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 unhealthy the unwanted effects truly are. We additionally cowl implications of the treatment 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 drugs like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching matter proper now.
Celebrities are publicly attributing their weight reduction to those drugs (Oprah being the most recent one as I’m scripting this). Docs are prescribing them left and proper for weight reduction (and every other ailment you may convey to the physician that they assume is correlated to your weight). Sufferers with diabetes (for whom these drugs have 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 ads to water cooler speak, Ozempic is in every single place. As a non-diet, weight-inclusive dietitian, I wish to make it possible for I’m empowering my purchasers and my neighborhood with all of the evidence-based data we’ve got (and spotlight what we don’t have) in an effort to make an knowledgeable resolution on whether or not or to not take these drugs. It’s not my position to influence you (as a result of I consider in your company and physique autonomy) however it’s my position to coach and inform, which I hope to do right here.
I might by no means, ever disgrace or decide somebody who decides to take these drugs. It will make sense when you select to take them or are enthusiastic about taking them given the anti-fat tradition we reside in and the stress from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve realized about these drugs 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 assume), what the identified unwanted effects are, and why you ought to be cautious about the place you’re accessing these meds from.
What’s GLP-1?
These weight reduction drugs fall into a category of medicines known as GLP-1 agonists. GLP-1 is glucagon-like peptide, often known 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 treatment is now getting used to regulate urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic title for the energetic ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the therapy of diabetes, and in 2021, Wegovy grew to become FDA-approved for the therapy of weight reduction. Each are primarily the identical treatment solely Wegovy has increased doses of semaglutide.
As soon as Wegovy grew to become FDA-approved for weight reduction, it rapidly went into scarcity after which docs started prescribing Ozempic off-label (which means prescribing it for one thing apart from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages rapidly adopted swimsuit.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes therapy aren’t attending to the individuals who want them essentially the most and might have severe well being ramifications for these with diabetes.
Semaglutide continues 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 decreased (by about 30%), which ends up in increased 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 drugs may also help decrease A1c ranges by 1 – 2.4 proportion factors and might cut back the chance of cardiac occasions, no matter weight modifications.
5 issues it is best to find out about Ozempic and Wegovy (and different GLP-1 agonists)
1. It’s possible you’ll or could not reduce weight with Ozempic and when you cease taking it, you’ll possible acquire the burden proper again.
Not everybody loses weight taking these drugs, which is necessary to notice, in any other case individuals who don’t reduce weight 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 drugs lose some quantity of weight. So about 20% of oldsters who take these meds received’t lose any weight. For individuals who do reduce weight, 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 average 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 drugs.
However let’s take into account that these trials weren’t solely funded by the maker of the drugs but additionally had loads of exclusion standards. Folks couldn’t be part of these research in the event that they have been depressed, had any present cardiovascular points, and in the event that they have been females of childbearing age with out a extremely efficient contraception technique, simply to say a couple of.
Once 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 couple of research exhibiting extra important weight reduction, round 25-40 lbs.
In case your purpose is to lose about 5-10% of your physique weight then these drugs may make it easier to get there however in case you are on the lookout for extra dramatic weight reduction, these meds most likely received’t make it easier to meet your objectives.
It’s additionally necessary to acknowledge what occurs while you cease taking the drugs. As a result of possibly your insurance coverage will cease protecting it, or you possibly can now not afford it, or there’s a scarcity, and many others.
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 courses.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a eating regimen (you acquire 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 drugs 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 couple of days and extra gentle GI unwanted effects often resolve inside 8-12 weeks.
These drugs additionally include a black field warning that they will enhance the chance of thyroid tumors. That is based mostly purely on research completed in rodents so we don’t know the way 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 drugs 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 checklist of unwanted effects on the label, which is when your bowel stops functioning and you may’t take away waste – it might solely be handled with surgical procedure and will be deadly.
After which there’s the aesthetic reported facet impact individuals are speaking about, “Ozempic face”. Because of speedy weight reduction (for some) and sure not getting sufficient vitamin, individuals report having unfastened 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 checklist, 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 energetic 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 drugs at a low value.
4. There’s no long-term knowledge on Ozempic.
Let’s not overlook that we’ve got NO long run knowledge on these medicine. Semaglutide was accredited by the FDA for diabetes therapy in 2017 and the longest examine I discovered was follow-up with slightly over two years. We simply don’t know if there are any long-term unwanted effects. We additionally don’t know when you keep your weight reduction while you keep on this drug long-term.
It’s an eerily related image to previous weight reduction meds like Fen-Phen and Ephedra, each of which have been hailed as miracle weight reduction medicine with no long-term knowledge and have been ultimately taken off the market due to irreversible severe antagonistic unwanted effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and demise.
It’s necessary to weigh this when deciding to take the treatment – 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 will 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 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 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 may end up in important upswings in starvation, which can make you extra prone to binges.
After which there’s the impression of weight modifications in your psychological well being. When you don’t reduce weight taking the treatment, you might go to extremes to limit your meals consumption. Or shedding pounds could set off you to wish to lose much more, fueling extra restriction. Or when you lose important weight after which acquire 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 means I wouldn’t suggest a eating regimen or intentional weight reduction to people with an energetic consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t suggest these weight reduction drugs both. It reinforces the concept skinny is greatest and leads to insufficient nourishment and vitamin.
In case you are struggling to get sufficient vitamin whereas taking certainly one of these drugs or are debating on taking certainly one of these drugs and would really like extra individualized vitamin assist, our workforce would love that will help you. E-book a vitamin evaluation right now.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://dom-pubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.14863
https://pubmed.ncbi.nlm.nih.gov/35441470/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full
Consuming Problems & Diabetes: A Concentrate on Diabetes Drugs 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 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 Food plan?
What Is Orthorexia? When Wholesome Consuming Turns into Obsessive
