by Nate Widom
This article has been reviewed by Ashley Boyer, RD, LDN. Ashley is a Certified Diabetes Care and Education Specialist from the Certification Board for Diabetes Care and Education (CBDCE) with five years of experience collaborating with endocrinologists specializing in diabetes education. Ashley is also a Registered Dietitian with the Academy of Nutrition and Dietetics, a national professional organization, and is licensed in nutrition with the State of Delaware.
Ozempic is among the ever-evolving trends in weight loss. The drug has gained popularity in Hollywood, with even Oprah chiming in on its use!1 While it may be effective for losing weight, it was initially designed to manage type 2 diabetes. Now, those who truly need it are facing challenges accessing it. I spoke with Ashley Boyer, a registered dietitian and Certified Diabetes Care and Education Specialist, to delve into this issue further.
From Diabetes Drug to Weight Loss Trend
To begin, Ashley mentions these popular drugs are considered semaglutides. There are only three FDA-approved ones: Ozempic, Wegovy, and Rybelsus. All are relatively new and only available via prescription. They work by mimicking the GLP-1 hormone in your gastrointestinal tract. Naturally, this hormone is released when you eat food—it signals your brain that you’re full once you’ve eaten enough. By mimicking GLP-1, semaglutides cause the brain to trick you into feeling full, leading you to eat less.
“Basically, it kind of works by slowing down digestion, which results in people eating a lot less. And when people eat a lot less, they’re obviously losing weight,” Ashley says. While effective for weight loss, semaglutides can have dangerous side effects and are not for everybody. We’ll cover that later.
Ozempic, the first of these drugs, was federally approved in 2017 to treat type 2 diabetes, along with Rybelsus, in 2019.2,3 That same hormonal process described earlier is critical for those patients because GLP-1 also results in the body producing more insulin, controlling blood sugar.4
But, “the makers of Ozempic saw the potential of a weight loss drug, even for people without diabetes,” Ashley says. In fact, she even mentions that unintended weight loss was listed as a side effect! As a result, the same company that manufactures Ozempic released a similar drug, Wegovy, in 2021 specifically for weight loss.2 While Wegovy works using the same mechanism as Ozempic, it is not approved to treat diabetes.
A Shortage and its Effect on Diabetes Patients
“There’s definitely a shortage that is impacting a lot of patients,” Ashley says. Since May 2023, Ozempic and Wegovy have been on the FDA’s drug shortages list.4 In 2023, just under 2% of America had been prescribed a semaglutide!2
Thanks to the increase in demand, it’s difficult for type 2 diabetics to get their hands on the medicine they genuinely need. Both diabetics and non-diabetics looking to lose weight are ending up with prescriptions for Ozempic, even though it’s intended for those with type 2 diabetes.5 “They’re relying on it. It’s a very effective drug for them,” Ashley stresses.
Semaglutides are designed to be taken long-term, so any disruption in getting these drugs can be catastrophic to people with diabetes. If their blood sugar isn’t controlled, those with diabetes can experience excess hunger, thirst, urination, heart and kidney disease, headaches, nerve damage, and more.
Considerations and a Takeaway
The liberal prescription of Ozempic makes it harder for those who need the drug to obtain it. That said, harboring excess weight comes with its own set of consequences, and semaglutides can help reduce excess weight to prevent those poor health outcomes. “We have to consider that – because that [excess weight] can lead to death through heart problems and lots of different issues,” Ashley says. “So, I’m not opposed to people having an aid to get them on a weight loss track.” Plus, semaglutides offer a much less invasive option than bariatric surgery.
Essentially, bariatric surgery shares the same goal as the semaglutides approved for weight loss—it’s all about losing weight. There are different types of bariatric surgery, but it generally entails a surgical procedure that physically shrinks the stomach. Patients will be unable to consume as much food as before, even if they feel hungry. If they overeat, they’ll get sick. This results in misery for many patients and possible malnutrition. Ashley recommends semaglutides before any bariatric surgery.
Still, she feels the general public is misled about semaglutides. “People want quick fixes, and it’s unfortunate because it doesn’t work like that,” she explains. Taking them can be challenging, getting your hands on them can be challenging, and for many, affording them can also be challenging.
“People want quick fixes, and it’s unfortunate because it doesn’t work like that.”
“People aren’t changing their diets, so a lot of times when people come off this drug, they’re rebounding and gaining that weight back,” Ashley elaborates. “That’s why a lot of us dietitians recommend changing your behaviors, changing your food choices, along with using the medication itself. Even if someone doesn’t have diabetes and decides to use it, I highly recommend them meeting with a dietitian to help change those underlying behaviors and choices.”
Plus, there are serious side effects—namely malnutrition. As described earlier, these drugs trick your brain into feeling that you’re full. This can result in a dangerous situation where people won’t eat enough, even if they feel they have. “Some of these people are only eating 800 calories a day,” Ashley shares. “People can’t function on that. Your brain can’t function on that.” While consuming less calories than you burn is a basic principle of weight loss, there’s a limit to what’s healthy, and you still need to consume enough essential nutrients to live.
Some of the most common side effects of semaglutides include nausea, vomiting, and diarrhea. There’s also the chance for constipation, bloating, stomach pain, and headaches.6
Ashley wants the public to be informed about how the high demand for Ozempic affects those with diabetes. While other semaglutides can be used to aid your weight loss journey, they’re not an instant solution for weight loss. If you need to lose weight, she recommends going the traditional route: eating unprocessed, nutritious food while staying in a calorie deficit and getting enough exercise. Semaglutides can help assist, but they must be used responsibly alongside a healthy lifestyle. If you want to try semaglutides, please consult a doctor to determine if they’re right for you.
References
- https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552
- https://www.cnn.com/2023/11/02/business/novo-nordisk-eli-lilly-earnings-boost-weight-loss-ozempic/index.html
- https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-glp-1-treatment-type-2-diabetes
- https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss
- https://www.nbcnews.com/health/health-news/people-diabetes-struggle-find-ozempic-soars-popularity-weight-loss-aid-rcna64916
- https://www.goodrx.com/ozempic/semaglutide-side-effects