Should You Take Ozempic For Weight Loss?

If you haven't heard about the "new" weight loss drugs on the market, you've obviously maintained a quiet lifestyle that I envy. For the rest of us, you've probably caught yourself singing, "Oh ohh ohhh Ozempic!" in the shower over the last year. Ozempic (semaglutide) has been approved as a diabetes drug for years, but it recently exploded in popularity as a weight loss drug. Hilariously, Ozempic is NOT technically approved for weight loss by the FDA.

Wegovy, also semaglutide, is FDA-approved for weight loss, and the only real differences from Ozempic are the dosing and cost. Wegovy has a maintenance dose of 2.4 mg per week whereas Ozempic has a maximum recommended dose of 2 mg per week. Wegovy also costs more per mg of semaglutide at ~$1,349 a month vs ~$969 a month without insurance coverage.

The FDA-approved indication for Wegovy is as follows:

WEGOVY® is indicated in combination with a reduced calorie diet and increased physical activity to reduce excess body weight and maintain weight reduction long term in:
• Adults and pediatric patients aged 12 years and older with obesity
• Adults with overweight in the presence of at least one weight-related comorbid condition

Great! Now, what are the potential downsides to relying on semaglutide for weight loss, and how many people are using semaglutide (or other GLP-1 receptor agonists) "off-label"?

The goal of this article is not to dissuade you from taking a GLP-1 agonist for weight loss, and it's probably an appropriate option for many. However, it is definitely NOT the right option for everyone. This article will review some of the potential downsides to taking a drug like semaglutide for weight loss and I'll specifically talk about cases where I think semaglutide isn't the best option. Before we get into that, what kind of weight loss results can one expect while taking semaglutide?

In clinical studies, patients with and without diabetes lost anywhere from 9-16% of their body weight while taking these drugs. If you weigh 300 pounds, that's 27-48 pounds of weight loss. Importantly, patients in these studies received instruction for a reduced calorie diet (approximately 500 kcal/day deficit) and increased physical activity counseling.

Safety Issues:

There is no drug in existence without side effects. That's an unfortunate truth that you must consider when taking a drug like semaglutide for weight loss, particularly because there are other less-toxic ways to lose weight!

Semaglutide has a "black-box warning" in its label which is the highest safety-related warning medications can receive from the FDA. In this case, semaglutide has the following: "WARNING: RISK OF THYROID C−CELL TUMORS". This warning is clarified by explaining that semaglutide does in fact cause dose-dependent and duration-dependent thyroid C-cell tumors in rodents. Importantly, we don't know if it causes cancer in humans. For this reason, semaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma.

Semaglutide also has several other warnings and precautions in its label including acute pancreatitis, acute gallbladder disease, hypoglycemia, acute kidney injury, hypersensitivity reactions, diabetic retinopathy complications (in patients with diabetes), heart rate increase, and suicidal behavior and ideation.

These drugs are obviously not completely innocuous, and in some cases, they can be downright harmful. Of course, these adverse events will not happen to everyone! It's simply a roll of the dice whether they will happen to you when taking these drugs. There are other less harmful adverse events associated with semaglutide that are also much more likely. For instance, 44% of people will experience nausea, 30% diarrhea, 24% vomiting, 24% constipation, and 20% abdominal pain. 3% of people even experience hair loss!

Off-Label Use:

Having gone through many of the safety issues, it's important to understand that there is a risk/benefit assessment required before taking GLP-1 agonists for weight loss. Wegovy is also FDA-approved "to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight."

If you have 42% body fat, hypertension, and a history of heart attack, these drugs might be a reasonable option for you. Unfortunately, many people (potentially most people) taking semaglutide do not fit that description! There are relatively healthy, non-obese people all over the world on these drugs simply because they help them lose weight. That's the only reason.

That is an obvious case of off-label use, but that's not illegal in the US. For instance, there are thousands of people on Ozempic right now which isn't FDA-approved for weight loss. Whether or not insurance will cover off-label use is a different question, but that doesn't stop people with money from taking the drug anyway.

Other Issues:

Speaking of off-label use, there are young people all over the world seeking out these drugs. This is particularly true for young girls without obesity or cardiovascular comorbidities trying to lose weight. You can also imagine how these drugs would be attractive to anyone, including teenagers, with eating disorders. Unfortunately, many of them can access these drugs and get prescriptions based on telehealth visits over a Zoom call.

Then there are Hollywood movie stars using these drugs off-label for weight loss, many of whom will deny doing so. It's similar to Dwayne "The Rock" Johnson claiming that he doesn't use performance-enhancing drugs. Hilarious. Celebrities have been using drugs to look better for years, and semaglutide is just another tool in their toolboxes. For instance, Zac Efron used furosemide to look leaner in the 2017 film Baywatch.

The vast majority of people who stop taking semaglutide will gain the weight back, which is no surprise. Some people are able to use semaglutide to initiate lifestyle changes that they maintain after discontinuation, but this is not the norm. What does this mean for patients? Unless you change your lifestyle, this will be a lifetime drug that you will never be able to stop if you want to keep the weight off.

Additionally, this drug is technically approved for kids aged 12 years and older with obesity. That approval comes from studies with a total of 201 pediatric patients aged 12 years and older with a BMI corresponding to ≥95th percentile for age and sex. I'll save my thoughts on treating pediatric obesity with drugs for another article, but you can find a quick rundown of the current guidelines from a previous article below:

Discussion:

There are obviously pros and cons to taking semaglutide for weight loss and much of that is based on the risks associated with obesity vs the side effects of drug use. Obesity increases your risk of many diseases, including but not limited to diabetes, heart disease, stroke, and cancer. This is why semaglutide might be a good option for many people. For instance, in a clinical trial in obese patients with a composite outcome of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke, semaglutide significantly decreased risk compared to placebo, HR 0.8 (0.72 - 0.9).

However, if you aren't obese or overweight with comorbidities, this should not be a drug that you seek out for weight loss. The risk/benefit analysis does not make sense for you. If you aren't obese, weight loss with semaglutide isn't preventing chronic disease! Not to mention, weight loss with semaglutide has been shown to significantly decrease muscle mass. As I've said many times, any intervention that causes significant muscle loss is likely detrimental to your long-term health!

Even if you are obese, semaglutide should not be your first choice. Lifestyle management should always be your preferred approach for weight loss if possible. Unless you want to be on drugs for the rest of your life, it's something you'll have to figure out anyway. Even if you are on semaglutide, the FDA makes it clear that it should be taken in combination with a reduced calorie diet and increased physical activity.

Obviously, all of this is just my opinion. It's a data-driven opinion, but it's still just one guy's thoughts. What do you think? Will most people end up on GLP-1 agonists over time? Will this become a social norm? Are there mental health benefits to weight loss through drug use that aren't properly captured here? Is weight loss through lifestyle intervention too hard for most people given the current culture and access to high-calorie foods? Should we expect people to lose weight without drugs in this environment? Let us know your thoughts in the comments below!

*Information presented on RxTeach does not represent the opinion of any specific company, organization, or team other than the authors themselves. No patient-provider relationship is created.