You’ve likely seen the commercials during the nightly news — you know, the ones proclaiming “O-O-O-Ozempic!” to the catchy 1974 tune “Magic” by the band Pilot. Those ads highlight a diabetes medication that’s been getting a lot of attention lately because of its nearly magical ability to help some people lose significant amounts of weight.
Essentially, Ozempic makes you eat less, though the exact mechanism isn’t clear, explains Dr. Heather Martin, a family medicine physician based in Tennessee. The medication, however, keeps the stomach full for longer, which reduces appetite.
Ozempic also affects gut bacteria, which can help with weight loss, says Dr. Neil Paulvin, a board-certified doctor in family practice and regenerative medicine in private practice in New York City.
Trials of this class of medication have shown it can help users shed 10% to 15% of their total body weight, he adds.
[READ: Weight Loss Plateau: How to Break Through.]
How Does Ozempic Work?
“Ozempic is semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist,” explains Dr. Andres Acosta, who is an assistant professor of medicine, a consultant in gastroenterology and hepatology and the director of the nutrition obesity research program at Mayo Clinic in Rochester, Minnesota.
Semaglutide and other GLP-1 medications mimic the function of a hormone called glucagon-like peptide 1. In response to the rise in blood sugar you experience after eating a meal, GLP-1 receptor agonists help the body produce more insulin to keep those blood sugar levels from spiking.
Martin, who is also medical director of the primary care program at K Health, a virtual primary care practice headquartered in New York City, says this medication is delivered as a once-weekly injection that you administer yourself. “That may sound a little scary, but the device makes it easy,” she explains. “You just put the tiny needle against your skin and press a button, and it’s over in an instant with just a little pinch.”
Martin also uses Ozempic herself. “I was the first K Health patient who started on Ozempic,” she recalls. “Since I started taking it, it’s hard for me to finish all the food on my plate, which is a new and welcome change for me.”
There are other medications in this class of drugs, including Wegovy, which is the exact same compound, semaglutide, just at a higher dose. While Ozempic is approved for the treatment of Type 2 diabetes, Wegovy is used for obesity management.
Ozempic lowers blood sugars “independently of its effect on weight, but its ability to help individuals lose weight has made it appealing to non-diabetics as well as diabetics,” explains Dr. Joe Barrera, an endocrinologist at Providence Mission Hospital in Orange County, California. “It can be easier and less expensive to obtain through insurance overage compared to Wegovy, (which) has led to a large number of off-label prescriptions to non-diabetics.”
In all instances, you should discuss your options with your doctor. Your physician “can determine if Ozempic or an alternative medication, such as Wegovy, may be a more appropriate choice,” Barrera adds.
[READ: How to Safely Lose Weight Fast.]
Efficacy
Ozempic and other semaglutide medications work for many people, but your results may not be the same as someone else’s, notes Acosta, who is also the co-founder of Phenomix Sciences, a precision obesity biotechnology company based in Excelsior, Minnesota.
“We know from the years of work we have done at Mayo Clinic and the studies of each of these medications that not all patients respond to them,” he says. “Thus, it is essential to develop tools to identify the best responders to each obesity intervention.”
To that end, Acosta says that the National Institutes of Health is supporting ongoing work at Mayo Clinic to develop real-world evidence for how to identify “the best responders for obesity interventions. We recently identified that patients with abnormal postprandial satiety, also called ‘hungry gut phenotype,’ are the best responders.”
Figuring out how to identify hungry gut phenotypes before prescribing medications is the next frontier in their research, he adds. “Our Mayo Clinic spinout company, Phenomix Sciences, is working on the first-of-its-kind hungry gut response test,” Acosta explains. “They have been able to develop a test that tells providers that ‘yes,’ a patient will respond, or ‘no,’ a patient won’t respond to a given intervention. This is a big step forward for the field of obesity and for patients because for the first time, patients are being told what kind of obesity they have and how it should be treated.”
Martin says that “as a prescriber, I’ve seen patients’ health improve dramatically because of their weight loss.” Some have seen improvement in blood pressure, cholesterol and energy, along with other benefits. “Obesity is correlated to a lot of serious chronic diseases,” she adds, “and being able to treat and manage patients for these conditions in the primary care setting is important.”
In her own life, Martin says this new class of medications has been a game changer. “I have been overweight since medical school and have tried different diets and health programs, but even when I managed to lose weight, it always came back,” she explains. “My blood pressure and cholesterol were elevated, and I had sleep apnea, meaning my breathing would stop and start without notice while sleeping. It’s a potentially serious condition that can contribute to high blood pressure, fatigue and heart problems, among other negative health outcomes.”
Because of the sleep apnea, “(I) wore a sleep apnea mask every night and I was tired every day,” Martin recalls. “I didn’t have a ton of energy to play with my kids, and I was starting to develop back and joint problems from the wear and tear of carrying more weight around than my 5’4″ frame could easily support.”
But since she started taking semaglutide, Martin has lost 16% of her body weight and says she feels better than ever. “My BMI is no longer in the obese or overweight range. I’m eating a healthier amount and staying more active, and I have an easier time playing with my kids. I also have stopped having to use my sleep apnea mask, a huge, welcome change to my quality of life.”
[READ: How to Calculate Weight Loss Percentage.]
Safety and Possible Side Effects
Before you start Ozempic or another semaglutide medication, it’s important to know what the possible side effects could be. Paulvin says that even if you’re just going to be on it for a few months, it’s important to understand that there will be side effects when you start it.
Acosta notes that Ozempic has been approved by the FDA because this medication and others like it have been found to be safe during clinical studies. However, every medical intervention brings the potential for side effects, and Ozempic has some drawbacks. The most common side effects of semaglutide medications include:
— Nausea.
— Vomiting.
— Diarrhea.
— Constipation.
Starting at a lower dose and slowing increasing the dosage could help ward off some of these common side effects. “Sometimes we even decrease dosage if the side effects become unbearable,” Martin says.
Paulvin adds that people taking Ozempic should shift to eating “two or three smaller meals a day,” rather than fasting. Opting for lower-carb, higher-protein meals can also support healthy, sustainable weight loss with Ozempic. “Most people can use about two-thirds of the amount of food they normally would,” he says.
Less commonly, some patients who are taking other medications for diabetes may experience hypoglycemia, or very low blood sugar levels. If you have diabetes and start taking a semaglutide medication, be sure to check in with your doctor regularly to monitor your progress.
Paulvin adds that some patients may see some muscle loss as part of their overall weight loss on Ozempic. To offset this, he instructs patients to consume adequate amounts of protein and to engage in weight-bearing exercise regularly to maintain as much muscle as possible.
Patients with a personal or family history of medullary thyroid cancer or a rare condition called multiple endocrine neoplasia 2 should not take these medications, Acosta says. Those with a history of chronic pancreatitis should also give it a miss, Paulvin adds.
For her part, Martin says she has not experienced any side effects from Ozempic. “I started at 0.25 milligrams for my first four weeks. I increased to 0.5 milligrams and was at that dosage for four weeks. I’m taking 1.0 milligrams and will probably stay on this dose for as long as I continue to lose weight.” She notes that the maximum dose of Ozempic is 2.0 milligrams.
So-called “Ozempic face,” or a loss of fat in the face that can lead to a gaunt appearance, sagging skin and more obvious wrinkles, is not officially listed as a side effect of the medication, but some users have reported looking older after taking Ozempic for a while. This is a natural consequence of losing fat, Paulvin says, because the body sheds fat from all over, not in just specific places. “People who are using it more for cosmetic reasons need to understand the pluses and minuses there,” he notes.
Supply Shortages
Because Ozempic has gotten so much attention for its weight loss results, there’s been a vast and growing demand for the medication from the more than 41% of Americans with obesity. This has led to an ongoing shortage of the medication, meaning that some patients with Type 2 diabetes have had difficulty getting their prescriptions filled.
Acosta says that as of February 2023, “it’s my understanding, based on communications from Novo Nordisk, that the short supply issues are resolved.”
Still, it may be a while until that improvement trickles down to your local pharmacy. “I’m hearing two to three months minimum,” before the shortage is resolved, Paulvin says. However, even that might be an optimistic outlook. “Demand is going up, and I think with the summer coming up, I don’t think that shortage is going to alleviate anytime soon,” he adds.
Who Should Use Ozempic?
While Wegovy, the other semaglutide medication, is approved to treat obesity, the FDA approved Ozempic for use specifically in people with Type 2 diabetes. Weight loss is a secondary effect of the medication, though, so it is sometimes prescribed off-label to manage obesity.
“Obesity is a chronic condition, like Type 2 diabetes, and should be treated as such,” Martin says. Because being overweight has been associated with a range of chronic conditions, including Type 2 diabetes, hypertension and kidney disease, “safely and sustainably managing your weight is an essential part of keeping you healthy for the long haul,” she explains. “The new class of GLP-1 receptor agonists is a safe, effective way to do so.”
However, Paulvin says you shouldn’t plan to be on Ozempic for the rest of your life unless you have diabetes. Despite its effect on weight loss, Barrera also advises reserving this drug for its intended use in patients with diabetes.
Ozempic shouldn’t be viewed as a stand-alone solution either. Acosta notes that “it’s important to mention that this medication and other medications need to be part of a multidisciplinary lifestyle program that includes diet, exercise and physical activity.” Pharmacological interventions like Ozempic are just one piece of a puzzle, but they can be powerful tools to “help fight back the metabolic adaptions that occur with a low-calorie diet.”
Martin adds that Ozempic is not for just anyone who wants to try to drop a couple pounds for their high school reunion. She says K Health has strict criteria for prescribing GLP-1 agonist medications to ensure they’re only going to patients who really need them.
“Patients must have a BMI over 30, or a BMI over 27 with one associated condition like hypertension or Type 2 diabetes, and have been unable to lose and keep off weight with lifestyle changes alone (diet, exercise),” says Martin. “We also do a full intake, which includes blood tests, to ensure you’re a good fit.”
You can calculate your BMI with this NIH calculator.
Lastly, Martin notes that “weight loss medication is not ‘cheating.’ Obesity is a chronic condition and is associated with many other chronic conditions that could be incredibly detrimental to your health. We are lucky that medication now exists to help treat it.”
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