A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to take a look at how efficient at weight reduction it really is and simply how dangerous the unintended effects really are. We additionally cowl implications of the treatment scarcity and concerns for these with a historical past of an consuming dysfunction or disordered consuming. 
Set off warning: discussions of weight reduction numbers, consuming dysfunction behaviors
Ozempic and different weight reduction drugs like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching matter proper now.
Celebrities are publicly attributing their weight reduction to those drugs (Oprah being the newest one as I’m scripting this). Docs are prescribing them left and proper for weight reduction (and another ailment you may deliver to the physician that they suppose is correlated to your weight). Sufferers with diabetes (for whom these drugs have been initially developed) can’t entry these meds as a result of there are shortages throughout the nation and their well being is struggling because of this.
From information headlines to TV commercials to water cooler discuss, Ozempic is in all places. As a non-diet, weight-inclusive dietitian, I need to be sure that I’m empowering my purchasers and my neighborhood with all of the evidence-based info now we have (and spotlight what we don’t have) so as to make an knowledgeable resolution on whether or not or to not take these drugs. It’s not my function to steer you (as a result of I imagine in your company and physique autonomy) however it’s my function to teach and inform, which I hope to do right here.
I might by no means, ever disgrace or choose somebody who decides to take these drugs. It will make sense for those who select to take them or are occupied with taking them given the anti-fat tradition we reside in and the strain from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve discovered about these drugs on this submit and am highlighting what the analysis exhibits us on weight reduction (how a lot weight you’re really more likely to lose – trace: it’s not as a lot as you may suppose), what the identified unintended effects are, and why you ought to be cautious about the place you’re accessing these meds from.
What’s GLP-1?
These weight reduction drugs fall into a category of medicines referred to as GLP-1 agonists. GLP-1 is glucagon-like peptide, also called an incretin. Incretins are secreted within the small gut and assist to extend insulin, lower glucagon and decelerate gastric emptying (i.e. digestion), all of which assist to handle blood sugar. With incretin, glucose can slowly enter the bloodstream as an alternative of being flooded with it.
It additionally stimulates satiety and fullness and helps you keep full longer, which is why the treatment is now getting used to manage urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic title for the energetic ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the remedy of diabetes, and in 2021, Wegovy grew to become FDA-approved for the remedy of weight reduction. Each are basically the identical treatment solely Wegovy has greater doses of semaglutide.
As soon as Wegovy grew to become FDA-approved for weight reduction, it rapidly went into scarcity after which medical doctors started prescribing Ozempic off-label (that means prescribing it for one thing aside from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages rapidly adopted go well with.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes remedy aren’t attending to the individuals who want them essentially the most and may have critical well being ramifications for these with diabetes.
Semaglutide continues to be in scarcity as of scripting this weblog submit in December 2023.
How do GLP-1 agonists assist these with diabetes?
In of us with diabetes, incretin’s results are lowered (by about 30%), which results in greater blood sugars and poorer blood sugar management. GLP-1 agonists assist management blood sugar and decrease A1c ranges, which measure your common blood sugar ranges over the past three months. Research present these drugs might help decrease A1c ranges by 1 – 2.4 share factors and may scale back the danger of cardiac occasions, no matter weight adjustments.
5 issues it’s best to learn about Ozempic and Wegovy (and different GLP-1 agonists)
1. You could or might not drop a few pounds with Ozempic and when you cease taking it, you’ll seemingly achieve the load proper again.
Not everybody loses weight taking these drugs, which is essential to notice, in any other case individuals who don’t drop a few pounds on these meds are left feeling like failures.
The analysis on semaglutide for weight reduction largely comes from the STEP trials, randomized managed trials (RCTs) that are funded by, you guessed it, the pharmaceutical firm that makes this drug, Novo Nordisk.
When trying solely on the STEP trials, outcomes present that 80% of individuals taking these drugs lose some quantity of weight. So about 20% of parents who take these meds gained’t lose any weight. For many who do drop a few pounds, on the very least, they’re shedding about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).
Roughly half of the oldsters who took this treatment noticed a extra reasonable weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of parents taking this treatment noticed a fairly substantial weight lack of 20% or extra physique weight (about 40 lbs weight reduction for somebody weighing 200 lbs). This extra substantial weight reduction is after all what’s driving all of the hype and media protection on these drugs.
However let’s remember the fact that these trials weren’t solely funded by the maker of the drugs but in addition had lots of exclusion standards. Folks couldn’t be part of these research in the event that they have been depressed, had any present cardiovascular points, and in the event that they have been females of childbearing age and not using a extremely efficient contraception technique, simply to say just a few.
If you take a look at different trials on semaglutide, with out the pharma funding and intensive exclusion standards, the outcomes are much less spectacular. Solely 40% of parents are shedding a minimum of 5% of physique weight. a meta-analysis (overview) of RCTs, most weight reduction totals hovered round a mean of 8-10 lbs, with just a few research exhibiting extra vital weight reduction, round 25-40 lbs.
In case your aim is to lose about 5-10% of your physique weight then these drugs may show you how to get there however in case you are on the lookout for extra dramatic weight reduction, these meds in all probability gained’t show you how to meet your targets.
It’s additionally essential to acknowledge what occurs whenever you cease taking the drugs. As a result of possibly your insurance coverage will cease overlaying it, or you’ll be able to not afford it, or there’s a scarcity, and so on.
Research have checked out what occurs whenever you take somebody off semaglutide and exchange it with a placebo and located that weight regain occurs in a short time. Inside a 12 months, individuals regain virtually all of their weight misplaced, even whereas nonetheless doing behavioral interventions like vitamin, train, and cooking lessons.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a eating regimen (you achieve it again).
2. Ozempic comes with very disagreeable unintended effects.
Research present {that a} vary of 60% as much as 93% of individuals taking these drugs will expertise some unintended effects – the most typical being gastrointestinal misery. These unintended effects might embrace nausea, vomiting, diarrhea, constipation, GERD, and belly ache. For most individuals, extreme GI signs ought to resolve inside just a few days and extra gentle GI unintended effects normally resolve inside 8-12 weeks.
These drugs additionally include a black field warning that they will enhance the danger of thyroid tumors. That is primarily based purely on research accomplished in rodents so we don’t know the way that extrapolates to people, but. There are human research being carried out now however we gained’t know the outcomes till 2035 on the earliest. Due to this these drugs are contraindicated for these with a household historical past of thyroid tumors.
There are different very uncommon unintended effects like pancreatitis, gallbladder illness, kidney harm, and suicidal ideation. The FDA additionally not too long ago added ileus to the checklist of unintended effects on the label, which is when your bowel stops functioning and you may’t take away waste – it may solely be handled with surgical procedure and will be deadly.
After which there’s the aesthetic reported aspect impact individuals are speaking about, “Ozempic face”. On account of speedy weight reduction (for some) and sure not getting sufficient vitamin, individuals report having unfastened pores and skin on their face and a hollowing beneath the eyes and close to the temples. This look can be seen in these affected by malnutrition.
3. There’s a scarcity of those weight reduction medication, which is main compounding pharmacies to create variations that aren’t permitted or regulated.
When a drug goes on the FDA drug scarcity checklist, the FDA permits compounding pharmacies to combine up their very own model of the drug with none FDA approval or screening.
However, right here’s the catch. Novo Nordisk has a has a patent on the semaglutide molecule and solely they will produce it till 2032 so compounding pharmacies don’t have entry to this energetic ingredient.
If you wish to take a weight reduction treatment, get a prescription out of your physician and safe it from a licensed pharmacy. Keep far-off from wellness facilities, spas, or telehealth suppliers touting these drugs at a low price.
4. There’s no long-term knowledge on Ozempic.
Let’s not neglect that now we have NO long run knowledge on these medication. Semaglutide was permitted by the FDA for diabetes remedy in 2017 and the longest research I discovered was follow-up with just a little over two years. We simply don’t know if there are any long-term unintended effects. We additionally don’t know for those who preserve your weight reduction whenever you keep on this drug long-term.
It’s an eerily comparable image to previous weight reduction meds like Fen-Phen and Ephedra, each of which have been hailed as miracle weight reduction medication with no long-term knowledge and have been ultimately taken off the market due to irreversible critical opposed unintended effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and loss of life.
It’s essential to weigh this when deciding to take the treatment – you merely can’t know what the security or efficacy is of taking Ozempic long-term. What we do know is that if you wish to have a shot at sustaining your weight reduction, you’ll have to keep on it long-term.
5. Ozempic will be harmful for these with a historical past of an consuming dysfunction or disordered consuming.
This treatment in the end places you out of contact together with your physique’s pure starvation and fullness cues, which is counterproductive to consuming dysfunction restoration and the intuitive consuming framework. It causes you to eat much less, which may exacerbate and gasoline already restrictive consuming patterns, and result in potential nutrient deficiencies.
For these with binge consuming dysfunction or who battle with episodes of binging, coming off the treatment can lead to vital upswings in starvation, which can make you extra inclined to binges.
After which there’s the influence of weight adjustments in your psychological well being. For those who don’t drop a few pounds taking the treatment, you might go to extremes to limit your meals consumption. Or reducing weight might set off you to need to lose much more, fueling extra restriction. Or for those who lose vital weight after which achieve all of it again when you come off the treatment, that change in physique look might trigger emotional misery and result in disordered consuming.
In the identical manner I wouldn’t suggest a eating regimen or intentional weight reduction to of us with an energetic consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t suggest these weight reduction drugs both. It reinforces the concept that skinny is finest and ends in insufficient nourishment and vitamin.
If you’re struggling to get sufficient vitamin whereas taking one in every of these drugs or are debating on taking one in every of these drugs and would love extra individualized vitamin help, our crew would love that will help you. Guide a vitamin evaluation at this time.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://dom-pubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.14863
https://pubmed.ncbi.nlm.nih.gov/35441470/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full
Consuming Problems & Diabetes: A Concentrate on Diabetes Drugs Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
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