Trigger warning: talk about weight loss, and images of weight loss.
For decades, we’ve been looking for a magic weight loss bullet.
Ozempic and these other GLP-1 inhibitors seem to be the closest things to it so far. But what is Ozempic, and if you want to lose weight, should you try it?
Let’s take a look.
There have been weight loss medications on the market before. Starting with amphetamines, which were addictive and dangerous, we then went on to produce drugs like Fen-Phen (caused heart damage and deaths, pulled from the market), Meridia (caused heart issues, pulled from the market), and Orlistat (causes oily stools, still available for those brave enough to take it).
In 2014, a drug called Contrave was approved. Contrave is a combination of naltrexone HCl – a narcotic blocker often used in people with alcohol and drug addictions, and bupropion, an antidepressant.
Contrave works in the brain’s hypothalamus to reduce hunger, and in the mesolimbic reward system in the brain, to reduce food cravings.
The drug isn’t without its side effects. Many users experience headaches, and the weight loss is minimal. The average weight loss with Contrave is around 5%, according to Spencer Nadolsky, D.O, who uses Contrave with patients for that purpose.
Because Contrave contains bupropion, it carries an increased risk for suicidal ideation, just like antidepressants that contain that same ingredient.
A study to evaluate Contrave’s effectiveness in weight loss and maintenance is apparently now in progress.
But the wheel of science keeps on turning, and there’s a new class of seemingly more effective weight loss drugs on the market. These are the GLP-1 receptor agonists, known by their trade names of Wegovy (semaglutide), Saxenda (liraglutide), and Ozempic (semaglutide).
The latest GLP-1 agonist medication, tirzepatide (trade name Mounjaro), seems to be the most effective GLP-1 agonist for weight loss yet, resulting in ‘substantial and sustained reductions in body weight’ in a 2022 trial.
Because of Ozempic’s popularity, this post is mainly about that drug in particular.
Semaglutide was originally prescribed for the treatment of diabetes, but doctors quickly noticed that the medication seemed to result in weight loss at higher doses.
In 2021, semaglutide was studied at 2.4 mg for weight loss versus 1 mg for diabetes, and resulted in around 15% weight loss at that dose. Wegovy was subsequently approved specifically for weight loss.
To qualify for these weight loss medications (at a reputable source), typically a person needs to be at a BMI of 27 or over, and even more importantly, have complications associated with clinical obesity. These can include high blood pressure, diabetes, and cardiovascular disease. This piece in Medpage Today talks about the efficacy of GLP-1 agonists and those conditions.
GLP-1 comes from cells in our intestines. These medications work like our own GLP-1, slowing down gastric emptying, helping with insulin secretion and sensitivity, and improving blood sugar regulation. They also work in the part of our brain that increases satiety and possibly food cravings as well.
Basically, these medications completely tank your appetite, promoting fullness after a few bites. Some people complain that they’re never hungry at all.
Predictably, people are clamouring to get their hands on this medication for fast and easy weight loss. The influx of Ozempic before and after posts on social media, and people’s ability to secure the drug – without officially qualifying for it – from sources like medi-spas and certain doctors, seem to a big part of the craziness.
Ozempic can be an alternative to the more invasive weight loss surgeries. And, it appears to be safe so far. It isn’t actually FDA-approved for weight loss (Wegovy is), but that’s not stopping people from wanting to take it. And for some, it’s easy to get: Ozempic is being prescribed to completely healthy, normal weight people by medical ‘spas’ and some doctors.
Hollywood is apparently in a frenzy over Ozempic. According to this article in Variety, “Moguls, reality starlets, veteran film producers and, of course, actors are quietly singing the drug’s praises…hair, makeup and styling teams for celebrities have come to accept the injections as part of grooming rituals ahead of major events. In a matter of months, it has become the worst kept secret in Hollywood – especially given that its most enthusiastic users are not pre-diabetic and do not require the drug.”
Apparently, it wasn’t just exercise and diet that helped Kim Kardashian fit into Marilyn Monroe’s dress for the MET Gala – it was, you guessed it, Ozempic.
The already unattainable standard of beauty that Hollywood shows us is now even more impossible, and the trickle-down effect is that people who don’t qualify for the drug are using it to shed small amounts of weight and stay thin.
Ozempic isn’t without side effects. In some people, these include constant vomiting, diarrhea, and heart palpitations. If you’re getting this medication from someone or some place that’s not your actual doctor, this can be detrimental to your health, should you run into issues.
Compared to weight loss surgery, which depending on which type you get is at least semi-permanent if not permanent, once you stop Ozempic and other GLP-1 agonists, the weight you’ve lost comes right back. GLP-1 agonists like Ozempic appear to be a lifelong commitment, and that will cost you.
Hollywood might be able to afford them just fine, but for the average person, the cost of Ozempic and other GLP1 agonists — around $1000-$1500 a month – is pretty steep. Many insurance companies do not cover these medications, even for people who actually need them for diabetes or who could benefit from them for weight loss.
That’s a travesty all its own, since it’s just another way that fat people are discriminated against. We know that a certain segment of the population has tried and failed to lose weight using other methods, and their weight has tremendous negative effects on both their health and their quality of life. Still, their fatness is apparently not enough of an issue to warrant the coverage of effective medication to help them achieve weight loss and potentially avoid other health complications.
Why all insurance companies would not cover these medications for people who qualify is beyond comprehension.
The program Calibrate uses GLP-1 agonists along with a multidisciplinary holistic approach to weight loss. So does Sequence, Dr. Nadolsky’s clinic.
Ozempic leads to around a 15% weight loss. If you’re 200lb, this is a 30lb weight loss, which isn’t insignificant. But if you’re around a normal weight and want Ozempic to fit into a tight dress, that’s not okay, ethically or from a disordered thinking perspective.
Non-obese people taking Ozempic off-label for weight loss is likely contributing to scarcity issues with the drug for people who actually need it.
I get that a lot of people want to lose weight. I also get that many of those people need to lose weight in order to improve their health. Obesity is a chronic disease, and should be treated as such. We give people medications for other chronic diseases like high blood pressure, diabetes, and COPD. Why shouldn’t people with obesity have the option to take a medication for their condition that’s potentially life-changing?
For a heck of a lot of people, losing weight isn’t about just eating less and moving more. What someone weighs often has extremely complex inner workings that are genetic as well as environmental, behavioural, and socioeconomic. Especially for these people, taking a medication that actually works for weight loss can have a tremendous impact on their health and their life.
Ozempic and weight loss, in short.
I’m 100% not against using Ozempic for weight loss. But as a dietitian, I think it’s unethical that it’s being prescribed to people who don’t qualify. Just as someone wouldn’t have weight loss surgery to lose ‘vanity’ weight, there should be the same amount of vigilance around medications that are used for weight loss.
Allowing access to these drugs that’s basically unfettered for nothing except the purpose of vanity can promote a disordered view of food, eating and bodies. It perpetuates our obsession with thinness and sets an unrealistic standard for adults, kids, and teens who are vulnerable to what they see in celebrities and influencers.
It also supports the ‘weight loss at any cost’ narrative that is diet culture, and I find that morally wrong, as I do taking medications away from those who need them to survive.
The side effects of these drugs can be intense, and people who are taking them should be followed by their own doctor, not by some medi-spa. Medications – especially life-saving ones – should not be trendy.
I repeat: MEDICATIONS SHOULD NOT BE TRENDY. The very fact that Ozempic is a TikTok weight loss trend is sickening.
Let’s not forget one very important thing: neither weight loss drugs or surgery will help the underlying issues of why and what you eat. Remember that our food choices and relationships with food and our bodies are complex, and these definitely need to be addressed for long-term, meaningful weight loss.
It may be easy to think that taking Ozempic for weight loss will be enough. But it isn’t going to heal your relationship with eating. Just the opposite, more likely, especially if you’re taking it for vanity reasons.
All in all though, I think Ozempic and the other GLP-1 agonists are great options for those who fit the criteria. Without a doubt, these medications have changed the lives of thousands of people for the better. Unfortunately, the hurtful and dangerous stigma around obesity and fatness in general still exists.