Is Ozempic “Good” or “Bad?” Cutting through the noise and navigating the nuance of semaglutide injections
Have you heard of the “Ozempic Effect” yet?
If not, it may be only a matter of time before you do, and a recent podcast episode I recorded dives deeper into this topic of semaglutide injectables.
There is so much to talk about (and so much nuance!) in this topic that we couldn’t cover it all in one podcast episode, so this post provides more context and background to the conversation.
WHAT ARE SEMAGLUTIDE INJECTIONS AND HOW DO THEY WORK?
Semaglutides are are GLP-1 injectable medications, known commonly by the brand name Ozempic, among others (you may have heard of Wegovy or Mounjaro, which are the same drug with different names; there is also the daily version of liraglutide, Saxenda, also known as Victoza).
These GLP-1 drugs have sparked off quite a media sensation. They were originally approved by the FDA for treating Type 2 Diabetes. However, lately, they've been in the spotlight for off-label use as a weight loss aid. Some celebrities have been singing praises about their weight loss experiences with these medications, and this has sparked both curiosity and controversy, and coined the term “The Ozempic Effect” as celebrities have been seen walking down red carpets recently with marked weight loss.
And while we've seen some shifts towards promoting body positivity and diverse body types in recent years, the pressure to conform to certain body ideals is still prevalent. Diet pills, despite their sketchy history (that we touch on in the podcast!), remain a part of this narrative and it seems that weight loss injections can now be added to the list of attempts at a “magic elixir” to weight loss.
Semaglutide is a GLP-1 agonist, initially developed and approved by the FDA for the treatment of Type 2 Diabetes. Beneath the trade names Wegovy, Ozempic, and Trulicity, the active substance remains the same: semaglutide.
GLP-1 agonists function by mimicking the actions of the naturally occurring hormone GLP-1. This hormone plays a dual role in the body:
First, it stimulates the production of insulin, which is the hormone responsible for regulating blood sugar levels. Insulin is an essential hormone that enables our bodies to use sugar from the carbohydrates in the food we eat for energy or store it for future use. It also keeps our blood sugar levels from getting too high or too low. So, in people with Type 2 Diabetes, Semaglutide helps control their blood sugar levels and keeps them within a healthy range.
Second, it promotes feelings of satiety or fullness, effectively acting as an appetite suppressant. It’s this second function of Semaglutide - the promotion of satiety - that has piqued a lot of interest. Satiety is the feeling of fullness we get after eating, and it's one of the main factors that stops us from eating more. So, by mimicking the action of GLP-1 and promoting feelings of satiety, Semaglutide can help people eat less and thereby lose weight by creating a calorie deficit.
These combined effects not only manage blood sugar levels in diabetics but, when used off-label, can promote weight loss in non-diabetic individuals.
While the appeal for significant weight loss might be enticing, it's essential to consider the medical implications, side effects, and long-term effects of such use, and it's interesting to see how the narrative around these drugs has been shifting: once prescribed discreetly for diabetes management, semaglutide injections like Ozempic have now become almost a status symbol, driven in part by their association with Hollywood's elite and rumors of dramatic weight loss results.
THE UNKNOWN IMPACTS OF SEMAGLUTIDE INJECTIONS
Semaglutide injections are not inexpensive medications. With these drugs being co-opted as a weight-loss tool, there's a real risk of limiting their availability to those who genuinely need them for diabetes management.
Beyond accessibility, there's also the issue of safety and the lack of research on the long-term impacts of these drugs for weight loss. While some studies have shown promising results for weight loss in the short term, we simply don't know enough about what happens when someone uses these drugs for years, or even decades.
The trial that led to the approval of the high-dose semaglutide for weight management, called the STEP trial, only followed patients for 68 weeks. We need longer studies to fully understand the long-term safety and effectiveness of these medications.
Furthermore, we have to consider the potential risks and side effects. Semaglutide injections are not without them. The most common side effects are gastrointestinal and include nausea, vomiting, and diarrhea.
“The most frequently exhibited side effects from GLP-1 agonists include nausea, vomiting, and diarrhea that could lead to an acute kidney injury due to volume contraction. Dizziness, mild tachycardia, infections, headaches, and dyspepsia may also occur. Patients should receive counseling that this class of drugs increases satiety, and transient, mild nausea may occur if they attempt to eat while feeling full.”
Other side effects, although less common, can be serious. A study published in the British Journal of Clinical Pharmacology in 2019 showed that GLP-1 agonists, including semaglutide, could cause an acute kidney injury due to volume contraction from vomiting or diarrhea. Other potential adverse effects include retinopathy, which is damage to the retina of the eyes, causing visual impairment.
In addition to these more severe side effects, there are also common symptoms that, while not life-threatening, can significantly interfere with people's daily lives. These include nausea, abdominal pain, and cramping.
And what about long term success with semaglutide injections?
According to a paper published in Diabetes, Obesity and Metabolism in April 2022, patients on a 2.4mg dose of semaglutide regained two-thirds of the weight they had lost in the first year after stopping the medication.
What's even more concerning is that the study found that those who had lost the most weight on the medication ended up gaining the most weight back.
Another key issue to consider is the potential risk of muscle loss. A study published in Diabetes, Obesity and Metabolism showed that GLP-1 agonists could cause loss of lean body mass. For people attempting to lose weight, it's important to maintain as much muscle mass as possible. The loss of muscle mass can decrease metabolic rate and make it harder to maintain weight loss. Muscle loss is a common effect alongside weight loss so I currently look forward to more research in this area to better understand if semaglutide plays a role in more significant muscle wasting than other weight loss methods that are more sustainable (namely, a calorie deficit and adequate protein intake).
WHAT ABOUT HABITS?
Medications do not address an essential aspect of weight management: lifestyle habits. Weight loss is also not the only worthwhile goal, nor is it one we should work towards perpetually.
Relying on a medication for weight loss often overlooks necessary skills and habits we must develop for long-term weight management. While semaglutide can help to reduce appetite, that does not necessarily cross over into developing awareness around portion control, food choices, regular movement, or other key elements of maintaining supportive habits.
The use of semaglutide injections are a physical intervention that don’t necessarily encourage the psychological and behavioral changes needed for sustainable weight management, but I don’t believe that means there is no place for these medications at all.
SO, IS OZEMPIC GOOD OR BAD?
As always, there is nuance to this question. I believe nuance is a great thing as it allows us to move away from restrictive absolutes and recognize again and again that there is no one size fits all approach to our health.
It's vital that we recognize that these drugs were not designed as weight loss solutions for the general population, but as a method of diabetes management, and we do not know the long term impacts of leaning on GLP-1 agonist medications as a mechanism for long-term weight loss
I believe there is a place for semaglutide injections in individuals who can utilize medication alongside working through habit changes and potentially also consulting with a mental health specialist to work through their relationship with food and body image. I have read many hopeful stories from those who used Ozempic (or Wegovy, Trulicity, Mounjaro, etc.) to “kick start” weight loss and work on more long-term habits, knowing that any long term success with GLP-1 drugs requires either staying on the medication or significant lifestyle changes once off medication.
With the help of knowledgeable practitioners and follow up support, I see a place for these medications among certain populations navigating metabolic syndrome or other weight-related health challenges.
But more often than not, we don’t see the situation above frequently. Instead, it seems that semaglutide injections are being offered at routine PCP appointments, in med spas and nail salons, to those with normal weight (here the use of “normal” refers to weight status as used in medical appointments), and with very little support or follow up. This is where these medications fall short: in the use of an appetite suppressant rather than any behavioral interventions for a change in body weight but not much beyond.
Anecdotally, it is easy to find both positive and negative experiences with Ozempic (or other semaglutide), but the take-home message is that weight loss and management are complex and multifaceted. While some populations could benefit from the use of semaglutide injections, what is far more problematic is the constant rhetoric on social media and from Hollywood that semaglutide injections can be a quick fix for appetite suppressant and subsequent quick weight loss in individuals who would benefit far more from lifestyle interventions. There's no quick fix, and a holistic, evidence-based approach is vital to the way we approach our health.
A few other interesting additional opinions regarding the use of GLP-1 agonists as weight loss aids:
“Ozempic for Weight Loss: A Good Option?” - this opinion piece by dietitian Abby Langer details more about the use of Ozempic as a trend on social media
“The Myths of GLP-1 Agonists” - a podcast episode from Drs. Karl and Spencer Nadolsky who are medical professionals in favor of the use of semaglutide for some individuals
Drugwatch page: Ozempic and Ozempic Side Effects