By now you've heard of the prescription medications Ozempic and Wegovy (both formulations of the injectable drug semaglutide). You can't help but get their catchy TV commercial jingle stuck in your head "Oh Oh Oh Oh-Zempic!!"... (well at least if you live in the U.S. where direct-to-consumer marketing of pharmaceuticals is allowed). So what's the deal with this new weight loss craze using "skinny shots"??
Ozempic is a semaglutide-based injectable drug that was originally developed to treat type 2 diabetes. After diabetic patients were treated with Ozempic, for some, it was noted that along with improving blood sugar control, they were also losing weight. People began using Ozempic "off-label" for weight loss, and it became a viral sensation on social media platforms like TikTok. While Ozempic is still only FDA-approved for treatment of Type 2 diabetes, a similar drug, Wegovy, has been FDA-approved for use in weight loss.
The recent craze has not been without controversy. These brand name drugs, Ozempic and Wegovy, are still on patent, and are not cheap. While insurance may cover a prescription for Ozempic if being used in the treatment of type 2 diabetes, it typically does not cover a prescription for Wegovy, which can cost over $1300 for a 28-day supply. Because the rush to buy these drugs has been driven by celebrity use and social media buzz, it has created a supply shortage, making them go on back order and not be available to diabetics who need them.
So how do these drugs work? Semaglutide increases the body's production of insulin, lowering blood sugar, and also slows the emptying of the stomach, which makes a person feel full and less hungry. Food is not as appetizing, and soon the weight begins to fall off. Common side effects of the drug include nausea, vomiting, fatigue, and changes in bowel habits. For those who experience rapid weight loss, they may notice skin laxity and sagging of the face, which is the reason behind the term "Ozempic face". This can happen to anyone who experiences significant and rapid weight loss, with or without taking Ozempic/semaglutide.
Who is the ideal candidate for taking Ozempic/Wegovy/semaglutide for weight loss?
The drug labeling indicates it is to be used in patients who are overweight with a body-mass-index (BMI) over 30 or a BMI over 27 plus a weight-related health condition (such as high blood pressure, Type 2 diabetes, obstructive sleep apnea, etc.). These drugs were not meant to be used for those who only need to drop 10 pounds or are trying to go down a dress size for a special event (even though there's plenty of evidence that it is being used and misused by celebs and others who simply want to weigh less). In severely obese patients who are facing life-threatening obesity related illnesses, these medications could be a game changer and may even allow them to avoid having bariatric (weight loss) surgery (like gastric bypass or sleeve gastrectomy).
Who should not take Ozempic/Wegovy/semaglutide? The drugs carry a "black box warning" stating that they should not be used in patients who have a personal or family history of medullary thyroid carcinoma, or in patients with a condition known as multiple endocrine neoplasia syndrome type 2 (MEN 2). Women who are pregnant, nursing, or trying to conceive should not use these drugs. Patients with a BMI less than 30 should try lifestyle modifications to lose weight before opting to use medications.
What happens when you stop taking Ozempic/Wegovy/semaglutide?
For those who have been on these medications, stopping them usually results in weight gain and return of their hunger, sometimes to levels greater than before their weight loss. The scientific community and the manufacturer of the drugs now recognizes that obesity is a chronic condition that may require long term care. However, at the current cost, people with low incomes will have less access to these treatments compared to those with higher incomes.
Many people have tried to find a way to work around the high cost of these new drugs by purchasing them from a compounding pharmacy. And this too, is not without controversy, since the manufacturer of Ozempic/semaglutide, Novo Nordisk, holds a patent on the drug, and has stated that it doesn't sell semaglutide for compounding. So where are these versions of medication coming from? (To be continued...)
Here comes my unpopular opinion: we still don't have a "magic bullet" to cure obesity. The newest drugs available for weight loss such as Ozempic/Wegovy/semaglutide are showing great promise for those with severe obesity facing life-threatening health conditions. We now have a greater understanding of the pathophysiology involved in obesity, insulin resistance, and metabolic syndrome. To me, one of the most important points is that these conditions are indeed reversible, with certain long-term lifestyle changes. Medication might be a way for some people to reset, to lose enough weight to get them out of the "danger zone" of severe obesity. But for the best long-term outcomes, a commitment to a healthy lifestyle (including diet, exercise, stress management, and possibly hormone optimization) is needed.
You can use this link to my blog post about obesity and metabolic syndrome to learn more on this topic:
Take care and drop me any comments or questions. I'm interested in your feedback and ideas :)
Cheers to your health,
Dr. B
#weightloss #obesity #Ozempicchallenge #Ozempicface #semaglutide #metabolicsyndrome #healthmatters #Wegovy #weightmanagement
Comments