Doctors Reveal What They Really Think Of Weight Loss Drugs Like Ozempic
A new class of weight loss drugs on the market have been making waves since they were authorized as a treatment for obesity in 2021. Semaglutide injections, which you may know as Wegovy or Ozempic, have become wildly popular over the past several months, thanks to the buzz they’ve received from TikTok influencers (and rumors of use among some celebrities).
The prescription injections were introduced as a diabetes treatment in 2017, but people soon realized that the medications — which help people with diabetes to manage their blood sugar levels — also led to significant weight loss in people with obesity who’d struggled to lose weight with other treatments.
From there, interest in the drugs grew, and after clinical trials confirmed what people suspected — that semaglutide injections help people lose weight — demand soared, so much so that pharmacies across the country are experiencing shortages in both Wegovy and Ozempic. Obesity specialists understand the hype; this kind of prescription weight loss medication has been a long time coming.
“For those of us who treat obesity, this is a game-changer we’ve never seen before,” said Dr. Dan Azagury, a bariatric surgeon at Stanford Health Care. “This is the first time ever that we have really effective drugs to treat obesity.”
Obesity is one of the most common chronic health conditions in the United States, but until recently, we haven’t had very effective drugs to address the health complications it’s commonly linked to, such as high cholesterol and high blood pressure. Aside from lifestyle changes like diet and exercise, the go-to intervention for obesity has been surgery (think: gastric bypass or the duodenal switch).
According to Azagury, many obesity specialists noticed that, in the wake of receiving bariatric surgery, many patients were suddenly no longer diabetic. Upon investigating the reason for this, researchers identified new gut hormones, including one called glucagon-like peptide (GLP-1), that reacted to food going into the gut.
Further testing revealed that GLP-1, which increases after bariatric surgery, improves blood sugar levels, and consequently helps with diabetes. “That’s why major diabetes goes away within days of surgery,” Azagury said.
After this discovery, pharmaceutical companies set out to form a diabetes drug that could activate those GLP-1 receptors. That’s what led to the development of semaglutide ― a synthetic compound that mimics the effects of GLP-1 ― and later the semaglutide-based diabetes drug Ozempic, which got approval from the Food and Drug Administration in 2017.
The other key finding about GLP-1: It slows down digestion and reduces food intake, according to Dr. Janelle Duah, a Yale Medicine internist. This is why Ozempic, which is intended for diabetes, has been and continues to be prescribed off-label for weight loss, Azagury said.
The weight loss effects of GLP-1 (which are revved up through semaglutide), combined with the wild demand for Ozempic, drove the drug manufacturer, Novo Nordisk, to create a very similar drug specifically for weight loss: Wegovy. Essentially just a stronger dosage of Ozempic, Wegovy got FDA approval in June 2021.
Who’s a candidate for the medications?
Wegovy, a once-a-week shot, is for adults who have a body mass index over 30, or who have a BMI above 27 with at least one weight-related health issue (think: high blood pressure, diabetes or high cholesterol). It’s also meant to supplement physical activity and dietary changes, which is why obesity specialists like Azagury recommend that patients work with a comprehensive team of providers, including dietitians and therapists, if they can afford to. Patients can get the prescription through their primary care doctor, too.
Many people find that the injections help them feel fuller longer and reduce sugary cravings. It “makes them crave protein and fiber more — thus helping them stick to diet changes that can further enhance their weight loss,” Duah said. Some people say it also reduced their desire to drink alcohol, and helped them to get better sleep.
Ozempic is approved for Type 2 diabetes, not obesity or weight loss, although people are getting it off-label for weight loss purposes. It’s entirely legal for doctors to prescribe meds off-label, but this is likely adding to ongoing drug shortages — which is a major issue for people with diabetes who can’t get hold of the medications.
Obesity doctors are excited that there's finally a medication to help people, but there are some barriers and side effects to note.
What’s the overall take on these weight loss medications?
Obesity doctors are thrilled. Often, people retain weight because of health problems out of their control, not for lack of willpower or discipline. Many patients with obesity have tried it all, only to see minimal results. “Now we have something to help them,” Azagury said.
According to Duah, the recent surge in prescriptions, for the most part, is for good reason. “It is by far the most efficacious weight loss medication on the market, with users losing up to 20% of their starting body weight,” Duah said.
And even though interest in these drugs is soaring, Azagury thinks they can help still more people. The original class of obesity drugs from the 1960s and ’70s had nasty consequences and likely soured many people on the whole idea. It might take some convincing for more people to accept that there’s finally an effective drug for weight loss available, Azagury said.
There’s also the issue of cost. These drugs aren’t always covered by insurance, Azagury said, so it can get expensive (to the tune of $1,500 to $1,800 a month). “That is the biggest challenge people will face,” Azagury said. “It’s FDA-approved; that doesn’t mean insurance is going to pay for it.”
According to Duah, this is one of the main reasons providers end up prescribing Ozempic instead. Unlike Wegovy, Ozempic is often covered for diabetes or insulin resistance, so patients looking for semaglutide injections can get access to them at a reasonable price.
There are some risks associated with semaglutide injections
As with any drug, there are risks — but the injections are surprisingly well tolerated, Azagury said. The most common side effects are gastrointestinal issues, like nausea, vomiting, constipation, gas and heartburn. These GI-related side effects should subside as your body gets used to the injections; until then, they can mostly be handled by eating smaller, more frequent meals or taking over-the-counter medications like bismuth subsalicylate or heartburn relief tablets, Duah said. (If the side effects persist, be sure to talk to your doctor about finding relief or other, more tolerable options.)
In rare cases, semaglutide injections can lead to thyroid tumors, which can be cancerous. Other potential serious side effects include pancreatitis, gallbladder problems, low blood sugar, kidney issues, allergic reactions and depression. The injections also shouldn’t be used with other drugs that contain semaglutide or that target GLP-1 receptors.
We’re still learning about long-term side effects, since the drug is relatively new. The injections aren’t a quick fix, and most people will have to stay on the medications for at least a year (and likely longer) to meet their weight loss goals and improve their health, according to Azagury. One study found that many people who stop taking the medications rapidly gain the weight back, supporting the growing belief that the injections are meant to be taken for the long haul.
Other than a slightly higher risk of gallstones (which is common with many types of rapid weight loss), we haven’t seen any long-term effects with liraglutide, a similar drug that’s been on the market since 2010. Azagury expects the same will be true with semaglutide-based medications, given their similarity ― but, of course, time will tell.
If you’re interested in semaglutide injections, talk to your doctor. Understand the risks and benefits, and keep in mind that due to inflation, supply issues and growing demand, these drugs tend to be back-ordered — often for the people who need them most. Hopefully, supply will ramp up soon and more insurers will cover the cost. That, Duah said, will help more people get the drugs at a fair price.
“If insurances covered weight loss medications like Wegovy and supply was increased, we wouldn’t be seeing these issues with keeping Ozempic stocked on our pharmacies’ shelves,” Duah said.