What is Ozempic?
Ozempic (semaglutide) and its sister drugs are the most popular prescriptions in weight loss right now. Semaglutide’s effectiveness for weight loss is well documented. Especially as more people in the public eye use the drug for weight control. While this medication is popular and effective, is it safe for you to consider taking on your weight loss journey?
One of the first things you should understand about semaglutide is that it is available under multiple brand names. Ozempic and Wegovy are two of the brand names for semaglutide. There are also other drugs in the same drug class. These drugs are known as GLP-1’s and are used to control blood sugar levels in diabetic patients. The FDA currently also approves two of these drugs for the treatment of obesity: Wegovy and high-dose liraglutide (Saxenda). No oral GLP-1 medications are FDA approved to treat obesity as of today.
While Ozempic is not approved for weight loss therapy, your provider can prescribe this medication “off label.1”“Off label” means they can prescribe semaglutide for a condition that it is not FDA approved to treat. Providers feel safe to do this because clinical trials have shown semaglutide to be effective for weight loss in patients with and without diabetes.
Semaglutide is an Effective Weight Loss Drug
Semaglutide has some of the strongest data proving efficacy as a weight loss medication. Efficacy is the drug’s ability to produce the desired effect. In the case of semaglutide, the desired effect being weight loss.
The STEP trials studied semaglutide as a weight loss therapy in diabetic patients and patients who did not have diabetes.1 Semaglutide was shown to be effective for weight loss in obese patients who did not have diabetes. Patients lost 11% of their body weight when compared to placebo.2
Another benefit of semaglutide is long-term weight loss. Treatment with semaglutide, along with changes in behavior, was associated with long term weight loss. Patients lost over 15% of their weight after 2 years of treatment.3 In addition to that, patients also saw improvements in weight-related cardiac risk factors.3
Semaglutide Has Health Benefits Outside of Weight Loss
In clinical trials, semaglutide improved blood pressure and blood sugar control.1 It also lowered cardiovascular and cardiometabolic risks in patients.4 This makes semaglutide a promising drug option for patients with obesity and other related diseases.
Semaglutide is heart protective in addition to being an effective weight loss therapy. Wegovy is now the first weight loss medication that is FDA-approved to help prevent heart attacks and strokes in non-diabetic patients.4
In a recent study, semaglutide reduced symptoms like tiredness and shortness of breath in patients with obesity and heart failure. It also led to improvements in physical and exercise function.5 These heart protective benefits of semaglutide will, no doubt, be studied further in clinical trials.
Most Common Side Effects of Semaglutide
We have a larger amount of side effect information for semaglutide than we would for most new drugs. Ozempic has been on the mark since 2017 as a diabetic treatment.
Semaglutide doses required to treat weight loss are higher than the doses used to treat diabetes. These higher doses can lead to a higher chance of experiencing side effects.
Nausea and vomiting are the most common side effects reported for higher doses of semaglutide.6 These symptoms typically do not last long and are of mild-to-moderate severity. They occur most commonly during dose increases and rarely lead to the patient stopping the medication.
Semaglutide can increase the risk of gallstones and inflammation in the gallbladder. Gall bladder-related issues ranged between 0.2% and 4.9% during clinical rials.2
Increased pancreatic lipase was observed in clinical trials of semaglutide in diabetic patients.1 Semaglutide also increases the risk of pancreatitis. Pancreatitis can be treated, but this condition may also lead to long-term complications in severe cases. Treatment with semaglutide is contraindicated in patients with a history of chronic or acute pancreatitis of unknown cause.
Retinopathy complications were reported in patients treated with semaglutide compared with placebo.1 This was thought to be related to the rapid improvement of glucose control.1 Patients should report any change in vision, including blurry vision to their providers.
Some good news is that dangerously low blood sugar levels were not frequently reported in patients without type 2 diabetes.6
Patients can experience rapid weight loss with semaglutide. This can lead to other side effects like hair loss and what some call “Ozempic face.” In clinical trials, 3% of people taking semaglutide reported hair loss compared to 1% of people taking the placebo.6 The condition leading to hair loss caused by semaglutide treatment is known as stress-related hair loss. “Ozempic face” is a hallowed look to the face caused by rapid loss of fat. These conditions are rarely permanent.
Unknown Long-term Risks and Other Considerations
Long term risks with semaglutide are rare, occurring in less than 2% of patients taking semaglutide2. it is important for you to be aware of these more severe side effects.
Semaglutide carries an FDA black box warning for possible association with certain rare types of thyroid tumors.6 A black box warning is the highest safety warning that the FDA can assign to medications. During safety studies prior to FDA approval, some rodents given semaglutide developed thyroid tumors. Note that this has not been seen in human trials.6 People with a history or family history of thyroid cancer should not take semaglutide.
Some people taking semaglutide and similar medications have reported stomach paralysis or gastroparesis.6 This condition occurs when food and liquids in the stomach empties into the intestines too slowly. Gastroparesis was not observed in the initial clinical trials of semaglutide. A few people have reported this side effect since the drug has been on the market.6 Some people also reported blocked intestines, called a bowel obstruction, while taking Wegovy.
Acute kidney injury happens when something causes kidney damage, causing them to not function as well as normal. This can happen during semaglutide treatment most often due to dehydration. Patients with impaired renal function should not take semaglutide.
Cardiovascular issues ranged between 1.5% and 9.8% in STEP clinical trials.1 Some patients in the trial experienced increased heart rates. Speak with your provider if you have conditions like atrial fibrillation, heart failure, or palpitations.
Suicidal thoughts were reported by some patients taking semaglutide in clinical trials reported .1 While this side effect was uncommon, it is serious enough to discuss with your provider.
Lastly, people with a family or personal history of multiple endocrine neoplasia type 2 should not take semaglutide.
Other Limitations of Semaglutide
Besides side effects, there are other reasons patients and providers may hesitate to start semaglutide therapy for weight loss. These limitations should be further studied as the drug becomes a popular weight loss option.
Semaglutide therapy is a high-cost weight loss medication if not covered by insurance. Obesity and complications related to obesity can disproportionately affect the neediest of our population. These people may not have the money to cover semaglutide without insurance.
We should also consider the low number of the higher number of white and female participants in the clinical trials studying semaglutide. These limitations in the clinical trials should give us pause when applying trial data to all patients. That includes side effect data. Side effects from patients not represented well in the study should be taken seriously by the patients and providers.
Conclusion
The FDA currently only approves the use of semaglutide and high-dose liraglutide to help treat obesity. While semaglutide is safe and effective for most people, you should consider your own health journey. If you have struggled with weight loss and have not had success with lifestyle modifications, semaglutide may be the additional drug therapy you need. It is a good idea to discuss starting weight loss therapy with a trusted medical professional before using semaglutide. Your provider can go over the potential side effects discussed in this article with you. Together, both of you can decide if semaglutide is the best weight loss treatment option for you.
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