What’s the deal with Ozempic? (May 2023)
By Carrie Dennett, MPH, RDN
Unless you shut yourself off from the world, it’s nearly impossible to have not heard about Ozempic. In spite of that, I’m getting a lot of questions from people who are confused about exactly what it is, why it’s getting so much attention—and how to escape some of the chatter about it.
Ozempic is one brand name for semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist drug manufactured by pharmaceutical company Novo Nordisk. Under the brand name Ozempic, semaglutide was first approved by the FDA in 2017 for use in managing type 2 diabetes in adults via a once-weekly injection. Produced in the small intestine, GLP-1 is a hormone that’s released after we eat, stimulating the pancreas to make and secrete insulin, which helps manage our blood sugar levels. Semaglutide and other GLP-1 receptor agonist drugs mimic this hormone, but they also slow stomach emptying (which can make people feel full sooner) and blunt hunger signals coming from the brain.
When Novo Nordisk found that semaglutide resulted in weight loss in many patients, there was a rush to get it approved for that use. In June 2021, the Food and Drug Administration did just that, approving semaglutide under the brand name Wegovy for weight loss, with the intent that patients also eat a low-fat, low-calorie diet and exercise regularly.
To help manage diabetes, Ozempic is typically prescribed at a maximum dose of 2 milligrams per week, while Wegovy is typically prescribed at a maximum dose of 2.4 milligrams per week. Because Wegovy is in short supply, many healthcare providers (including cosmetic surgeons) have been prescribing Ozempic for “off label” use. That’s why you’re hearing more talk about Ozempic than you are Wegovy. This off-label use is a problem, because some people with type 2 diabetes—which is an actual health condition with serious complications that are directly caused by chronically high blood sugar—can no longer get the drug.
There’s been a lot of hoopla about celebrities, “socialites” and other people deeply invested in thinness using Ozempic to lose that “last few pounds.” There has also been media coverage of people in larger bodies using the drug to lose significant amounts of weight. In many cases, this weight loss comes at a price.
As with all GLP-1 receptor agonists, oral semaglutide is associated with gastrointestinal side effects such as nausea, vomiting, abdominal pain, and diarrhea that could lead to a kidney injury. Dizziness, increased heartrate, infections, headaches, and indigestion are other reported side effects. Major loss of lean muscle is another side effect, at rates that might be higher than the loss of muscle that happens with weight loss through any means—even when eating enough protein and doing strength building physical activity. This could be especially detrimental in middle age and older adults, who already have a more difficult time maintaining muscle tissue.
Semaglutide is expensive, and maintaining any lost weight (some people don’t lose weight) requires being on the drug for life, even though these drugs have not been on the market long enough to know what the long-term effects are.
The primary clinical trials assessing semaglutide for weight loss randomly assigned patients to take the maximum dose of semaglutide, or a placebo drug, for 68 weeks. The semaglutide patients did lose a significant amount of weight—although about 13% lost no weight or even gained weight. However, a follow up study one year later found that on average, patients who had been taking semaglutide (but no longer had access to it), regained two-thirds of the weight they had lost.
Anecdotally, some users have reported experiencing a ravenous appetite and rapid weight regain when they go off the drug. This isn’t surprising, because these are the body’s natural responses to starvation, whether due to intentional food restriction or unintentional famine. Some of these anecdotes are from women who took the drug to lose weight but did not want to stay on it for more than a year—confident that this would still allow them to maintain any lost weight, because their doctors told them the drug would lower their set point range. (The set point range is the weight range that your body tries to defend.) That’s not what ended up happening, because while the artificial early fullness and reduced hunger caused by semaglutide temporarily prevented the body from returning to higher set point range, the set point range itself did not change.
If you’re sick of hearing about Ozempic, you’re not alone. Back in March in her Substack newsletter, journalist and author Virginia Sole-Smith wrote the essay, “Can Mainstream Media Stop with the Lady Mag Pieces About Ozempic.” It’s worth a read. Also worth reading is Ragen Chastain’s piece on semaglutide and a similar drug on her Substack newsletter. Or, if you feel like you just want to set boundaries around reading or talking about this topic anymore, like you might be doing with diet talk, generally, then do what you need to do to take care of yourself.
References and Resources:
National Institute of Medicine. Glucagon-like Peptide-1 Receptor Agonists. https://www.ncbi.nlm.nih.gov/books/NBK551568/
Wilding JPH, Batterham RL, Calanna S, et al; STEP 1 Study Group. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Mar 18;384(11):989-1002. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
Wilding JPH, Batterham RL, Davies M, et al; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725
Ragen Chastain, “Weight Loss Drugs Part 3 – Wegovy and Tirzepatide”: https://weightandhealthcare.substack.com/p/weight-loss-drugs-part-3-wegovy-and
Virginia Sole-Smith, “Can Mainstream Media Stop with the Lady Mag Pieces About Ozempic”: https://virginiasolesmith.substack.com/p/can-mainstream-media-stop-ozempic-pieces