LRx Wellness

Weight Loss Wonder Drug- Ozempic

Did you know that more than 2 in 5 adults in the US are obese1? Obesity rates continue to increase across the nation and globe. We are living in an obesity pandemic with serious health and financial consequences. Many are looking for a “quick, easy fix”. Along comes a weight loss wonder drug, also known as Ozempic.

I am going to review what Ozempic is, how it works, criteria, warnings, precautions, side effects, new literature, and pros and cons. In conclusion, I will discuss Ozempic’s place in weight loss therapy.

What is Ozempic?

Ozempic, generic name semaglutide, belongs to a class of drugs referred to as, GLP-1 Receptor Agonists AKA Glucagon-like Peptide 1 Receptor Agonists. That’s really long so let’s call them GLP-1 RAs. A few other drugs in this class include: exenatide, tirzepatide, and liraglutide. Initially, this drug class was approved for diabetes and highly effective with a unique mechanism of action. Glucagon is a peptide hormone which increases glucose (blood sugar) by breaking apart glycogen (stored sugar). An increase in glucose in turn means release of insulin (a hormone to lower blood sugar). These drugs mimic glucagon, binding to receptors thus preventing spikes in blood sugar and resulting in a release of insulin.

How Do GLP-1 RAs Work for Weight Loss?

GLP-1 RAs also cause delayed gastric emptying resulting in feeling full and decreased appetite. Studies have found GLP-1 RAs + lifestyle changes result in a 17% weight loss compared to 6% with lifestyle changes alone. The effects appear to be more profound in those without diabetes.4

GLP-1 RAs RX Criteria for Weight Loss

Technically speaking, in order to be prescribed a GLP-1 RA for weight loss one of the criteria shall be met:

1) BMI >/= 30

2) BMI >/= 27 + 1 weight related health complication

So far it sounds great, right? Let’s consider a few important points.

Black Box Warning

A black box warning is the highest safety-related warning. There is reasonable evidence to support potential serious adverse effects.

**Thyroid C-cell tumors– risk is dose and duration dependent. Studies were conclusive in rodent models. Human trials are lacking.

Warnings/Precautions

Pancreatitis, Kidney Injury, Diabetic Retinopathy complications, Acute Gallbladder Disease

Risk of low blood sugar (hypoglycemia) is fairly low. However, when used in combination with insulin or other insulin like products risk significantly increases.

Common Side Effects

Nausea, vomiting, diarrhea, constipation, abdominal pain. These side effects may improve over time.

Effect on Gut Health

With many GI effects you might be wondering “is there a negative impact on gut health”? As discussed in my recent blog post: optimal gut health leads to improved weight and blood sugar management. (For more information check it out https://lrxwellness.com/how-to-support-gut-health/.) It is known that conditions like obesity and/or diabetes lead to a disruption in gut microbiome. So in contrast “is it possible that GLP-1 RAs actually improve gut health”? A study in mice receiving liraglutide showed favorable effects on the gut microbiome. Additionally, these agents seem to have an anti-inflammatory effect. The GI side effects appear to be related to slowed gastric emptying and compensatory colonic contractions.5,6

Emerging Evidence

A new study has found significant increase in vision loss due to nonarteritic anterior ischemic optic neuropathy (NAION) with semaglutide use.3

Pros and Cons

Pros:

  1. effective/efficient weight loss
  2. improved blood sugar
  3. improved cardiovascular health
  4. potential decrease in blood pressure
  5. potential improvement in lipid profile (cholesterol)
  6. favorable effects on gut microbiome

Cons:

  1. side effects
  2. injection (weekly to daily)
  3. titration period- low starting dose, increasing monthly to target dose.
  4. long-term use- studies in non-diabetic population are only up to 6 months.
  5. weight gain after discontinuation
  6. emerging long-term side effects

Important Points

These medications are meant to be taken in adjunct to lifestyle changes.

Once medication is discontinued, effects also cease leading to weight gain.

Long-term studies for weight loss in non-diabetic patients are lacking. New literature is emerging with side effects of long term use.

Contraindicated in those with a history and/or family history of thyroid cancers.

Gastrointestinal side effects are common and may improve over time.

In Conclusion

We are living in an obesity pandemic with significant morbidity and financial burden! In effort to find an accessible, effective, and efficient solution along came Ozempic. GLP-1 RAs are highly effective for the treatment and management of diabetes. They also cause delayed gastric emptying which leads to feeling full and decreased appetite and therefore weight loss. When coupled with lifestyle changes GLP-1 RAs result in significant weight loss. This class of drug offers several health benefits when used appropriately. However, there are also health risks, no long-term use data, and weight gain after medication discontinuation.

So do GLP-1 RAs have a place in weight loss therapy? These medications may offer benefit to those who meet criteria, have struggled to lose weight with lifestyle modifications alone, and need that extra motivation. Seeing progress can be a motivator for many. While GLP-1 RAs may be a “quick fix” they are not an ideal long-term solution.

As always, please reach out with questions, comments, or for further discussion.

Lindsey, PharmD, BCPS

References

1Centers for Disease Control and Prevention. (2024, May 14). Adult obesity facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/php/data-research/adult-obesity-facts.html


2GLP-1 agonists. Cleveland Clinic. (2023, July). https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists

3Hathaway, J. T., Shah, M. P., Hathaway, D. B., Zekavat, S. M., Krasniqi, D., Gittinger, J. W., Cestari, D., Mallery, R., Abbasi, B., Bouffard, M., Chwalisz, B. K., Estrela, T., & Rizzo, J. F. (2024). Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed SEMAGLUTIDE. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.2296

4Jensterle, M., Rizzo, M., Haluzík, M., & Janež, A. (2022). Efficacy of GLP-1 RA approved for weight management in patients with or without diabetes: A narrative review. Advances in Therapy, 39(6), 2452–2467. https://doi.org/10.1007/s12325-022-02153-x

5Kant, R., Chandra, L., Verma, V., Nain, P., Bello, D., Patel, S., Ala, S., Chandra, R., & Antony, M. A. (2022). Gut microbiota interactions with anti-diabetic medications and pathogenesis of type 2 diabetes mellitus. World Journal of Methodology, 12(4), 246–257. https://doi.org/10.5662/wjm.v12.i4.246


6Kato, S., Sato, T., Fujita, H., Kawatani, M., & Yamada, Y. (2021). Effects of GLP-1 receptor agonist on changes in the gut bacterium and the underlying mechanisms. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-88612-x

7Ozempic® [package insert]. Plainsboro, NJ: Novo Nordisk Inc.; October 2022.


Lindsey

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4 responses to “Weight Loss Wonder Drug- Ozempic”

  1. Great article! “Heath benefits when used appropriately”sums it up perfectly. All too often I see these injections prescribed for anyone who wants to lose “5-15 lbs.” Social media feeds the obsession. It is especially triggering for eating disorders. I saw someone combine Ozempic, intermittent fasting and excessive water intake to lose weight. Needless to say she ended up hospitalized. The glorified goal of quick weight loss has risks that most don’t weigh into, no pun intended. Thanks again Lindsey.

    • Oh my word!! I did not hear about this individual taking such extreme measures for rapid weight loss. Scary. And I am sure it is not the first or the last. But you are so right, social media can be a dangerous place.

  2. Very good article! All of the health problems that goes with obesity makes this truly a miracle drug when used correctly!
    Lindsey you covered it all!