A drug known as Ozempic has gained a lot of notoriety in the weight loss world over the last 12-18 months. This drug, which was originally used as a glycemic control medication for diabetes, has recently been approved for weight loss by the FDA.
Despite the rise in popularity, there is still a lot of confusion about exactly what this drug does, and how exactly a diabetes medication is being utilized for weight loss.
What is Ozempic
Ozempic is a brand name for a drug known as Semaglutide. It also goes by the brand names names Wegovy and Rybelsus. This drug is part of a family of drugs known as GLP-1 drugs.
These drugs are designed to mimic a protein in the body known as Glucagon Like Peptide-1 (GLP-1). The GLP-1 protein is made by specific cells in the human gastrointestinal tract. These cells are known as L-cells and are located mostly in the lower GI tract, such as the lower ileum and the colon.
GLP-1 drugs, such as ozempic, were originally developed as a tool to help manage blood sugar among people with diabetes. It was developed as an alternative medication (or adjuvant medication) for insulin, insulin secretagogues, and drugs like metformin.
These drugs helped lower blood sugar through a few specific mechanisms:
- Increased insulin secretion from the pancreas
- Reduced how much sugar the liver put into the bloodstream (via reducing glucagon)
- Slowed gastric emptying, which makes glucose appear slower in the blood stream.
These drugs proved to be quite effective therapies for lowering blood sugar. For example, one randomized trial showed that GLP-1 receptor drugs lowered HbA1c levels by ~2-3% and sustained the reduction out to 40 weeks.
However, one of the most interesting findings in the early studies on glucose control was that the participants who utilized the drugs also lost weight, and it was not a small amount of weight. Some studies showed weight loss of up to 20-30 pounds. Which prompted more investigation into these drugs as weight loss agents.
How Does Ozempic Work for Weight Loss
Ozempic, and other GLP-1 drugs, have been studied fairly extensively for weight loss over the last decade or so, and we have learned quite a lot about them. I have to warn you though… things are going to get a little nerdy here.
There are several mechanisms by which these drugs result in weight loss, with MOST of the effect being related to hunger and satiety.
One of the first places to start here is the brain. GLP-1 has been shown to have effects in portions of the brain that manage hunger and feeding. This stuff can get REALLY complicated, even beyond what I can dissect, but the short story is that when GLP-1 levels increase they activate circuitry in the brain that makes us want to eat less. So, higher GLP-1 means the brain wants less food.
The next place to look is in the gut, where GLP-1 can slow gastric emptying which can often make you feel “full” longer than you normally would, which can delay periods between feeding as you are less likely to eat again if you feel full longer.
Now that we know how it works, let’s talk about how well it works…
Ozempic as a Weight Loss Drug
These drugs definitely can work for weight loss. If you look at studies across a wide range of people, we see a very wide range of answers. Some studies suggest weight loss as high as 10-20 pounds, while other studies suggest weight loss as moderate as 2-4 pounds. From my review of all the studies I could find, the real answer appears to be somewhere between 2-10 pounds of weight loss from these medications.
However, this weight loss doesn’t come without it’s list of side effects…
What are the Side Effects of Ozempic
Now… this is where things start to really come to light and I think needs A LOT more attention.
There are some very clear side effects and adverse events and they occur at quite shocking rates. Additionally, the weight loss itself may be problematic in some sense.
Let’s tackle adverse events/side effects first. They occur… a lot. I mean… a lot. And I can’t really sugar coat this at all. If you look across the randomized trials, the adverse event rates to me are fairly alarming.
Here is an example of one study done in adolescents. Individuals on a GLP-1 receptor drug reported the following:
- 65% reported nausea, compared to 16% of placebo
- 37% reported abdominal pain, compared to 6% of placebo.
- 22% reported vomiting, compared to 4% of placebo
- 31% reported dizziness, compared to 6% of placebo
- 12% reported heart palpitations, compared to 2% of placebo.
Here is another example in adults. Individuals on a GLP-1 receptor drug reported the following:
- 33% reported nausea, compared to 9.5% of placebo
- 23% reported diarrhea, compared to 7.3% of placebo.
- 12% reported vomiting, compared to 1.7% of placebo
These side effects/adverse events are fairly high when you examine other drugs and is definitely something to consider.
Another REALLY important thing to consider is how the weight loss occurs in these individuals. In one of the “landmark” studies that supported the use of this drug for weight loss, the individuals who were on the drug actually lost a meaningful amount of lean mass, not just fat mass.
Let me put a finer point on this. The average weight loss from the drug in one trial was ~8.4kg. Of that, ~60% was from fat mass and 40% was from lean body mass. And sadly, this has been shown in more than one study.
Yes. That is correct. A lot of the weight loss came from lean body mass. Now, that may not be the end of the world, but it is something to really consider. Especially when you look at the fact that lifestyle induced weight loss is usually ~90% of the weight loss is from body fat, even in extreme weight loss examples.
What Happens When You Stop Taking Ozempic
These drugs have transient effects and when they are withdrawn, the weight returns. This is the same that we saw with the appetite suppressant drugs in the 1990s and 2000s. The graphs looks basically identical, with the rebound being quite sharp. In fact, after ~68 weeks on the drug, roughly 40% of the weight is regained within 3 months of stopping the medication.
Is Weight Loss from Ozempic Permanent
The answer here is unfortunately no. Without making efforts to change habits, relying on medication to suppress appetite will only work while the medication is being utilized.
And, the issue here is that once you reach a target body weight, the indication for the medication should, in theory, not be present anymore. This means that there is no medical necessity for drugs after a substantial weight loss.
While Ozempic has gained popularity as a weight loss drug in recent times, the side effects of the drug and the long-term impact on health are still not well understood. The high rates of adverse events associated with the use of Ozempic for weight loss are concerning as more and more choose it over healthier methods of losing weight.
Additionally, the weight loss caused by this drug may not necessarily be healthy compared to weight loss achieved through diet and exercise. Therefore, it is essential to be cautious about the use of Ozempic as a weight loss drug until more research is conducted to better understand its long-term impact on health.