KBW | Ozempic - is it all it’s cracked up to be?

Ozempic is an incredibly popular (and controversial!) drug at the moment. Ozempic is a semiglutide medication that acts on GLP-1 receptors and is an FDA-approved treatment for Type 2 Diabetes. It works by stimulating the release of insulin from the pancreas, reducing the release of glucose from the liver, suppressing appetite, and slowing the rate of food absorption from the stomach. Together all of these actions can reverse Type 2 diabetes and lead to rapid weight loss as well. 

Once practitioners and patients caught on to the weight loss miracle Ozempic provides, usage skyrocketed. On June 4th, of 2021, the FDA announced the approval for Ozempic for use as a weight loss medication in adults with a BMI of 30 or above, or 27 or above in the presence of at least one weight-related comorbidity (ex: high blood pressure, diabetes, etc.). Technically, Ozempic has a sister drug, Wegovy, that is the same exact semi-glutide medication, but Ozempic is labeled for use in Type 2 diabetes, and Wegovy is labeled for use in obese patients and has a higher dosing range.

Yes. It Works. And It Works Well. 

In the STEP 1 trial, 1961 adults were randomized to receive semaglutide or placebo and a reduced calorie diet and increased physical activity. Results showed the semaglutide group lost 14.9% of their body weight, compared to 2.4% in the placebo and lifestyle group (​​NCT03548935: Semaglutide Treatment Effect in People with Obesity (STEP 1). 

Sounds like a miracle drug, so what’s the problem? There’s no denying Ozempic does exactly what it is designed to do, but with everything, there is more to the story, and there are pros and cons that individuals should consider with all of the information possible before they make a decision. 

Problem #1: The Weight May Come Right Back. 

For starters, Ozempic/Wegovy doesn’t actually fix anything. This drug doesn’t permanently enact any lasting change in the patient's body. It only works as long as you take it, and the moment you stop taking it, you can easily regain all of the weight and re-reverse your Type 2 Diabetes. Your pancreas will go right back to producing the amount of insulin it did before, your stomach emptying will go right back to the speed it emptied at prior, and your appetite will return with a vengeance as the body fights to return to homeostasis after a calorie deficit and everything will go right back where it was…exactly the opposite of what the user wants. Famous influencer and model Remi Bader openly discussed her DOUBLE weight gain after she stopped taking Ozempic 

This is why the prescribing information states that Ozempic is indicated as an ADJUNCT to diet and exercise…that means the patient should also make diet and lifestyle changes. But if they could just easily make those changes…wouldn't they have already? These are the types of changes my staff and I work hard on assisting our clients with, and these changes aren’t easy; they take time and they take work. For the average patient taking Ozempic without the support, guidance, and assistance of a team as we have here at KB Wellness, it’s not as easy as just magically making changes. There are many barriers to these types of changes ranging from limited knowledge to limited time due to having to work multiple jobs or a limited budget for healthy fruits and vegetables. There are very few prescribing providers that are providing assistance for their patients in making these diet and exercise changes which therefore keeps the patient stuck on this medication for life with no way to come off because they lack the ability to make those changes without knowledge and assistance.

The take-home point here? Whether you take Ozempic or not, unless you want to be administering those injections at 99 years old, or unless you want the weight and blood sugar dysregulation to go RIGHT back to where it was before you started, you’re going to need to learn how to make diet and lifestyle changes to help you maintain a healthy blood sugar level and healthy weight.  

Problem #2: The Side Effects

All medications have side effects, depending on the individual, Ozempics can be pretty rough. The side effects listed are: 

• low blood sugar 
• upset stomach, heartburn, burping, gas, bloating
• nausea, vomiting, stomach pain, loss of appetite
• diarrhea, constipation
• runny nose or sore throat
• stomach flu symptoms
• headache, dizziness, tiredness

Ref: https://www.everydayhealth.com/drugs/ozempic

I’ve talked to women who have taken it that stated the side effects were so intense they had to stop taking the medication because they were completely intolerable. 

Take home point: You may or may not experience any of the above in a minor or major way, so you’ll want to consider this while weighing your pros and cons. 

Problem #3: Serious medical problems

While the side effects above do not look fun at all, they are temporary and limited. Once the medication is stopped, the side effects will disappear as well. But some of the serious medical complications that have been correlated to Ozempic use are more dangerous and potentially much more long-term. 

 1. Pancreatitis: 

 One of the most significant risks associated with Ozempic is the potential for pancreatitis. Pancreatitis is a severe inflammation of the pancreas, which can be life-threatening if left untreated. Studies are mixed where some show no problems at all, and others, such as Bethel et al.’s 2016 study, have shown that Ozempic can increase the risk of pancreatitis. 

2. Gallbladder Disease:

 Another risk associated with Ozempic is the potential for gallbladder disease. Again, studies are mixed, but several studies have shown that individuals taking Ozempic may have a higher risk of developing problems with their gallbladder disease. The Sustain 6 trial, for example, found that individuals in the Ozempic group were more likely to experience cholecystitis (inflammation of the gallbladder) or cholelithiasis (gallstones) compared to those in the placebo group (DOI: 10.1186/s12933-019-0871-8). 

A 2019 FDA Review of the data on Ozempic and other GLP1 receptor agonists found an increased risk of gallbladder-related adverse events, such as cholecystitis and cholelithiasis, in individuals taking these medications.

 3, Thyroid Cancer:

 There is a potential risk of thyroid cancer associated with Ozempic. This link has been very compelling in animal studies and has been far less compelling to date in humans. But the risk is enough that it is listed on the manufacturer’s website under important safety information, which you can view here → ozempic.com

The following excerpt is taken directly from the above page on their website: 

Ozempic® may cause serious side effects, including:

• Possible thyroid tumors, including cancer. Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumors, including thyroid cancer. It is not known if Ozempic® will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people. 
• Do not use Ozempic® if you or any of your family have ever had MTC or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Do not use Ozempic® if:

• You or any of your family have ever had MTC, or if you have MEN 2.
• You are allergic to semaglutide or any of the ingredients in Ozempic®. See symptoms of serious allergic reaction in "What are the possible side effects of Ozempic®?".

 4. Kidney Damage:

 There is also a potential risk of kidney damage associated with Ozempic. In a 2021 publishing by Leehey et al., it was reported that 2 patients with chronic kidney disease due to diabetic kidney disease experienced rapid worsening of kidney function and increased proteinuria after being prescribed the GLP-1 receptor agonist semaglutide. This is why Ozempic warns against its use in those with pre-existing kidney problems. However, it is also noteworthy that the authors advise that because most adverse kidney events have occurred in patients who experience adverse gastrointestinal symptoms, patients that experience these symptoms should have laboratory tests to assess kidney function. 

Take home point: Will these happen to everyone? No. Will they happen to you? Who knows. But if you are considering taking Ozempic, or any other medication for that matter, you should thoroughly read through all information the drug company provides so you are fully informed and making a decision out of informed consent, not blind trust. 

 In conclusion, Ozempic can be an effective option for weight loss in certain individuals, but it is important to consider the potential side effects and contraindications. A healthy lifestyle, including a balanced diet and regular exercise, should always be the first line of defense. It is important to consult with a healthcare provider to determine the best course of action for achieving weight loss goals and to go into that conversation fully informed of the pros and cons, side effects and contraindications, and more. 

Drugwatch, a health site, featured in publications such as The New York Times and Healthline recently published an article covering Ozempic's use, side effects, interactions, and more. You can read the Drugwatch Ozempic article here. 

If you and your health care provider end up deciding that Ozempic, Wegovy, Monjaro, or any of the other semaglutide medications are not for you and you’d like some alternatives to consider instead, read my blog on Ozempic Alternatives