Written by Courtney Human RD(SA)

Maybe you’ve heard it about, maybe you’ve just noticed some people around you are shrinking in size by the minute, or maybe this is more of a niche topic than I expected. This month we are speaking about Ozempic also known generically as semaglutide. Incorrectly known as the weekly weight loss injection. Scientifically known as an FDA (Food and Drug Administration) approved drug used in the treatment of type 2 diabetes which alongside diet and exercise improves blood sugar control – and yes, subsequently an added effectof weight loss. But, Ozempic is not approved for weight loss alone. So, let’s dive in and see how this all played out and into the hands of any Tom, Dick and Harry who wants to just shed a few kilos and the implications of this.

Since Ozempic is not FDA approved for weight loss they created Wegovy which is. Wegovy is an injection prescribed alongside a reduced calorie diet and exercise regimen for chronic weight management in adults with obesity with at least one weight related condition. Previous weight loss drugs on the market helped with 5-8% weight loss with serious side effects whereas semaglutides lead to 15% weight loss when paired with healthy lifestyle interventions. How could this not become a popular drug, right?

Of course, Wegovy ran out and Ozempic started being prescribed off label for obesity management. Hence, came the shortage of the drug for those dependent on it for their type 2 diabetes. This created a desperation frenzy with pharmaceutical companies climbing on board creating unregulated generic forms at a cheaper cost than the brand names. These have since developed into compounded weight loss cocktails with increased dosages of semaglutides. Ineffective at best and dangerous at worst. Not worth the risk according to this dietitian as the original Ozempic and Wegovy already have side effects, so imagine increasing the dose to untested limits and volunteering yourself as a human guinea pig.

Putting this aside, when semaglutides are used correctly they are appetite suppressants that slow gastric emptying, allowing us to feel fuller quicker. They repress natural compensatory mechanisms that kick into high gear when we are put into a calorie deficit. Normally on a diet our body fights to maintain body weight balance by increasing hunger hormones and decreasing fullness hormones to make us eat more with every kilo we lose – that’s why weight loss maintenance is so hard! But it’s not magic, you can’t just eat whatever you want and still lose weight. Nor think I can eat ten pizzas and magically not absorb calories. If anything, the pairing of excessive food intake would probably increase negative side effects some being nausea, dizziness, reflux, tiredness increased thyroid cancer risk and even pancreatitis – a colleague of mine actually had a patient admitted into ICU with semaglutide induced pancreatitis! Overall, these drugs just make achieving a calorie deficit way easier.

They say obesity is 70% genetically determined and only 20% environment. Genetics loads the gun; environment pulls the trigger. Some people claim those with obesity should be second fiddle to those with diabetes for a coveted semaglutide dose. Yes, the stress of being unable to fulfil a prescription can empathize frustration and fear. However, obesity is recognised as a chronic disease and deserves medical support too. Obesity may need these drugs to override genetic factors responsible for why some folks may not be able to dramatically shift their set point weight. Believe it or not weight gain and weight loss capabilities are genetically determined (but, this topic I will save for another blog post!)

Whether Ozempic is used for weight loss or chronic disease management we need to do some myth busting. First one being that most Ozempic attributed weight loss comes from muscle. Understand, those who are truly carrying excess body fat tend to lose more fat than muscle. A calorie deficit in most cases will lead to some muscle mass losses. Most weight loss on this drug shouldn’t if one is gradually increasing the doses at set intervals based on the effects and side effects as intended. Hence, this form of medical nutrition therapy should come alongside a dietician consult, to ensure adequate protein intake while on a low-calorie diet. Moreover, resistance and weight training with this to maintain muscle mass!

Second myth is that Ozempic is great for casual weight loss as advertised by celebrities like the Kardashians and even Elon Musk. This drug is not meant for people of a “healthy weight” trying to get “skinny.” Frankly, a short-term mindset means short term results. Ozempic wants to be a lifelong marriage not a casual diet affair and studies confirm this with patients regaining back two thirds of weight lost one year after going off Ozempic. It is a real struggle maintaining weight loss after a pharmaceutical boost. However, sustainable weight loss should be 0.4kg – 1kg per week not 7kg weekly like people are claiming in a non-prescribed uncontrolled way.

Moral of the story: semaglutide medications should not be prescribed to just anyone who needs to lose weight as first line treatment. One needs to assess the risk/benefit ratio alongside immediate and long-term individualized needs. We as dietitians need to see this drug as a tool in our medical nutritional therapy! We cannot lose sight of the bigger picture which is first assessing food intake, mental health, sleep, and exercise within our control. On Ozempic alone you may be making yourself metabolically healthy in one way at the expense of another (which is a biscuit not worth risking it for.)

Although one chronic disease cohort is not more worthy of access to a life changing drug than another. We need to be fully aware of this modern hunger games to get this medication and know the risks of stooping to underground semaglutide forms. Ozempic is a life changing drug with potential to improve quality of life, decrease risks of cancers or disease and essentially prolong life but weight is not the sole determinant of one’s health. For the love of sustainable lifestyle change reassess your social media echo chamber.

Don’t let Tik Tok testimonials or celebrity Ozempic bodies become the new icon for health moving forward. Scientific evidence shows, Ozempic alone is not a free ride.