Diabetes Drug Ozempic Trending for Weight-Loss

In this article, we present the current scientific evidence on the diabetes drug Ozempic for weight loss that has been trending in popular culture. We explore the science behind Ozempic, how Ozempic works for weight loss and whether or not weight loss is sustained long-term.

 

What’s in the News with regard to Ozempic for weight loss?

Ozempic® is a brand name drug by Novo Nordisk. Ozempic® is a once-weekly, injectable, semaglutide medication and has been approved by the FDA for the treatment of type 2 diabetes. 

Semaglutide, and Ozempic® specifically, has recently been trending on social media sites including Tik Tok and Instagram, with influencers & celebrities talking about how to use the drug as a weight loss method (instead of a diabetes drug). Celebrities like Khloe Kardashian, Kyle Richards & Elon Musk have been reported to be using Ozempic® for weight loss. 

Popularity of Ozempic for weight loss became so high that it resulted in supply chain shortages of the drug.  However, this increase in the popularity of Ozempic for weight loss may have to do with a shortage of Wegovy®, a form of semaglutide available in higher doses and approved by the FDA for weight management

 

How does Ozempic work for weight loss?

Semaglutide is a GLP-1 receptor agonist. Let’s break down how this works in the body: 

• • GLP-1 receptor agonists activate GLP-1 receptors in the pancreas (1). 

• • GLP-1 is an incretin hormone (2,3). Incretin hormones are produced by the intestinal system following nutrient consumption to enhance insulin secretion (2,3). They also regulate insulin levels when glucose levels are normal (2,3).

• • GLP-1, specifically, works in the body to lower glucose, slow gastric emptying, suppress glucagon secretion, and can lower appetite and food intake (2,3).

 

How does semaglutide impact weight and health parameters? 

Here are some of the key messages from notable high-quality studies conducted on Ozempic®:  

• • Individuals with Type 2 Diabetes: In studies looking at the impact of semaglutide on glycemic control for individuals with type 2 diabetes, weight loss was a secondary outcome (4,5). These include clinical trials, cited on the Ozempic® website, which observed a mean weight loss of 9.3 lbs for Ozempic® at 0.5 mg dose and 14.1 lbs at a 2 mg dose, from baseline to week 40 (4,5). All patients in the studies had type 2 diabetes and were taking metformin (4,5). 

• • Individuals with Type 2 Diabetes: A 2018 systematic review and meta-analysis of once-weekly injections of semaglutide for type 2 diabetes found a reduction of HbA1C, body weight, and systolic blood pressure, compared to placebo (1). The resulting weight loss was an average of 9 lbs for 0.5 mg dose, and 7.4 to 10.6 lbs for 1 mg doses (1). Study lengths ranged from 12 to 56 weeks, with one study at almost 2 years (1). 

• • Individuals without Type 2 Diabetes (weight loss): Most recently, A 2022 meta-analysis specifically focused on 2.4 mg once-weekly, injectable semaglutide for weight loss in adults with BMI greater than or equal to 27 kg/m2 and without diabetes (6). Weight loss, when compared to placebo was on average 26.2 lbs and 12.57% of body weight. Improvements in glycemic control, systolic and diastolic blood pressure and lipid profiles were also observed as well as physical functioning and physical and mental components of quality of life, compared to placebo (6).

 

Is the Ozempic weight loss sustained for individuals without Type 2 Diabetes? 

• • A 2022 extension study analyzed weight regain and cardiometabolic risk factor changes in adults with BMI greater than or equal to 27kg/m2 without diabetes, one year after a 68 week trial of treatment with once weekly 2.4mg injectable semaglutide (7). In the 68 weeks of treatment with semaglutide, a weight loss average of 17.3% was observed compared to 2.0% on placebo (8). Participants in both arms of the original study also received counseling sessions every 4 weeks. They were encouraged to follow a reduced-calorie diet, increase physical activity, and record their diet and activity (8). There was an average weight regain of two-thirds of the weight lost during treatment (7). Systolic and diastolic blood pressure, which had improved with treatment, also reverted to baseline without treatment (7). C-reactive protein and lipids increased without treatment. However, improvements in LDL cholesterol, C-reactive protein, HDL cholesterol, and triglycerides remained improved from baseline measures (before treatment with semaglutide) (7).

 

What are the issues associated with semaglutide?

Side effects observed in clinical trials were mostly gastrointestinal, including nausea, vomiting, and diarrhea (6). An increased risk of cholelithiasis (biliary disease) has also been observed (9). 

Advisories on the Ozempic® and Wegovy® websites state that semaglutide may cause thyroid c-cell tumors in rodents. It is unknown whether it has the same effect on humans. 

With Wegovy®, other potentially serious side effects include pancreatitis, gallbladder problems, hypoglycemia, kidney failure, allergic reactions, changes in vision, increased heart rate, depression, or thoughts of suicide. Common side effects are also listed including nausea, diarrhea, vomiting, abdominal pain, headache, fatigue, dizziness, bloating, belching, gas, stomach flu, and heartburn. 

In addition to physiological effects, semaglutide medications can be very expensive, at almost $ 900 USD for one 3mL pen. If patients are using Ozempic for weight loss (“off-label” purposes, i.e. not for diabetic treatment), it may not be covered by insurance providers. The interest in Ozempic for weight loss resulting in supply chain shortages may mean that those using the drug for its intended purpose as a diabetes treatment may not be able to access the medication when needed. 

 

What should dietitians and health practitioners know about semaglutide?

• • The Semaglutide medication Ozempic®, used for diabetes treatment, and Wygovy®, used for medically managed weight loss, have become popularized on social media as weight loss strategies.

• • Semaglutide is a GLP-1 receptor agonist, which can improve glycemic control and reduce food intake by suppressing appetite. 

• • Semaglutide injections can result in loss of body weight, but weight regain is likely to occur when treatment is stopped (7). 

• • Other health parameter improvements have been observed with semaglutide including  cardiovascular risk factors, glycemic control, physical functioning, and mental health (6). It is unclear whether these are related to dietary and lifestyle changes while taking the medication, the medication itself, the weight loss itself, or a combination of all factors. 

• • There are serious potential side effects of the medication and it may cause some uncomfortable GI symptoms. 

• • The medication also has a high cost and may not be covered by insurance plans. 

• • Popularity of the medications as a weight loss strategy has resulted in supply chain shortages, potentially affecting those who require it for diabetes management.

 

Key Messages for Dietitians

• • When working with clients who are considering or currently using medication for weight loss purposes, focus on their individual health needs and goals. Aim to stay-client centered, validate their concerns, and support them with decision-making. 

• • Presenting the potential health effects and drawbacks to clients in an unbiased way may help them in their decision-making. 

• • Nutritional care should always be individualized. There are many reasons that people desire to lose weight, and for some people, medication may be an appropriate option.

• • Dietitians can help to support individuals taking weight loss medications in meeting their nutritional needs, preventing undereating, and enjoying a wide range of foods. 

• Ultimately, for some clientele, usage of drugs like Ozempic® as a ‘quick fix’ weight loss strategy is a side effect of the diet culture that they are surrounded by. As dietitians, we can support clients/patients to unpack some of these underlying feelings and messages around weight loss and body image through compassionate, client centered care.

References

1. Andreadis, Panagiotis et al. “Semaglutide for type 2 diabetes mellitus: A systematic review and meta-analysis.” Diabetes, obesity & metabolism vol. 20,9 (2018): 2255-2263. doi:10.1111/dom.13361
2. Hinnen, Deborah. “Glucagon-Like Peptide 1 Receptor Agonists for Type 2 Diabetes.” Diabetes spectrum : a publication of the American Diabetes Association vol. 30,3 (2017): 202-210. doi:10.2337/ds16-0026
3. Baggio, Laurie L, and Daniel J Drucker. “Biology of incretins: GLP-1 and GIP.” Gastroenterology vol. 132,6 (2007): 2131-57. doi:10.1053/j.gastro.2007.03.054
4. Pratley RE, Aroda VR, Lingvay I, et al, on behalf of the SUSTAIN 7 investigators. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018;6(4):275-286.
5. Frías JP, Auerbach P, Bajaj HS, et al. Efficacy and safety of once-weekly semaglutide 2.0 mg versus 1.0 mg in patients with type 2 diabetes (SUSTAIN FORTE): a double-blind, randomised, phase 3B trial. Lancet Diabetes Endocrinol. 2021;9(9):563-574. doi: 10.1016/S2213-8587(21)00174-1.
6. Zhong, Ping et al. “Efficacy and safety of once-weekly semaglutide in adults with overweight or obesity: a meta-analysis.” Endocrine vol. 75,3 (2022): 718-724. doi:10.1007/s12020-021-02945-1
7. Wilding, John P H et al. “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension.” Diabetes, obesity & metabolism vol. 24,8 (2022): 1553-1564. doi:10.1111/dom.14725
8. Wilding, John P H et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” The New England journal of medicine vol. 384,11 (2021): 989-1002. doi:10.1056/NEJMoa2032183
9. Smits, Mark M, and Daniël H Van Raalte. “Safety of Semaglutide.” Frontiers in endocrinology vol. 12 645563. 7 Jul. 2021, doi:10.3389/fendo.2021.645563