Ellie Cheale | Registered Dietitian (RD) BSc
Ozempic, the not-so-secret "Hollywood weight loss miracle", has stirred up quite a buzz on social media and among healthcare professionals. Opinions vary from it being the "future of weight loss" to concerns about potential harm. Deciphering fact from fiction can be daunting, but as a registered dietitian, I'm here to help shed light on the matter.
So, what exactly is Ozempic?
Ozempic is an FDA-approved Semaglutide injection designed to improve blood sugar levels in adults with type 2 diabetes. Generally administered weekly into the stomach, to be used alongside exercise to improve blood sugar levels. While it was quickly discovered that it may aid in weight loss, it's important to note that Ozempic isn't officially approved for this purpose.
Wegovy, another Semaglutide based drug, has FDA approval for weight loss at a higher dosage. Due to supply shortages, doctors turned to prescribing Ozempic for similar purposes. Both drugs are currently in high demand, with a contender called Mounjaro also awaiting FDA approval for weight loss.
How Ozempic works...
When we eat, our bodies release various hormones to aid digestion, including GLP-1, which signals when we're full. Ozempic's key ingredient, Semaglutide, mirrors GLP-1. Upon food entering the stomach, the body releases GLP-1 in the intestine, triggering receptors throughout the body. It stimulates insulin production, curbing blood sugar spikes, and slows gastric emptying, fostering a lasting feeling of fullness. Intriguingly, this hormone also communicates with the brain, taming hunger cravings. While our bodies can achieve this naturally, Ozempic amplifies this process, making it quite effective.
Does it actually work?
Yes, it really works.
A substantial study in the New England Journal of Medicine (2021) revealed that pairing Ozempic with diet and lifestyle intervention led to an average weight reduction of 15% over 68 weeks. In contrast, the placebo group experienced only a 2% weight reduction in the same period.
However, it's important to debunk the notion of Ozempic as a magical cure-all. It's not a shortcut to weight loss while maintaining the same habits. Instead, it empowers individuals to eat less, but it doesn't perform miracles on its own.
The concerns...
As with any medical intervention, there are potential side effects. Nausea is a common one, usually declining over time. Nonetheless, for some, it can be overwhelming, impacting their relationship with food and even water intake. There are also concerns from animal research about thyroid cancer and possible pancreatitis or gallstones associated with Ozempic use.
Moreover, the lack of long-term research is a significant gap in our understanding. While Ozempic offers hope, it's not a guaranteed remedy for obesity or diabetes. It's a tool that can make life easier for those in need but not without its nuances.
Concerns also extend to muscle loss. One study showed that up to 39% of weight loss with Ozempic may be muscle mass. Maintaining muscle mass is essential for strength, mobility, and overall health, suggesting a need for a high-protein diet and regular exercise alongside the medication.
For those adopting Ozempic without embracing a healthy lifestyle, there's a risk of nutritional deficiencies. The drug's intermittent shortages pose threats to individuals with type 2 diabetes.
Ozempic also has implications on body image. It presents a "quick fix" that might inadvertently reinforce damaging ideals of thinness, promoting the message that “thinner is better at any cost”. This messaging, especially in a world influenced by media, could negatively impact individuals, including children.
And then there's the issue of spin-offs—various similar products created in response to Ozempic's popularity, raising questions about their safety and efficacy.
The FDA's black label warning on Ozempic underscores its potential risks. While it can be transformative for those who need it, such as individuals with type 2 diabetes or considering invasive gastric surgery, veering from its intended purpose could be detrimental.
What Happens When you Stop Taking Ozempic?
When discontinuing Ozempic, the complexities of obesity persist. It's not a one-size-fits-all scenario. The diverse factors that contribute to obesity—environment, mental health, genetics—continue to influence weight regain. This was highlighted by a study in April 2022, showing that within a year of stopping Ozempic, individuals regained about two-thirds of their lost weight. It is predicted that if the study had continued for longer than a year, the participants would have regained all of the weight that they lost.
Stopping the medication can trigger an insatiable hunger due to prolonged undernourishment, often leading to more weight gain than the initial loss. Additionally, Ozempic can disrupt natural hunger signals, potentially fostering disordered eating behaviours, especially for those who have struggled with binge eating disorders.
Should You Take Ozempic To Lose a Few Pounds?
In my professional view, Ozempic doesn't align with the general population, particularly those with a BMI under 35 kg/m2 looking to "shed a few pounds". The potential drawbacks overshadow the benefits for this subgroup.
Individuals should be screened by their doctor or general practitioners and I believe there should be a stringent set of criteria for the utilisation of Ozempic in weight loss, possibly encompassing a number of factors such as:
Previous attempts with multiple weight loss interventions.
Presence of a medical condition or a heightened risk of developing one due to obesity.
A BMI exceeding 35 kg/m2.
Commitment to long-term use of the drug.
Comprehensive understanding of the associated risks.
If you're considering or currently taking Ozempic, it's essential to recognise that it's not a standalone solution. Seeking guidance from healthcare experts is paramount. Engaging with your doctor, a registered dietitian and possibly a personal trainer, can help establish healthier habits, safeguard against muscle loss, and ensure a nutritionally balanced diet that mitigates potential risks. Remember, successful weight management involves a holistic approach that extends beyond the medication itself.
References
McCrimmon et al., 2020 - Once-weekly semaglutide vs once-daily canagliflozin effects on body composition in type 2 diabetes: Diabetologia, 63, 473-485.
Wilding et al., 2021 - Once-weekly semaglutide in adults with overweight or obesity: New England Journal of Medicine, 384(11), 989-1002.
Wilding et al., 2022 - Weight regain and cardiometabolic effects after semaglutide withdrawal: Diabetes, Obesity and Metabolism, 24(8), 1553-1564.
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