresses hunger. When people don’t feel hungry, they don’t eat. And when they don’t eat, then they lose weight due to energy intake being less than energy expenditure. The Ozempic website explicitly instructs users to incorporate diet and exercise along with the usage of the drug1. However, people who are not obese and do not have type 2 diabetes are using this drug to lose weight without having to exercise or go on a specific diet. So, this drug has gained recognition for its ease of usage and effective results.
Are there any drawbacks to taking Ozempic?
Where do we even start with this? Before we get into the physiological health-related concerns, let’s talk about the logistics of even obtaining this drug. First and foremost, for a person to medically qualify for this drug, their BMI needs to be greater than or equal to 30, and they need to have a history of failed weight loss/diabetes control attempts. Keep in mind that a majority of people who are using this drug for weight loss likely have a BMI less than 30, but they have connections, personal doctors, and other resources that make this drug readily available to them. Ozempic costs about $1000 per pen5. So, when starting out, it’s going to be cheaper because someone on a 0.25mg dose can use a 2mg pen 8 times. However, as the usage continues, there is an increased dosage after a month to 0.5mg, and then eventually it will be necessary to take a 2mg dose every week. This means that the drug gets progressively more expensive the more it is being used. To do the math, someone who is on Ozempic from the 0.25mg to the 2mg doses, it would cost $7,500 over 4 months. People who have the disposable income may not flinch at this price, but for others, this may be equal to or more than paying rent multiple times. Luckily, for people who have type 2 diabetes, their insurance may be able to cover some portion of the cost. Another drawback is that Ozempic is currently only an injectable drug, and there are no oral versions on the market. It is designed to be a personal medication for people who need it and should not be shared. Sharing it as an injectable could transmit diseases through the blood.
There are physiological side effects and increased risk of disease when using this drug. As stated on the Ozempic website, common side effects are nausea, vomiting, diarrhea, stomach pain, and constipation. More serious side effects include pancreatitis, vision changes, hypoglycemia, kidney failure, allergic reactions, and gallbladder problems1. Because ozempic causes sudden weight loss, we should take time to get into that:
Effects of Sudden Weight Loss:
Let’s talk about malnutrition and the body’s response to starvation. When our body is in starvation mode, it becomes more adaptive to the environment. This means that the amount of calories needed to sustain the body decreases. In addition, the body starts to use fat as the main energy source to conserve glucose. Basically, your body burns fat when it is starving, and not that many calories are needed to do basic functions. Sounds like a dream, right? Well, it’s actually quite the opposite. When there is too much fat floating in the bloodstream, it could lead to ketoacidosis, which can lead to death if it doesn’t get resolved quickly4. It could also lead to gallbladder issues, pancreatitis, and fatty liver disease if the person is not regularly checking in with their doctor6,7. Malnutrition can be defined as inadequate nutrient intake, and it happens when people are not eating enough food, or they’re eating foods with low nutritional value. This leads to deterioration of healthy skin, nails, and hair, due to protein, iron, and other nutrient deficiencies. Of course, this only occurs in healthy individuals who undergo dramatic weight loss. For people with obesity, they are already intaking too many nutrients, so by losing weight and eating less, their body can still obtain a “normal” amount of the nutrients. People who use Ozempic should have consistent visits scheduled with their doctor in order to monitor their nutritional status and overall health to prevent any negative nutrient deficiencies.
The Aftermath
Ozempic is designed to be an easy-to-administer medication, to allow people with type 2 diabetes to do it from home. They are regularly following up with their doctors and have a physical activity and diet plan. For healthy people only using Ozempic for rapid weight loss, all they have to do is inject the medication without having to change their lifestyle. The catch is: once they stop taking the drug, they tend to gain all the weight back PLUS additional weight because the hunger signals come back tenfold. Remember how Ozempic helps to retain food in the stomach, causing people to feel fuller for longer? Now that those signals are no longer in the body, the stomach empties regularly, BUT the person hasn’t adjusted to the change. The signals get messed up now, and they will feel like they’re starving when they’re not. This can cause them to eat even more than they need and the weight can rapidly come back. The ideal solution is to use Ozempic while also incorporating a healthy diet and exercise regimen8. Making actual lifestyle changes alongside the use of Ozempic can optimize results and help with long term success. This way, once off the medication, the person is already used to eating less and exercising regularly which can build into sustainable wellness.
The Bottom Line is that in order to lose weight in a healthy manner, lifestyle and habit changes are necessary for successful long term weight loss. This drug is revolutionary in the health field for the people who struggle with changing life-threatening habits. It gives them the assistance that they need to reach their health goals. For people who are not in dire need to lose weight for their health, there are plenty of other, more sustainable strategies to get there. Maybe it’s not a medical approach that we should be taking to make us love our bodies, and instead, we should be focused on making more permanent lifestyle changes.
Written by: Brittney Dare, dietetic intern, and Reviewed by: Sarah Koszyk, MA, RDN.
References
1. What Is Ozempic®? | Ozempic® (semaglutide) Injection 0.5 mg or 1 mg. Accessed March 22, 2023. https://www.ozempic.com/why-ozempic/what-is-ozempic.html?&utm_source=google&utm_medium=cpc&utm_term=ozempic&utm_campaign=&mkwid=s-dc_pcrid_605526776129_pkw_ozempic_pmt_e_slid__product_&pgrid=141675575207&ptaid=kwd-392229870365&gclid=CjwKCAjwzuqgBhAcEiwAdj5dRpsCBNeZw57vbTgxJvoHveg5GlQYCI1Zt2jcBfhbFVRlTu_dvxbVAhoC5q0QAvD_BwE&gclsrc=aw.ds
2. ozempic.pdf. Accessed March 22, 2023. https://www.novo-pi.com/ozempic.pdf#guide
3. Wegovy® (semaglutide) injection 2.4 mg Official Physician Site. novoMEDLINK. Accessed March 22, 2023. https://www.novomedlink.com/obesity/products/treatments/wegovy.html, https://www.novomedlink.com/obesity/products/treatments/wegovy.html
4. Nahikian-Nelms M, ed. Nutrition Therapy and Pathophysiology. Third edition. Cengage Learning; 2015.
5. Ozempic Prices, Coupons & Savings Tips. GoodRx. Accessed March 22, 2023. https://www.goodrx.com/ozempic
6. Tsai JH, Ferrell LD, Tan V, Yeh MM, Sarkar M, Gill RM. Aggressive non-alcoholic steatohepatitis following rapid weight loss and/or malnutrition. Mod Pathol Off J U S Can Acad Pathol Inc. 2017;30(6):834-842. doi:10.1038/modpathol.2017.13
7. Ard J, Fitch A, Fruh S, Herman L. Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists. Adv Ther. 2021;38(6):2821-2839. doi:10.1007/s12325-021-01710-0
8. Smits MM, Van Raalte DH. Safety of Semaglutide. Front Endocrinol. 2021;12:645563. doi:10.3389/fendo.2021.645563