Dan Feldman, RD, has contributed to information in this blog post.

In the constant quest for effective weight loss solutions, the pharmaceutical world has introduced a new player: Ozempic. Initially a diabetes medication, now it’s being gaining attention to help with weight loss. But is this truly the holy grail of weight loss? In this article, we’ll dive into what Ozempic is, how it works, its pros and cons, and what you need to consider before using it.

Understanding Ozempic

Ozempic is the brand name for a drug called Semaglutide; other brand names for different semaglutide formulations are Wegovy and Ryebelsus. Ozempic was originally a drug created for diabetes management, to help people control their blood sugar levels (keep them lower). The drug was very effective at this, and interestingly researchers were also finding consistent weight loss.

How Does Ozempic Affect Weight Loss?

Semaglutide belongs to a class of drugs called GLP-1 receptor agonists, which mimic the effects of a hormone called glucagon-like peptide-1 (GLP-1) in the body. GLP-1 regulates blood sugar levels by increasing the production of insulin – the hormone that brings blood sugars down, and inhibiting glucagon – the hormone that increases blood sugar release from the liver. GLP-1 also helps reduce appetite. 

GLP-1 affects the brain’s hunger center, leading to reduced appetite and increased feelings of fullness. This unique mechanism of action has earned Ozempic the spotlight as a potential game-changer in the world of weight loss. GLP-1 also slows down gastric emptying (slows down food moving from your stomach into your intestines to be digested), making you feel “full” longer than you normally would. This helps increase the time between meals and snacks where you might feel hungry.

Essentially, semaglutide helps people adhere to a reduced-calorie diet.

Dosing

Ozempic is typically administered once weekly through a subcutaneous injection. The recommended starting dose is 0.25 mg, gradually escalating to the maintenance dose of 1 mg to optimize both glycemic control and weight management. The injection is easy to self-administer, involving a small, thin needle that delivers the medication under the skin, usually in the abdomen or thigh. The once-weekly format not only simplifies the regimen but also enhances adherence, offering individuals a convenient and effective means of incorporating Ozempic into their weight loss journey.

The Pros of Ozempic for Weight Loss

• Appetite Suppression: By reducing appetite and increasing fullness, ozempic can make it easier to make healthier food choices and avoid overeating.
• Steady Weight Loss: Studies that have used Ozempic have shown that individuals using Ozempic experience steady and sustainable weight loss over time as long as they continue to use it.
• Improved Blood Sugar Control: For individuals with type 2 diabetes, Ozempic offers the added advantage of better blood sugar control. By facilitating both weight loss and blood sugar control, it can greatly benefit individuals with type 2 diabetes.
• Potential Cardiovascular Benefits: Some research suggests that Ozempic might improve heart health, by reducing the risk of cardiovascular events. As individuals with obesity are often at higher risk for heart-related issues, the cardiovascular benefits are crucial.

The Cons of Ozempic for Weight Loss

• Side Effects: As with any medication, Ozempic has potential side effects – possibly higher than other medications. These side effects include nausea, vomiting, diarrhea, abdominal discomfort, and acid reflux. While these side effects often subside over time, they can be challenging to manage initially.
• Long-Term Safety: Researchers are still studying Ozempic’s long-term safety as a weight loss drug. Since Ozempic is a relatively new weight-loss drug, unforeseen risks might only become apparent after prolonged use.
• Injection: Patients administer Ozempic via injections. This aspect might be a hurdle if you fear needles or struggle with self-administration.
• Cost: Ozempic is expensive. In Canada each pen costs around $300 CAN, and is not usually covered by benefit plans. Each pen, depending on the individual’s dosing, lasts about a month.
• Loss of Muscle: While patients taking Ozempic experience significant weight loss, much of that weight loss tends to be muscle. Patients taking Ozempic should engage in weight-bearing exercise and eat a high-protein diet to minimize losses in muscle mass.
• Accessibility: In Canada it is not easy to get prescribed Ozempic by your doctor since Health Canada hasn’t approved it as a weight loss drug.

Permanent Weight Loss?

When discontinued, weight regain is possible — especially if you haven’t made any long-term lifestyle (diet and exercise) changes.

Is Ozempic Right for You?

Deciding whether Ozempic is right for you requires careful consideration. You need to consider your individual health circumstances, preferences, and the potential impact on your lifestyle. You should have open and honest discussions with your healthcare team, particularly your doctor and registered dietitian, and ensure they monitor and support you along the way. In Canada most Doctors won’t prescribe it unless you have a pre-existing health condition (e.g., diabetes, cardiovascular disease) that makes weight loss a priority; they don’t just prescribe it because you want to lose weight.

Mike’s had clients that have seen a lot of success with Ozempic, while others have had some pretty bad side effects (diarrhea, feeling nauseas whenever eating). Ozempic, and any formulation of semaglutide (e.g., Wegovy, Rybelsus), is not a standalone solution for weight loss, and shouldn’t be used in replacement of a balanced diet, regular physical activity, and sustainable lifestyle changes. You’re a good candidate for Ozempic if you have these foundational practices in place, but still struggle with weight management – especially hunger and cravings. And, If you do take Ozempic, it’s highly recommended to engage in weight-bearing exercise and eat a high-protein diet to minimize losses in muscle mass.

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References:

• Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus
• Anti‐diabetic drugs and sarcopenia: emerging links, mechanistic insights, and clinical implications
• Effect of oral semaglutide compared with placebo and subcutaneous semaglutide on glycemic control in patients with type 2 diabetes: a randomized clinical trial
• Once-Weekly Semaglutide in Adults with Overweight or Obesity
• Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1
• Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
• Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes
• Insulin degludec versus insulin glargine in insulin-naive patients with type 2 diabetes: a 1-year, randomized, treat-to-target trial (BEGIN Once Long)
• National Institute for Health and Care Excellence (NICE). Semaglutide for managing overweight and obesity: technology appraisal guidance. Published 2021.
• FDA. Ozempic (semaglutide) prescribing information
• The Discovery and Development of Liraglutide and Semaglutide
• Dieter, Brad. Overview of Ozempic. Facebook, 31 May 2023, https://www.facebook.com/10133821/posts/pfbid07iLakEUcmTWsP1KfsPcfMpTu66wq3oPC6yFWGqby4TiTdoX9WuWKA7oojjDibiSTl/?mibextid=cr9u03.