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Weight loss drugs have been trending on social media for quite a while now. According to the American Society of Health System Pharmacists, there has been a shortage of some doses of semaglutide, sold as Ozempic and Wegovy, due to an increase in demand. Unfortunately, the growth in popularity of semaglutide as a weight loss aid also negatively affected patients with diabetes who need it to manage their blood sugar.
With all the focus being placed on these drugs by both traditional media outlets and social media influencers, you may be asking yourself:
"Do these weight loss drugs really work?"
"Are they a way to eat whatever you want and never gain weight?"
Perhaps the most important question of them all is,
"Are they safe?"
To answer these questions, we will have to look and see what the data have to say.
What is Ozempic?
Before I get into the research, let’s cover some background info. Ozempic is a prescription drug that is mainly used to help people with type 2 diabetes manage their blood sugar levels. Its active ingredient is semaglutide, which belongs to the medication class called glucagon-like peptide-1 receptor agonists or GLP-1 RAs for short. GLP-1 agonists stimulate GLP-1 receptors in the pancreas, which tells the body to make more insulin - a hormone that lowers blood sugar - and less glucagon, which is a different hormone that raises blood sugar.
This class of drugs also makes the whole process of digestion slower, which helps you to feel fuller for longer. This effect in turn can lower your appetite, thus helping you to eat less. This is the pathway via which taking Ozempic can lead to weight loss. Ozempic is administered as a once a week injection.
If you aren't a fan of needles, don't worry - the needle is actually very tiny.
What are its side effects?
As is the case with any drug, it does have some side effects, including:
Nausea
Vomiting
Constipation
Diarrhea
Stomach pain
In the worst of cases, this drug may also cause:
Pancreatitis, which is an inflammation of the pancreas
Gallstones or gallbladder inflammation
Low blood sugar, which can be very dangerous if not corrected
Thyroid tumors/thyroid cancer
Diabetic retinopathy, which is a type of irreversible blindness that is brought on by uncontrolled diabetes
It is important to note that the risk for thyroid tumors/thyroid cancer is very small and is based on findings from animal studies. With regards to the risk for diabetic retinopathy, there does appear to be a bit more cause for concern. In this study, the SUSTAIN-6 clinical trial of over 3,000 people with type 2 diabetes, it was found that there was an increased risk of diabetic retinopathy in people taking Ozempic when compared to other medications used in the treatment of diabetes.
Permanent vision loss is a scary potential outcome, but there are two important things to remember: one, is that this research was done in people with diabetes, so we cannot be sure of the effects that semaglutide may have on the vision of people without diabetes who are just taking the drug to lose weight. The second thing to note, is that people with diabetes who are at greater risk for retinopathy are instructed to have their eyes regularly checked by an ophthalmologist, regardless of the medications that they are taking. This close monitoring would likely help to catch any problems with your retina and allow the your care team to make changes to your medication regimen if necessary.
If you have diabetes, your medical provider will tell you how often you need to get your eyes checked.
Has it been shown to actually lead to long-term weight loss?
Semaglutide, the active ingredient in Ozempic and Wegovy, has indeed been proven to help people to lose weight. However, there is more to the story.
Semaglutide was tested in a clinical trial that was published in 2022. In this study, 300 people who were overweight or obese, but did not have diabetes, were randomly assigned to take 2.4mg of semaglutide in a once weekly shot, or a placebo. Those taking semaglutide lost significantly more weight than those in the placebo group – an average of 15% of body weight versus 3% after two years.
Semaglutide was also linked to improvements in:
Hemoglobin A1c (a long-term measure of blood sugar)
Fasting blood sugar
Fasting insulin
C-reactive protein (a measure of inflammation)
Total cholesterol
Low density lipoprotein (LDL) cholesterol (aka “bad” cholesterol)
Triglycerides
Taking semaglutide also led to a lower chance of developing type 2 diabetes.
However, like I said earlier, there is more to the story. These amazing health benefits did not come from just from the medication; semaglutide had help from two tried and true weight loss tools: diet and exercise. All of the participants were instructed to eat 500 calories less each day and exercise for 150 minutes (2 and a half hours) per week.
Yes... it took WORK.
There were some negative side effects that were reported more commonly in the those taking semaglutide, including:
Nausea
Constipation
Diarrhea
Vomiting
Usually, these side effects were mild and went away over time.
Just as an FYI, this study was funded by Novo Nordisk, which owns the trademark for Ozempic.
"Can I eat whatever I want and still lose weight on Ozempic?”
Sorry to burst your bubble, but, no. Ozempic is not a magical injection that will allow you to make 10 slices of pizza vanish with no consequence. It works by slowing down your digestion, causing you eat less overall. You likely wouldn’t be able to stomach those 10 pizzas - you simply wouldn't have the appetite for it. Remember, nausea and vomiting are both common side effects for people taking this drug while trying to follow a calorie-restricted diet. Attempting to overeat while on this drug would probably just lead to more of those negative side effects, which is not something that you want.
Based on the research, Ozempic works best when combined with a healthy diet and regular exercise. There is no getting around the basic tenets of health, even with a drug as effective as semaglutide. You will still need to work on eating meals that are nutritionally balanced, not just to keep your weight in check, but to protect your health in all aspects. Remember, good nutrition is not just tied to a number on the scale. It is also tied to your mental health, your brain power, your endurance, your sleep quality, and so many more facets of your well being! Even if there was a drug that would keep you thin on a diet of pizza and ice cream, it wouldn’t take long for you to feel worse than you did when you started taking it because our bodies run on nutrients.
Even if you manage to acquire a more slender body, a diet low in nutrients will cause you harm in many ways down the line. You have to eat your vegetables!
If you have tried semaglutide, let us know down in the comments what your experience was like!
If you learned anything new or think that someone you care about could benefit from this information, share this article and subscribe to the blog for regular updates on commonly asked nutrition questions.
Enjoy today!
References:
Reports on the Ozempic shortage:
American Society of Health System Pharmacists. (2023, May 22). Drug Shortage Detail: Semaglutide Injection. Www.ashp.org. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=813&loginreturnUrl=SSOCheckOnly
Choi, A., & Vu, H. (2023, March 17). Ozempic prescriptions can be easy to get online. Its popularity for weight loss is hurting those who need it most. CNN. https://www.cnn.com/2023/03/17/health/ozempic-shortage-tiktok-telehealth/index.html
How semaglutide works:
Shaefer CF Jr, Kushner P, Aguilar R. User's guide to mechanism of action and clinical use of GLP-1 receptor agonists. Postgrad Med. 2015;127(8):818-26. doi: 10.1080/00325481.2015.1090295. Epub 2015 Sep 15. PMID: 26371721.
Diabetic retinopathy:
National Eye Institute. (2019, August 3). Diabetic Retinopathy | National Eye Institute. Nih.gov. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy
Thyroid cancer in rats:
Kannan S, Nasr C. Should we be concerned about thyroid cancer in patients taking glucagon-like peptide 1 receptor agonists? Cleve Clin J Med. 2015 Mar;82(3):142-4. doi: 10.3949/ccjm.81a.13066. PMID: 25932736.
Studies on semaglutide:
Grace Xiao, Albert Li; Food and Drug Administration Adverse Event Reports of Diabetic Retinopathy, Macular Edema and Blurred Vision Associated with GLP-1 Receptor Agonist Use. Invest. Ophthalmol. Vis. Sci. 2020;61(7):290.
Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, Woo V, Hansen O, Holst AG, Pettersson J, Vilsbøll T; SUSTAIN-6 Investigators. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov 10;375(19):1834-1844. doi: 10.1056/NEJMoa1607141. Epub 2016 Sep 15. PMID: 27633186.
Boye, J. (2023, May 5). Weighing the Cost. The Ophthalmologist. https://theophthalmologist.com/subspecialties/weighing-the-cost
Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, Jódar E, Kandler K, Rigas G, Wadden TA, Wharton S; STEP 5 Study Group. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022 Oct;28(10):2083-2091. doi: 10.1038/s41591-022-02026-4. Epub 2022 Oct 10. PMID: 36216945; PMCID: PMC9556320.
McDermid, E. (2021, February 11). A quick guide to the STEP trials. Diabetes.medicinematters.com. https://diabetes.medicinematters.com/semaglutide/obesity/quick-guide-step-trials/18854832
Link to all the STEP trails that received some funding/influence from Novo Nordisk: https://diabetes.medicinematters.com/semaglutide/obesity/quick-guide-step-trials/18854832
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