Losing weight can be incredibly difficult, and anything that could offer a helping hand in the journey is worth investigating. There are a lot of purported solutions offered out there, from the questionable to the outright ridiculous, and it can be hard to sift through the junk for potentially truly valuable solutions. This article takes a closer look at a medication originally made for type 2 diabetics, marketed as Ozempic, to analyse whether or not it is an appropriate and effective way of aiding with weight loss.
Ozempic
Ozempic, the marketing name for semaglutide, is a drug which type 2 diabetics can be prescribed in order to help maintain regular blood sugar levels. It was developed by Novo Nordisk, a Danish pharmaceutical company, and is one of the longer lasting options in the GLP-1 receptor agonist class of medications. GLP-1 (glucagon-like peptide 1) receptor agonist drugs work by mimicking the GLP-1 hormone, which lowers blood sugar levels after eating.
It is neither a substitute for insulin nor insulin itself, but when glucose is present, it helps stimulate pancreatic release of insulin. It is not appropriate for type 1 diabetics, as in this condition, the pancreas is incapable of creating insulin in the first place.
How does Ozempic work for weight loss?
While Ozempic is a potentially useful drug for type 2 diabetics, GLP-1 medications, including Ozempic, have been found to have an effect other than controlling blood sugar levels – a useful side effect if you will. As well as increasing pancreatic release of insulin, those using Ozempic experience reduced appetites.
This is because there are GLP-1 receptors in the area of the brain which controls the appetite. This effect, in addition to Ozempic slowing gastric emptying, results in those taking Ozempic eating less, as a result of feeling full. It also has the potential to alter dietary preferences away from high fat foods, all of which can help with weight-loss through aiding with adjustment to a healthier diet.
Other GLP-1 medications traditionally used for treatment of type 2 diabetics, such as Saxenda, have been approved for use for weight loss. Ozempic has not yet been approved, however it has gone through several trials, and will very likely be approved for use in the very near future. When this happens, it will most probably be marketed under a different name. Until it’s approved, while Ozempic may be effective for weight loss, it can often only be prescribed for those who also suffer from type 2 diabetes.
Dosage and trials
For use with diabetics, a dose of either 0.5mg or 1mg is administered once a week. When used for treatment of type 2 diabetes, the dose is started at 0.25mg; after 4 weeks, the dose is increased to 0.5mg. After a further 4 weeks, if necessary, the dose may be increased to 1mg. This is the highest current dosage that is approved. Unlike some medications, it is not necessary to self-monitor blood glucose levels while adjusting Ozempic doses. For use with weight loss regimes, various different doses have been trialled, the trials of which are explored in more depth below.
Trial 1
One such trial took three groups, one group receiving 100mg of Januvia, a leading weight loss pill, the second group took 0.5mg Ozempic, the third group 1mg Ozempic.
The starting average weight in the groups was between 197 and 198 pounds. After the 56-week trial was over, the Januvia group had lost an average of 3.7 pounds, the 0.5mg Ozempic group had lost 9.2 pounds, and the 1mg Ozempic group lost 12.1 pounds. This study suggests that Ozempic is good for weight-loss, and that higher dosages are more effective, although the study did only experiment with a wide variety of dosages, only those currently deemed safe for use by pharmaceutical regulatory bodies.
Trial 2
Another study of 1,961 adults with a BMI of 30 or higher took two groups, giving one a placebo and the other 2.4mg of Ozempic. All of the individuals in the trial did not have diabetes at the start of the trial, although almost half were prediabetic. During a slightly longer timeframe than the first trial (68 weeks rather than 56 weeks) the results showed that the placebo group had achieved around 2.4% weight loss, compared with 15% in the Ozempic group. The most effective dose in trial 1, 1mg, achieved 6.1% weight loss, meaning that an increase to 2.4mg is seemingly more effective.
In this trial, the injection of Ozempic was combined with a healthier lifestyle – the drug was not the sole intervention. It is unlikely that there is a medication out there which can achieve healthy weight loss alone, and it is often the case that significant lifestyle changes are required in order to achieve your goals. More trials are sure to follow in the coming months and years, which will shed more light on which doses are the most effective.
In addition to weight-loss, this trial discovered a wide range of positive effects resulting from Ozempic weight-loss intervention. Among these were improved cardiovascular health, blood pressure, fasting lipid levels, and general quality of life. It is certainly positive to see that a weight-loss drug can have such wide-ranging positive effects, not just on weight but on overall health.
Potential benefits over the competition
Whereas many medications for weight loss require regular dosage, one benefit of Ozempic is that it only needs to be taken at most once per week. The long-lasting nature may be appealing to some – it’s more convenient, and means you’re less likely to forget. It is currently administered via injection however, which might not be as appealing to some. Injector pens are safe and easy to use, and subcutaneous injections are not at all painful, but for those with trypanophobia, oral options will undoubtedly be more appealing.
Semaglutide has been available as an oral drug since 2019, sold under the name Rybelsus, however this method of taking the drug has not undergone any trials with regards to weight-loss. Given time, the literature on the subject will doubtless expand; it is still comparatively early days, and as has been seen, studies which are to be of any real consequence take both significant time and resources to conduct.
While traditionally, weight-loss medications which aim to slow the appetite have been stimulants, Ozempic achieves appetite control through other means. Continual ingestion of stimulants does not suit everybody and can produce significant side effects. For those who find that stimulants affect them particularly negatively, this may mark Ozempic as a more preferable solution.
Who is it suitable for?
Not all causes of obesity are the same, and each cause needs a different approach. As such, Ozempic and other GLP-1 medications will be especially effective with certain groups of people.
Those who are diabetic or prediabetic, and those who are prone to insulin resistance are especially receptive to GLP-1 medications. In addition to that, people who keep eating as they don’t feel full, even after large meals, will find Ozempic to be particularly effective, as it will put a stop to a lot of that unhelpful appetite.
This isn’t an exhaustive group – there are certainly other people who could benefit from these medications, but these groups are most likely to see significant benefits.
Who can’t take Ozempic?
As with most medications, Ozempic does not suit everybody. It is not suitable for those with type 1 diabetes, as it is not a substitute for insulin, nor is it suitable for treating diabetic ketoacidosis. There have not been any studies to ascertain its safety when used during pregnancy, and it is therefore currently not recommended for those who are pregnant.
People who take Ozempic in addition to insulin or sulfonylurea may experience a higher risk of hypoglycaemia, a condition in which the blood glucose level dips below 72mg/dl. This does not mean that these individuals cannot take Ozempic however, and the risk can be reduced by lowering the dose of insulin or sulfonylurea while taking Ozempic. While adjusting Ozempic dosage, it may be necessary to self-monitor blood glucose levels, in order to minimise the risk of hypoglycaemia. This must, of course, always be a decision that is made by a healthcare professional.
Side effects
There are various side effects which have been reported during treatment with Ozempic. The most common of these are diarrhoea, vomiting, constipation, and abdominal pain. There are however more severe side effects, which are also far less common. These include an increased risk of medullary thyroid cancer, an extremely rare type of thyroid cancer, which was seen in rats during trials.
Another potential severe side effect is acute pancreatitis, which has been seen in those using GLP-1 receptor agonist type drugs. The symptoms of pancreatitis are similar to the side effects of Ozempic – abdominal pain, vomiting, nausea, and loss of appetite. If you experience any of these potential symptoms of pancreatitis, it’s imperative that you seek medical attention immediately. If it’s found that you do have pancreatitis, Ozempic treatment must not continue.
The studies on side effects have been carried out on doses up to 1mg, which is the dose that is currently approved for safe use. That the most promising results for weight-loss so far have been achieved using a dosage of 2.4mg means that new studies will have to be carried out on side effects potentially resulting from this significantly higher amount.
Side effects could take months or even years to become visible, so it could take some time for pharmaceutical regulatory bodies to decide whether it is safe or not. Should your medical provider choose to prescribe it off-label, be aware that Ozempic is not currently approved for use solely as a weight-loss medication, and you are to a certain extent acting as a Guinea pig. Results from trials which have taken place so far seem to indicate that higher doses will have similar side effects to lower, more widely studied doses, but only time will tell if these initial studies are truly accurate.
Other considerations
There are a few further things which you will want to consider when taking Ozempic, whether for weight-loss or type 2 diabetes. First of all, as Ozempic slows down gastric emptying, it is possible that this will alter the way that other orally taken drugs are absorbed by the body. If you are taking any other medications, it is important to consult your doctor to find out whether or not this has the potential to negatively affect those medications, effects which may be remedied through an altered dosage.
Secondly, alcohol consumption should be lowered, especially if you are also diabetic. Not only does alcohol affect blood sugar levels, further raising the risk of hypoglycaemia, it can also irritate your stomach. Combined with the fact that Ozempic is already known to cause gastric irritation, this can bring about remarkably worse side effects.
As it is a relatively new drug, you’ll want to disclose any medications you’re taking, including over the counter ones, to your doctor, who will be better able to judge if they will bring about further negative side effects.
It takes time
One of the key things to note about weight-loss is that to achieve it healthily and sustainably, it takes time. There is no wonder drug that can achieve weight-loss for you, and although the trials show that Ozempic may be highly beneficial in aiding with the process, the two trials mentioned above took place over a time frame of more than a year. In addition to that, these trials, in their methodology, note the importance of a holistic approach to weight loss.
Neither studied the effects of semaglutide alone, but rather in conjunction with significant lifestyle changes. The second trial mentioned above also involved individuals cutting their daily caloric intake by 500-kcal, and maintaining at least 150 mins per week of physical activity.
It is both unhealthy and unreasonable to expect significant results to be seen in a short time frame. Losing weight healthily is a complex process, and the aim should be to gain muscle mass and lose fat.
This can only be achieved through physical activity combined with a healthy diet, with appropriate macros in order to receive sufficient nutrition. A serious weight-loss program should always be done with consultation of a qualified dietician, who can help tailor make meal plans to suit your specific needs. Each person is different, and there is no generic approach that will work for everyone.
Alternatives
If you’re looking for another, similar drug for your weight loss needs, Saxenda (liraglutide), also produced by Novo Nordisk, is another GLP-1 medication. Unlike Ozempic, it is currently approved for weight loss, so it is possible that there are fewer risks to taking it, and it is much easier to receive a prescription.
If you are keen to try Ozempic, and are encouraged as to its efficacy by the various promising trial results, it is likely that it will be approved for use with weight loss sometime this summer, depending on where you are in the world of course. For those in America, the FDA is currently reviewing its safety and efficacy – the application was submitted by Novo Nordisk in early December of 2020, and the priority review designation means that it should take around 6 months for approval.
The advice in this article is intended for general research purposes only, and should not be used as a replacement for consultation with a qualified healthcare professional. Weight-loss is a complex process, and in order for it to be undertaken in a safe and sustainable manner, it’s imperative that short term solutions aren’t the goal.
Drugs like Ozempic may well be a valuable addition to lifestyle changes, but they are not wonder drugs, and should not be treated as such. They can also be expensive, and the side effects severe, so it’s important to weigh up the negatives and positives in a clear manner before committing to a long-term program.
The benefits from these types of programs start to become most apparent after a year or so, and should produce ongoing results into the future; it is not worth starting a course of a drug like Ozempic if you are not willing to commit to it in the long term, and you need to make sure that you are willing to live with the side effects.
Of course, that’s not to say that you cannot stop a course part way through, indeed this is sometimes necessitated by unforeseen circumstances such as rare side effects, rather, you need to do your research and make an informed decision. Ultimately, the last word will be with your doctor, but you can arm yourself with as much information through quality research as possible.
