A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to take a look at how efficient at weight reduction it really is and simply how unhealthy the unwanted effects really are. We additionally cowl implications of the treatment scarcity and concerns for these with a historical past of an consuming dysfunction or disordered consuming. 
Set off warning: discussions of weight reduction numbers, consuming dysfunction behaviors
Ozempic and different weight reduction medicines like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching matter proper now.
Celebrities are publicly attributing their weight reduction to those medicines (Oprah being the newest one as I’m penning this). Docs are prescribing them left and proper for weight reduction (and another ailment you may deliver to the physician that they suppose is correlated to your weight). Sufferers with diabetes (for whom these medicines had been initially developed) can’t entry these meds as a result of there are shortages throughout the nation and their well being is struggling consequently.
From information headlines to TV commercials to water cooler discuss, Ozempic is all over the place. As a non-diet, weight-inclusive dietitian, I wish to ensure that I’m empowering my shoppers and my group with all of the evidence-based data we’ve (and spotlight what we don’t have) to be able to make an knowledgeable resolution on whether or not or to not take these medicines. It’s not my position to steer you (as a result of I imagine in your company and physique autonomy) however it’s my position to teach and inform, which I hope to do right here.
I’d by no means, ever disgrace or decide somebody who decides to take these medicines. It might make sense for those who select to take them or are fascinated about taking them given the anti-fat tradition we reside in and the strain from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve realized about these medicines on this put up and am highlighting what the analysis exhibits us on weight reduction (how a lot weight you’re really more likely to lose – trace: it’s not as a lot as you may suppose), what the recognized unwanted effects are, and why you need to be cautious about the place you’re accessing these meds from.
What’s GLP-1?
These weight reduction medicines fall into a category of medicines known as GLP-1 agonists. GLP-1 is glucagon-like peptide, also called an incretin. Incretins are secreted within the small gut and assist to extend insulin, lower glucagon and decelerate gastric emptying (i.e. digestion), all of which assist to handle blood sugar. With incretin, glucose can slowly enter the bloodstream as an alternative of being flooded with it.
It additionally stimulates satiety and fullness and helps you keep full longer, which is why the treatment is now getting used to regulate urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic identify for the lively ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the remedy of diabetes, and in 2021, Wegovy grew to become FDA-approved for the remedy of weight reduction. Each are primarily the identical treatment solely Wegovy has larger doses of semaglutide.
As soon as Wegovy grew to become FDA-approved for weight reduction, it shortly went into scarcity after which docs started prescribing Ozempic off-label (that means prescribing it for one thing aside from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages shortly adopted swimsuit.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes remedy aren’t attending to the individuals who want them essentially the most and might have critical well being ramifications for these with diabetes.
Semaglutide remains to be in scarcity as of penning this weblog put up in December 2023.
How do GLP-1 agonists assist these with diabetes?
In of us with diabetes, incretin’s results are diminished (by about 30%), which ends up in larger blood sugars and poorer blood sugar management. GLP-1 agonists assist management blood sugar and decrease A1c ranges, which measure your common blood sugar ranges during the last three months. Research present these medicines might help decrease A1c ranges by 1 – 2.4 share factors and might cut back the chance of cardiac occasions, no matter weight adjustments.
5 issues it’s best to find out about Ozempic and Wegovy (and different GLP-1 agonists)
1. Chances are you’ll or could not drop pounds with Ozempic and when you cease taking it, you’ll seemingly achieve the burden proper again.
Not everybody loses weight taking these medicines, which is vital to notice, in any other case individuals who don’t drop pounds on these meds are left feeling like failures.
The analysis on semaglutide for weight reduction largely comes from the STEP trials, randomized managed trials (RCTs) that are funded by, you guessed it, the pharmaceutical firm that makes this drug, Novo Nordisk.
When trying solely on the STEP trials, outcomes present that 80% of individuals taking these medicines lose some quantity of weight. So about 20% of oldsters who take these meds received’t lose any weight. For individuals who do drop pounds, on the very least, they’re shedding about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).
Roughly half of the oldsters who took this treatment noticed a extra reasonable weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of oldsters taking this treatment noticed a fairly substantial weight lack of 20% or extra physique weight (about 40 lbs weight reduction for somebody weighing 200 lbs). This extra substantial weight reduction is in fact what’s driving all of the hype and media protection on these medicines.
However let’s take into account that these trials weren’t solely funded by the maker of the medicines but in addition had a variety of exclusion standards. Folks couldn’t be a part of these research in the event that they had been depressed, had any present cardiovascular points, and in the event that they had been females of childbearing age with out a extremely efficient contraception methodology, simply to say a number of.
If you have a look at different trials on semaglutide, with out the pharma funding and intensive exclusion standards, the outcomes are much less spectacular. Solely 40% of oldsters are shedding at the least 5% of physique weight. Taking a look at a meta-analysis (evaluate) of RCTs, most weight reduction totals hovered round a mean of 8-10 lbs, with a number of research exhibiting extra vital weight reduction, round 25-40 lbs.
In case your objective is to lose about 5-10% of your physique weight then these medicines may assist you get there however if you’re in search of extra dramatic weight reduction, these meds in all probability received’t assist you meet your objectives.
It’s additionally vital to acknowledge what occurs once you cease taking the medicines. As a result of perhaps your insurance coverage will cease overlaying it, or you possibly can not afford it, or there’s a scarcity, and so forth.
Research have checked out what occurs once you take somebody off semaglutide and change it with a placebo and located that weight regain occurs in a short time. Inside a 12 months, folks regain virtually all of their weight misplaced, even whereas nonetheless doing behavioral interventions like diet, train, and cooking courses.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a weight loss plan (you achieve it again).
2. Ozempic comes with very disagreeable unwanted effects.
Research present {that a} vary of 60% as much as 93% of individuals taking these medicines will expertise some unwanted effects – the commonest being gastrointestinal misery. These unwanted effects could embrace nausea, vomiting, diarrhea, constipation, GERD, and belly ache. For most individuals, extreme GI signs ought to resolve inside a number of days and extra gentle GI unwanted effects normally resolve inside 8-12 weeks.
These medicines additionally include a black field warning that they will enhance the chance of thyroid tumors. That is primarily based purely on research finished in rodents so we don’t understand how that extrapolates to people, but. There are human research being performed now however we received’t know the outcomes till 2035 on the earliest. Due to this these medicines are contraindicated for these with a household historical past of thyroid tumors.
There are different very uncommon unwanted effects like pancreatitis, gallbladder illness, kidney harm, and suicidal ideation. The FDA additionally not too long ago added ileus to the record of unwanted effects on the label, which is when your bowel stops functioning and you may’t take away waste – it could actually solely be handled with surgical procedure and might be deadly.
After which there’s the aesthetic reported aspect impact persons are speaking about, “Ozempic face”. Because of fast weight reduction (for some) and sure not getting satisfactory diet, folks report having free pores and skin on their face and a hollowing below the eyes and close to the temples. This look can also be seen in these affected by malnutrition.
3. There’s a scarcity of those weight reduction medicine, which is main compounding pharmacies to create variations that aren’t accredited or regulated.
When a drug goes on the FDA drug scarcity record, the FDA permits compounding pharmacies to combine up their very own model of the drug with none FDA approval or screening.
However, right here’s the catch. Novo Nordisk has a has a patent on the semaglutide molecule and solely they will produce it till 2032 so compounding pharmacies don’t have entry to this lively ingredient.
If you wish to take a weight reduction treatment, get a prescription out of your physician and safe it from a licensed pharmacy. Keep distant from wellness facilities, spas, or telehealth suppliers touting these medicines at a low price.
4. There’s no long-term knowledge on Ozempic.
Let’s not neglect that we’ve NO long run knowledge on these medicine. Semaglutide was accredited by the FDA for diabetes remedy in 2017 and the longest research I discovered was follow-up with just a little over two years. We simply don’t know if there are any long-term unwanted effects. We additionally don’t know for those who keep your weight reduction once you keep on this drug long-term.
It’s an eerily comparable image to previous weight reduction meds like Fen-Phen and Ephedra, each of which had been hailed as miracle weight reduction medicine with no long-term knowledge and had been finally taken off the market due to irreversible critical hostile unwanted effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and dying.
It’s vital to weigh this when deciding to take the treatment – you merely can’t know what the security or efficacy is of taking Ozempic long-term. What we do know is that if you wish to have a shot at sustaining your weight reduction, you’ll have to keep on it long-term.
5. Ozempic might be harmful for these with a historical past of an consuming dysfunction or disordered consuming.
This treatment in the end places you out of contact along with your physique’s pure starvation and fullness cues, which is counterproductive to consuming dysfunction restoration and the intuitive consuming framework. It causes you to eat much less, which may exacerbate and gasoline already restrictive consuming patterns, and result in potential nutrient deficiencies.
For these with binge consuming dysfunction or who battle with episodes of binging, coming off the treatment can lead to vital upswings in starvation, which can make you extra inclined to binges.
After which there’s the affect of weight adjustments in your psychological well being. For those who don’t drop pounds taking the treatment, you might go to extremes to limit your meals consumption. Or reducing weight could set off you to wish to lose much more, fueling extra restriction. Or for those who lose vital weight after which achieve all of it again when you come off the treatment, that change in physique look could trigger emotional misery and result in disordered consuming.
In the identical approach I wouldn’t suggest a weight loss plan or intentional weight reduction to of us with an lively consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t suggest these weight reduction medicines both. It reinforces the concept that skinny is greatest and ends in insufficient nourishment and diet.
If you’re struggling to get satisfactory diet whereas taking considered one of these medicines or are debating on taking considered one of these medicines and would love extra individualized diet assist, our crew would love that can assist you. E-book a diet evaluation immediately.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
Consuming Issues & Diabetes: A Deal with Diabetes Drugs Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
For extra weblog posts like this take a look at:
How you can Set Sustainable Well being Targets For the New Yr that Are Truly Sustainable
Am I Consuming Sufficient? 8 Indicators You’re Undereating
Is Intuitive Fasting Actually Intuitive or Is It Simply One other Weight loss program?
What Is Orthorexia? When Wholesome Consuming Turns into Obsessive
