A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to take a look at how effective at weight reduction it actually is and just how bad the unwanted 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. Trigger warning: discussions of weight reduction numbers, eating disorder behaviors

Ozempic and other weight reduction medications like Wegovy, Mounjaro, Trulicity and Rybelsus are a hot topic straight away.

Celebrities are publicly attributing their weight reduction to those medications (Oprah being the most recent one as I’m writing this). Doctors are prescribing them left and right for weight reduction (and every other ailment you may 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 consequently.

From news headlines to TV advertisements to water cooler talk, Ozempic is in all places. As a non-diet, weight-inclusive dietitian, I need to ensure that that I’m empowering my clients and my community with all of the evidence-based information we have now (and highlight what we don’t have) so that you would be able to make an informed decision on whether or to not take these medications. It’s not my role to influence you (because I think in your agency and body autonomy) but it surely is my role to teach and inform, which I hope to do here.

I’d never, ever shame or judge someone who decides to take these medications. It will make sense when you decide to take them or are fascinated 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 on this post and am highlighting what the research shows us on weight reduction (how much weight you’re actually prone to lose – hint: it’s not as much as you may think), what the known unwanted side effects are, and why you ought to be careful about where you’re accessing these meds from.

What’s GLP-1?

These weight reduction medications fall right into a class of medicines called GLP-1 agonists. GLP-1 is glucagon-like peptide, also referred to as an incretin. Incretins are secreted within the small intestine and help to extend insulin, decrease glucagon and decelerate gastric emptying (i.e. digestion), all of which help to administer blood sugar. With incretin, glucose can slowly enter the bloodstream as a substitute of being flooded with it.

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

What’s semaglutide?

Semaglutide is the generic name for the lively ingredient in Ozempic and Wegovy. Ozempic and Wegovy are only the brand names. Ozempic is FDA-approved for the treatment of diabetes, and in 2021, Wegovy became FDA-approved for the treatment of weight reduction. Each are essentially the identical medication only Wegovy has higher doses of semaglutide. 

Once Wegovy became FDA-approved for weight reduction, it quickly went into shortage after which doctors began prescribing Ozempic off-label (meaning prescribing it for something aside from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages quickly followed suit.

The issue with that is Ozempic and other GLP-1 and GIP agonists FDA-approved for diabetes treatment aren’t attending to the individuals who need them essentially the most and might have serious health ramifications for those with diabetes.

Semaglutide remains to be 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 results in 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 during the last three months. Studies show these medications may also help lower A1c levels by 1 – 2.4 percentage points and might reduce the danger of cardiac events, no matter weight changes.

5 things it is best to learn about Ozempic and Wegovy (and other GLP-1 agonists)

1. It’s possible you’ll or may not drop pounds with Ozempic and when you stop taking it, you’ll probably gain the load right back.

Not everyone loses weight taking these medications, which is vital to notice, otherwise individuals who don’t drop pounds on these meds are left feeling like failures. 

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

When looking solely on the STEP trials, results show that 80% of individuals taking these medications lose some amount of weight. So about 20% of parents who take these meds won’t lose any weight. For individuals who do drop pounds, on the very least, they’re losing about 5% of their body weight (that’s about 10 lbs for somebody who weighs 200 lbs).

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

But let’s bear in mind that these trials weren’t only funded by the maker of the medications but in addition had quite a lot of exclusion criteria. People couldn’t join these studies in the event that they were depressed, had any existing cardiovascular issues, and in the event that they were females of childbearing age with no highly effective contraception method, just to say just a few.

If you take a look at other trials on semaglutide, without the pharma funding and extensive exclusion criteria, the outcomes are less impressive. Only 40% of parents are losing at the very least 5% of body weight. Taking a look at a meta-analysis (review) of RCTs, most weight reduction totals hovered around a median of 8-10 lbs, with just a few studies showing more significant weight reduction, around 25-40 lbs.

In case your goal is to lose about 5-10% of your body weight then these medications might allow you to get there but when you are in search of more dramatic weight reduction, these meds probably won’t allow you to meet your goals. 

It’s also vital to acknowledge what happens once you stop taking the medications. Because possibly your insurance will stop covering it, or you possibly can not afford it, or there’s a shortage, etc.

Studies have checked out what happens once you take someone off semaglutide and replace it with a placebo and located that weight regain happens in a short time. Inside a yr, people regain just about all of their weight lost, even while still doing behavioral interventions like nutrition, exercise, and cooking classes.

Sounds very much like all of the research on what happens to your weight when you stop doing a weight-reduction plan (you gain it back).

2. Ozempic comes with very unpleasant unwanted side effects.

Studies show that a spread of 60% as much as 93% of individuals taking these medications will experience some unwanted side effects – essentially the most common being gastrointestinal distress. These unwanted side effects may include nausea, vomiting, diarrhea, constipation, GERD, and abdominal pain. For most individuals, severe GI symptoms should resolve inside just a few days and more mild GI unwanted side effects often resolve inside 8-12 weeks.

These medications also include a black box warning that they’ll increase the danger of thyroid tumors. This is predicated purely on studies done in rodents so we don’t understand how that extrapolates to humans, yet. There are human studies being conducted now but we won’t know the outcomes until 2035 on the earliest. For this reason these medications are contraindicated for those with a family history of thyroid tumors. 

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

After which there’s the aesthetic reported side effect individuals are talking about, “Ozempic face”. In consequence of rapid weight reduction (for some) and sure not getting adequate nutrition, people report having loose skin on their face and a hollowing under the eyes and near the temples. This appearance can also be seen in those affected by malnutrition.

3. There may be a shortage of those weight reduction drugs, which is leading compounding pharmacies to create versions that are usually not approved or regulated.

When a drug goes on the FDA drug shortage list, the FDA allows compounding pharmacies to combine up their very own version of the drug with none FDA approval or screening.

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

So these pharmacies are selling medication and calling it semaglutide but it surely’s really something else. It is perhaps a watered down version of it or it is perhaps something called semaglutide sodium or acetate, the salt types of semaglutide, which haven’t been shown to be protected or effective in humans, or it is perhaps something else all together.

If you wish to take a weight reduction medication, get a prescription out of your doctor and secure it from a licensed pharmacy. Stay far-off from wellness centers, spas, or telehealth providers touting these medications at a low price.

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

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

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

It’s vital to weigh this when deciding to take the medication – you just can’t know what the security or efficacy is of taking Ozempic long-term. What we do know is that if you wish to have a shot at maintaining your weight reduction, you should have to remain on it long-term.

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

This medication ultimately puts you out of touch along 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 may exacerbate and fuel already restrictive eating patterns, and result in potential nutrient deficiencies.

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

After which there’s the impact of weight changes in your mental health. When you don’t drop pounds taking the medication, you could go to extremes to limit your food intake. Or shedding weight may trigger you to wish to lose much more, fueling more restriction. Or when you lose significant weight after which gain all of it back when you come off the medication, that change in body appearance may cause emotional distress and result in disordered eating.

In the identical way I wouldn’t recommend a weight-reduction plan or intentional weight reduction to folks with an lively eating disorder, a history of an eating disorder, or disordered eating, I wouldn’t recommend these weight reduction medications either. It reinforces the concept thin is best and ends in inadequate nourishment and nutrition.

When you are struggling to get adequate nutrition while taking considered one of these medications or are debating on taking considered one of these medications and would really like more individualized nutrition support, our team would like to allow you to. 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://maintenancephase.buzzsprout.com/1411126/13747346-ozempic

Eating Disorders & Diabetes: A Give attention to Diabetes Medications Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Pro

For more blog posts like this try:

Easy methods to Set Sustainable Health Goals For the Recent 12 months that Are Actually Sustainable

Am I Eating Enough? 8 Signs You’re Undereating 

Is Intuitive Fasting Really Intuitive or Is It Just One other Diet?

What Is Orthorexia? When Healthy Eating Becomes Obsessive