A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to have a look at how efficient at weight reduction it truly is and simply how dangerous the unwanted effects truly are. We additionally cowl implications of the medicine scarcity and issues 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 sizzling matter proper now.
Celebrities are publicly attributing their weight reduction to those medicines (Oprah being the newest one as I’m scripting this). Medical doctors are prescribing them left and proper for weight reduction (and another ailment you may carry 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 in consequence.
From information headlines to TV ads to water cooler discuss, Ozempic is in every single place. As a non-diet, weight-inclusive dietitian, I wish to ensure that I’m empowering my purchasers and my group with all of the evidence-based data we’ve got (and spotlight what we don’t have) so to make an knowledgeable choice on whether or not or to not take these medicines. It’s not my function to steer you (as a result of I consider in your company and physique autonomy) however it’s my function to coach 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 will make sense in case you select to take them or are fascinated with taking them given the anti-fat tradition we dwell in and the strain from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve discovered about these medicines on this submit and am highlighting what the analysis reveals us on weight reduction (how a lot weight you’re truly prone to lose – trace: it’s not as a lot as you may suppose), what the identified unwanted effects are, and why try 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 referred to as 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 a substitute of being flooded with it.
It additionally stimulates satiety and fullness and helps you keep full longer, which is why the medicine is now getting used to manage urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic title 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 turned FDA-approved for the remedy of weight reduction. Each are basically the identical medicine solely Wegovy has greater doses of semaglutide.
As soon as Wegovy turned FDA-approved for weight reduction, it shortly went into scarcity after which medical doctors started prescribing Ozempic off-label (that means prescribing it for one thing apart 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 probably the most and may have critical well being ramifications for these with diabetes.
Semaglutide remains to be in scarcity as of scripting this weblog submit in December 2023.
How do GLP-1 agonists assist these with diabetes?
In people with diabetes, incretin’s results are lowered (by about 30%), which ends up in greater 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 over the past three months. Research present these medicines can assist decrease A1c ranges by 1 – 2.4 proportion factors and may cut back the chance of cardiac occasions, no matter weight adjustments.
5 issues you need to find out about Ozempic and Wegovy (and different GLP-1 agonists)
1. It’s possible you’ll or could not drop a few pounds with Ozempic and when you cease taking it, you’ll possible 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 a few 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 wanting solely on the STEP trials, outcomes present that 80% of individuals taking these medicines lose some quantity of weight. So about 20% of parents who take these meds gained’t lose any weight. For many who do drop a few 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 parents who took this medicine noticed a extra average weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of parents taking this medicine noticed a reasonably 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 after all 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 plenty of exclusion standards. Individuals couldn’t be part of these research in the event that they had been depressed, had any current cardiovascular points, and in the event that they had been females of childbearing age with out a extremely efficient contraception methodology, simply to say just a few.
While you take 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 parents are shedding a minimum of 5% of physique weight. a meta-analysis (evaluate) of RCTs, most weight reduction totals hovered round a median of 8-10 lbs, with just a few research exhibiting extra important weight reduction, round 25-40 lbs.
In case your aim is to lose about 5-10% of your physique weight then these medicines may make it easier to get there however if you’re on the lookout for extra dramatic weight reduction, these meds most likely gained’t make it easier to meet your objectives.
It’s additionally vital to acknowledge what occurs while you cease taking the medicines. As a result of possibly your insurance coverage will cease masking it, or you’ll be able to not afford it, or there’s a scarcity, and so on.
Research have checked out what occurs while you take somebody off semaglutide and exchange it with a placebo and located that weight regain occurs in a short time. Inside a yr, individuals regain nearly all of their weight misplaced, even whereas nonetheless doing behavioral interventions like vitamin, train, and cooking lessons.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a food regimen (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 embody nausea, vomiting, diarrhea, constipation, GERD, and stomach ache. For most individuals, extreme GI signs ought to resolve inside just a few days and extra gentle GI unwanted effects often resolve inside 8-12 weeks.
These medicines additionally include a black field warning that they’ll improve the chance of thyroid tumors. That is primarily based purely on research performed in rodents so we don’t understand how that extrapolates to people, but. There are human research being performed now however we gained’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 listing of unwanted effects on the label, which is when your bowel stops functioning and you may’t take away waste – it will possibly solely be handled with surgical procedure and might be deadly.
After which there’s the aesthetic reported facet impact persons are speaking about, “Ozempic face”. Because of fast weight reduction (for some) and sure not getting enough vitamin, individuals report having unfastened pores and skin on their face and a hollowing underneath 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 medication, which is main compounding pharmacies to create variations that aren’t accepted or regulated.
When a drug goes on the FDA drug scarcity listing, 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’ll produce it till 2032 so compounding pharmacies don’t have entry to this lively ingredient.
If you wish to take a weight reduction medicine, get a prescription out of your physician and safe it from a licensed pharmacy. Keep far-off from wellness facilities, spas, or telehealth suppliers touting these medicines at a low price.
4. There’s no long-term information on Ozempic.
Let’s not overlook that we’ve got NO long run information on these medication. Semaglutide was accepted by the FDA for diabetes remedy in 2017 and the longest examine 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 in case you preserve your weight reduction while 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 medication with no long-term information and had been ultimately taken off the market due to irreversible critical antagonistic 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 medicine – you merely can’t know what the protection 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 medicine finally places you out of contact together 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 might exacerbate and gas 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 medicine can lead to important upswings in starvation, which can make you extra prone to binges.
After which there’s the impression of weight adjustments in your psychological well being. For those who don’t drop a few pounds taking the medicine, chances are you’ll 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 in case you lose important weight after which achieve all of it again when you come off the medicine, that change in physique look could trigger emotional misery and result in disordered consuming.
In the identical means I wouldn’t advocate a food regimen or intentional weight reduction to people with an lively consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t advocate these weight reduction medicines both. It reinforces the concept that skinny is finest and ends in insufficient nourishment and vitamin.
If you’re struggling to get enough vitamin whereas taking considered one of these medicines or are debating on taking considered one of these medicines and would really like extra individualized vitamin assist, our staff would love that can assist you. Guide a vitamin evaluation right now.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
Consuming Problems & Diabetes: A Give attention to Diabetes Medicines Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
For extra weblog posts like this take a look at:
How one can Set Sustainable Well being Objectives For the New Yr that Are Really Sustainable
Am I Consuming Sufficient? 8 Indicators You’re Undereating
Is Intuitive Fasting Actually Intuitive or Is It Simply One other Food plan?
What Is Orthorexia? When Wholesome Consuming Turns into Obsessive
