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BTW, this is a great opportunity for me to fire some vintage Bill Burr and offend some people. God, I love this job*.
* I know, it's not a job. It's an adventure!
What You Need to Know About Ozempic: The Diabetes Drug Fuelling Hollywood’s Harmful Weight-Loss Obsession
BY FIORELLA VALDESOLO
10 February 2023
“Oh, oh, oh, Ozempic,” croon the voices in an oft-aired commercial for the Type 2 diabetes drug, Ozempic by Novo Nordisk. The jingle is sung to the tune of “Magic” by the 1970s band Pilot — which is fitting: With its reported ability to cause rapid weight loss as a side effect to blood-sugar management, the drug has been hailed as a miracle treatment by those in the know. “Patients consider it a wonder drug,” says New York dermatologic surgeon Paul Jarrod Frank, MD, who, like many doctors, is being asked about it with a dizzying frequency. “Other than Viagra and Botox, I’ve seen no other medication so quickly become part of modern culture’s social vernacular.”
That’s not an understatement. The term “post-Ozempic body” is trending and is increasingly batted around in social media and IRL as speculation swirls following any high-profile — and highly visible — weight loss. Last month Elon Musk credited Wegovy, a similar drug, as one of the reasons for his more svelte appearance (fasting was the other); Andy Cohen tweeted about #Ozempic in September, a hashtag that has clocked over 274 million views on TikTok; and it’s been widely suggested that Kim Kardashian relied on the drug for dramatic weight loss in pursuit of fitting into Marilyn Monroe’s famous wiggle dress at this year’s Met Gala. Whether celebrities admit to using it (or not), Google searches for Ozempic are also on the rise, signalling an insatiable desire to learn more about its sudden slimming effects.
With thinness currently dominating the fashion landscape again (some would argue that it never really went away), it’s a reminder of how easily weight can be influenced by the trend cycle. But the fact that many people are willing to subject themselves to regular injections and potentially uncomfortable side effects in the name of fitting into a narrow body standard is troubling, to say the least.
“I worry about the body distortion, dysmorphia, and the example we are setting for young women already so vulnerable to the unrealistically filtered versions of beauty,” says LA-based cosmetic dermatologist Ava Shamban, MD. Nancy Rahnama, MD, a board-certified internist and obesity-medicine specialist in private practice in Beverly Hills, agrees: Celebrities using, or rather abusing, these weight-loss drugs — not for health reasons but simply to achieve their ideal figure — is deeply problematic in its amplification of weight-loss culture, says Dr. Rahnama.
As diminutive waistlines become conflated with health, what, exactly, is this now perpetually name-checked class of drugs, and who should — and, perhaps more importantly, shouldn’t — be taking them?
What is Ozempic?
A semaglutide, which is the active ingredient in Ozempic, belongs to a class of medications called GLP-1 agonists. These compounds replicate a hormone we all make in our intestines that is released after we start eating. “Semaglutide increases insulin release in response to glucose intake and causes a minor delay in gastric emptying,” says Ariana Chao, MD, an assistant professor at the University of Pennsylvania School of Nursing and medical director of the school’s Center for Weight and Eating Disorders. “It also acts in areas of the brain involved in regulating appetite and food intake. The medication also makes your body more sensitive to the insulin that you produce on your own, adds Holly Lofton, MD, a clinical associate professor in the departments of surgery and medicine and director of the Medical Weight Management Program at NYU Langone Health. “By doing that,” explains Dr. Lofton, “it helps your body’s fat cells shrink over time.”
Novo Nordisk produces both the semaglutide Ozempic and Wegovy, which, while approved for two different purposes, are in fact similar. “Semaglutide 1 mg (Ozempic) is a once-weekly injection FDA approved to treat diabetes since 2017. A higher 2 mg dose was approved in early 2022,” says W. Scott Butsch, MD, MSc, director of obesity medicine in the Bariatric and Metabolic Institute at Cleveland Clinic. “Wegovy is a higher dose of weekly semaglutide (2.4 mg) that was approved for the treatment of obesity in July 2021.”
Is Ozempic approved by the FDA for weight loss?
Not exactly. Wegovy is approved for weight loss in adults 18 and over who have a body mass index (BMI) of 30 or higher, or a BMI of 27 plus a comorbidity, like high cholesterol or high blood pressure. (A new paper demonstrates its safety and efficacy in adolescents as well.) “Wegovy marked the beginning of a new generation of anti-obesity medications that are highly effective,” says Dr. Butsch. “Its 12.4% body weight loss in its 68-week randomised controlled trial of more than 1,900 people with an average BMI of 37 was superior to all of the existing anti-obesity medications. In addition, more than half of the study group (55%) lost more than 15% body weight, and 35% lost more than 20%.” But because Ozempic has traditionally been easier to get than Wegovy, many people are using this specific semaglutide to treat weight loss “leading to off-label use,” says Dr. Rahnama. The fact that it’s self-administered at home via injection — once a week into the abdomen, thigh, or upper arm — has added to its proliferation, especially during the pandemic.
How, exactly, does Ozempic work?
In the simplest terms, it curbs the appetite and tricks the body into feeling full. “When naturally produced, the hormone [that Ozempic mimics] only keeps us full for a couple of hours, whereas in medication form, fullness is appreciated for 24 hours,” says Dr. Rahnama. Every time you take it, you get that full feeling for six or seven days, and that will compound over time. “I have patients telling me they can eat a third of what they normally ate and be satiated, go longer without eating, and don’t snack anymore,” says Dr. Lofton. Studies of Wegovy have shown it to be a safe method for weight control, even for adolescents, according to a clinical trial published in The New England Journal of Medicine a few weeks ago. When semaglutides are used appropriately, says Dr. Rahnama, appetite is never fully suppressed but better controlled. But when used inappropriately, an appetite can be completely suppressed, which can lead to or worsen eating disorders.
Are there side effects or risks involved with Ozempic?
Yes. The most common side effects of Ozempic are, as outlined in the fine print of its advertisements, gastrointestinal. Nausea and vomiting, constipation, and loose stools are widely reported and, for some, lead to the discontinuation of the drug. “Rare but serious side effects that have been reported with a semaglutide include inflammation of the pancreas, diabetic retinopathy, kidney problems, gallbladder problems, and allergic reactions,” says Dr. Chao. For some, Ozempic is contraindicated: It’s not advised for anyone pregnant or breastfeeding or with a personal or family history of medullary thyroid carcinoma or multiple endocrine tumours.
How long are you meant to stay on Ozempic?
Because Ozempic is a medication that is used to treat a chronic disease, it’s not something designed to be stopped. “Ozempic treats patients who have diabetes, therefore it is meant to be taken indefinitely,” says Dr. Rahnama. “If the medication is stopped and patients go back to their previous eating habits because of increased appetite, they will regain any weight loss and go back to their original blood-sugar levels.”
Medications that treat obesity are no different from those that treat high blood pressure or high cholesterol, adds Dr. Butsch: Long-term control of the disease depends on the medication. “A short-term approach is a continued result of the disbelief that obesity is a disease, and therefore medications are only required to be used for short-term effect,” Dr. Butsch explains. Obesity, says Dr. Butsch, is often thought of as a lifestyle choice with medications acting as so-called management tools.
“This is an outdated belief, though. We know too much about the regulation of energy and body weight and the heritability of obesity to know that it’s not that simple,” continues Dr. Butsch. “While I do have concerns that this medication (as well as Wegovy and Mounjaro) will be used in people who do not have indications, I think the approval of these medications and similar drugs in the next several years will increase awareness of the complexity of obesity and weight regulation, which will help diminish previously held beliefs that have created this diet culture.”
What happens when you go off Ozempic?
Studies abound on Ozempic’s efficacy, but because it is a fairly new drug, there is no research as of yet on the long-term impact of taking it. Once you stop taking it, however, you may return to your baseline weight and blood-sugar levels. This is why nutritionists, such as Charles Passler, DC, underscore the simultaneous importance of nutrition choices and lifestyle while on the drug.
Dr. Passler, who approaches weight loss holistically, helps his Ozempic patients change the way they’re eating so they can maximise the fat loss the injection offers while maintaining muscle. He also emphasizes breathwork, biofeedback, stress management, and sleep, which he believes are beneficial for bolstering and maintaining a healthy diet.
Close monitoring of all patients while they are on Ozempic is also key, says Dr. Lofton, which is why using your friend’s medication or picking it up from a medi-spa is worrisome: Dispensing by inexperienced prescribers is a real concern, she says. “It should be used under medical supervision because there’s still that risk of poor side effects that could put you in the hospital,” continues Dr. Lofton, adding that stories circulating in the media about patients experiencing intense vomiting are an indication of its gross misuse. “It should not make you feel that way,” adds Dr. Lofton, explaining that anyone in that situation should have discontinued use, had their dose dramatically lowered, and/or had an evaluation sonogram. “Doctors who understand the physiology of the drug and have the time to follow up with patients regularly and appropriately should be the only doctors who prescribe the drug,” says Dr. Rahmana.
Who should be using Ozempic (and who shouldn’t)?
While the FDA guidelines about Ozempic’s use for Type 2 diabetes are there, many doctors are prescribing Ozempic off-label, something that, to be clear, is a very common practice in medicine. But it’s still troubling to Dr. Chao: “I do have concerns about prescribing semaglutide off-label because the medication has not been well studied in people without Type 2 diabetes or in people without obesity.” A number of medical professionals are dually concerned that it’s simply being over- or inappropriately prescribed. “If someone just wants to drop a few pounds, I mean, come on, this is not appropriate for them,” says Dr. Passler. Using BMI as a determining factor for who qualifies poses its own issues as well. “BMI is not perfect, and it does not directly correlate to morbidity and mortality,” says Dr. Lofton, who often relies on other health indications, including waist circumference, to determine if a patient has obesity and if they’re at high risk for heart disease.
Could Ozempic’s overprescription cause a shortage for those who need it most?
Yes. Within the first six months of Wegovy being introduced as a treatment for obesity in July 2021, there were supply shortages due to both demand and factory production, says Dr. Butsch, which led many to use Ozempic in its place. “Many new providers were now using the lower doses of semaglutide to treat obesity, and this obviously snowballed into more supply shortages for those taking Ozempic for diabetes, despite the approval of the 2 mg dose in early 2022,” Dr. Butsch continues. “There is now a concern for those patients who have been on this drug for years for blood-sugar control and are unable to get the medication because of its inappropriate use,” adds Dr. Rahmana. At this moment, there’s a shortage of both Ozempic and Wegovy for diabetes patients who rely on them to keep their blood-sugar levels manageable — and for those hoping for an off-label prescription.
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