15 Burning Questions About Ozempic, Answered
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When the U.S. Food and Drug Administration (FDA) approved Ozempic in 2017 for use in adults with type 2 diabetes, it ushered in a new era of blood sugar and weight loss drugs. Since then, its obesity counterpart Wegovy has become available. More recently, Mounjaro and Zepbound — two drugs potentially poised to have even bigger health impacts — have been FDA approved.
These weight loss drugs are in a league of their own, and they’ve captured the public’s eye in the doctor’s office and on social media alike. In a survey by Everyday Health, which queried more than 3,000 people in summer 2023, respondents who lost weight were about 2 times as likely to have tried these drugs than people who maintained or gained weight.
RELATED: Everyday Health’s Survey and Special Report: Weight Loss Reframed
Despite growing awareness of these injectables, many questions around them remain. How do they work? What are the side effects? And do you have to stay on them forever to retain their potential benefits?
Below are answers to common questions like these from a handful of experts: Beverly Tchang, MD, a diplomate of the American Board of Obesity Medicine and an assistant professor of clinical medicine at Weill Cornell Medicine in New York City; Erin Palinski-Wade, RDN, CDCES, who practices in Sparta, New Jersey; and Tiffani Bell Washington, MD, MPH, a diplomate of the American Board of Psychiatry and Neurology and of the American Board of Obesity Medicine, who lives in Boston.
1. How Do Ozempic and Other Popular Weight Loss Drugs Work?
Ozempic is a GLP-1 agonist. It mimics the action of one of the body’s hormones, glucagon-like peptide 1, which stimulates the pancreas to produce more insulin. More insulin helps more blood sugar enter the cells, lowering sugar levels in the blood. Ozempic has the additional bonus of preventing the liver from making and releasing too much sugar, Palinski-Wade says.
Besides its effect on blood sugar, GLP-1 is the primary actor behind Ozempic’s weight loss effects. “GLP-1 increases feelings of satiety and decreases appetite while also slowing digestion, which in turn mutes appetite as well,” says Palinski-Wade. She explains that the drug delays the food’s exit from the stomach, keeping you feeling full for longer.
“Some people feel the appetite-suppressing effects within 24 to 48 hours, but weight loss and blood sugar control will take longer,” Dr. Tchang says. “We see people lose weight and achieve blood sugar control over several months, and these benefits are sustained over a year.”
Similarly, GLP-1 and GIP receptor agonists mimic the action of a hormone in the lower gut to stimulate insulin release after you eat. Mounjaro and Zepbound (sold as the generic tirzepatide) are part of this drug class. Research also shows that GIP signals a sense of satiation to the brain.
2. Who Has Had the Most Success on Ozempic, From What We’ve Seen So Far?
Ozempic was first formulated by the pharmaceutical company Novo Nordisk in 2012, making it a mere 11 years old. Despite its “young” age, in the last decade-plus, several studies suggest it really does work for blood sugar control. For example, research found that people on the drug reduced their A1C by an average of .77 points over six months. A1C measures average blood sugar levels over two to three months, and is a marker for diabetes control.
Again, Ozempic also happens to boost weight loss. One study found that more than 1,900 people who took Ozempic for 68 weeks lost an average of 14.9 percent of their body weight. Wegovy seems to have comparable results. A study tracked the findings of multiple clinical trials, showing that people on Wegovy lost an average of 2.3 to 4.53 kilogram (kg) of body weight over the course of 30 to 104 weeks.
Tirzepatide has an impressive impact on weight as well. In one study, the average weight loss for people on drugs with the ingredient was 15 percent at a 5 milligram (mg) weekly dose, 19.5 percent at a 10 mg dose, and 20.9 percent at a 15 mg dose over 72 weeks.
Regarding Ozempic in particular, so far, it’s not clear if certain demographics might be able to manage blood sugar better or lose more weight on the drug than others. “We don’t have that granularity of evidence yet, but we have general trends from other studies,” says Tchang. “Earlier intervention is better (because of fewer years of uncontrolled diabetes), and people who have higher baseline weight tend to lose more weight.”
3. Who Shouldn’t Take Ozempic?
It’s not recommended if you’re pregnant, under 18 years old, or have a history of diabetic retinopathy or problems with your pancreas or kidneys, per the drug website. People with a family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome 2 (MEN 2) also shouldn’t get on semaglutide.
These same stipulations hold true for Wegovy.
Mounjaro and Zepbound are also not recommended during pregnancy or for people with family history of these conditions.
4. Should I Stay on Ozempic Forever?
For most people, Ozempic won’t be a short-term fix. “Semaglutide is a medication that people should take for a long time, not temporarily,” Dr. Washington says. “This is because obesity is a chronic disease, and the medication only works when you take it.” When people stop taking Ozempic, she says, they tend to regain lost weight.
So how long can you stay on Ozempic? No time limit has been established yet. (The same goes for other newer weight loss drugs.) But as long as you’re tolerating the medication well and your healthcare provider recommends it, you should be able to continue taking it.
5. I Know Ozempic Takes the Weight Off Fast. Are There Any Downsides to That?
When you need to shed pounds, a rapid weight loss drug may be a great fit. Still, losing weight quickly can come with downsides.
“A loss of appetite and a decrease in calorie consumption can promote weight loss. However, it can also lead to a lack of balanced nutrition and an increased risk of nutrient deficiencies,” says Palinski-Wade. These potential deficiencies could have lasting consequences. For example, if you’re not taking in enough calcium and vitamin D from your diet, you could increase your risk of osteoporosis, she notes. Rapid weight loss can also lead to reduced muscle mass, which can decrease overall metabolism, strength, and balance over time.
Ozempic and the other weight loss drugs might also have some drawbacks for your appearance. Many people report “Ozempic face,” a hollowed-out facial appearance that comes from rapidly losing fat. (Unfortunately, we can’t control which parts of our bodies lose fat the fastest or most noticeably.) Some Ozempic users even complain of “Ozempic butt.” The same principle applies here: As weight comes off rapidly, it can leave your buttocks looking saggy or hollow.
6. I’ve Heard About Some Pretty Yucky Side Effects With This Drug. Should I Be Concerned?
Most prescription drugs come with possible side effects, and Ozempic is no exception. The most common side effects of Ozempic are nausea, vomiting, constipation, diarrhea, and abdominal pain. Less commonly, some people experience fatigue, hair loss, and more severe stomach problems. According to a study, GLP-1 agonists for weight loss were associated with increased risk of pancreatitis, gastroparesis, and bowel obstruction.
Side effects from GLP-1 and GIP receptor agonists are similar, says Palinski-Wade, and are typically GI-related. Some research has shown that people on tirzepatide drugs experience more gastrointestinal side effects than people on semaglutides, but each person will respond uniquely to each drug.
Meanwhile, for most people, side effects of newer weight loss drugs are not debilitating and pass quickly. “Generally, these side effects are seen in the first few weeks of therapy as well as when dosing is increased,” Palinski-Wade says. She recommends avoiding large meals or meals high in fat to help to lessen GI symptoms.
7. What Are the Long-Term Health Effects of Ozempic?
Because drugs like Ozempic are relatively new, we don’t yet have a large body of data on their long-term health effects. Still, some research has raised the possibility of a few concerning long-term health outcomes. A study published in 2023 found a link between these drugs and serious GI problems like intestinal blockage, pancreatitis, and gastroparesis. For this reason, in September 2023, the FDA added a warning of these potential effects on Ozempic’s label.
Another concern has been Ozempic’s potential impact on thyroid cancer risk. Some animal studies, such as one from 2012, found an association between the drug and thyroid cancer in mice. Thus far, however, this link has not yet been demonstrated in humans. According to research conducted by the European Medicines Agency, the available evidence does not support a causal link between GLP-1 agonists and cancer of the thyroid.
That said, Tchang encourages caution if you have certain risk factors. “A personal or family history of medullary thyroid cancer is a contraindication to Ozempic because this type of cancer was associated with Ozempic in animal studies,” she said. “However, it’s important to discuss these concerns with your doctor, who best knows your individual circumstance.”
Like Ozempic, Mounjaro and Zepbound are so new that data on long-term effects isn’t yet available. Palinski-Wade says that thyroid tumors may eventually be a concern with these meds, too. “The FDA has warned tirzepatide can cause thyroid tumors in rats, but we do not yet know if this will be the case in humans. More research and longer term studies are needed.”
8. How Does Ozempic Affect Mental Health?
Washington says obesity and mental health issues have a bidirectional relationship — meaning it’s often hard to tell which came first. Research from 2021, for example, found that obesity was a risk factor for both anxiety and depression. And according to survey data from the Centers for Disease Control and Prevention (CDC), the proportion of adults with obesity rises as the severity of depressive symptoms increases.
It’s important, then, to tease apart how Ozempic might affect mental health. “There have been case reports that indicate there is an association between semaglutide and depression,” Washington notes. In a 2023 report, for example, two cases of depressive symptoms were recorded. When the two people with depression stopped taking semaglutides, their symptoms went away. The FDA’s Adverse Event Reporting System (FAERS) has received numerous reports of patients experiencing anxiety, depression, or suicidal thoughts while taking semaglutide, Washington says.
If you feel the medication is causing or worsening psychological symptoms, talk to your doctor. “It’s important to closely monitor a person’s mood and make changes if necessary,” Washington says.
9. How Can I Get Ozempic Covered by Insurance?
Insurance coverage of Ozempic (and all drugs, for weight loss or otherwise) may vary, depending on your provider and plan. In many cases, if you have a valid prescription for the drug, insurance will cover at least a portion of the cost. But some insurance companies only cover Ozempic when it’s prescribed as a treatment for type 2 diabetes, not when it’s prescribed off-label as a weight loss aid.
Now that Zepbound is FDA-approved for weight loss, there may be fewer instances of off-label prescription of semaglutides to help people slim down. “This would be up to individual healthcare providers based on availability, insurance coverage, and the patient’s needs,” says Palinski-Wade.
10. What Does Ozempic Cost?
There’s no sugarcoating it: These drugs aren’t cheap. Novo Nordisk, Ozempic’s manufacturer, lists the price of injection pens as $935.77 each without insurance. (This price applies to 0.25 mg, 0.5 mg, 1 mg, and 2 mg pens.) The company also offers an online tool to help you determine your cost with your unique insurance details.
Wegovy has its own savings card, which allows users to pay $0 for a 28-day supply of up to 12 fills. It’s a deal you’ll likely want to snag, considering that the list price for a package (about a month’s supply) of the drug is $1,349.02.
Without insurance, Mounjaro and Zepbound also cost a pretty penny. Mounjaro lists for $1,023.04 per fill and Zepbound lists for $1,059.87. Fortunately, both drugs do offer savings cards that can bring costs down to as little as $25 per month.
11. How Do You Get Ozempic When It’s Not Covered by Insurance?
If your particular insurance plan doesn’t cover Ozempic, you may have other options for reducing its cost. Ozempic offers a savings card that allows users with private or commercial insurance to pay as little as $25 per pen. To access this card, your prescription must be for a one-, two-, or three-month supply, and you’ll need to answer a few qualifying questions online. If you’re interested in another weight loss drug, check out their drug websites to seek potential options for similar savings.
You can also ask your doctor or pharmacist for insider info on any savings programs or patient assistance options available in your area. Some nationwide drug discount programs like GoodRx could also bring costs down.
12. Are There Cheaper Alternatives to Ozempic?
Considering the sometimes-high cost of Ozempic, no one can blame you if you’re looking for a less-expensive alternative. Unfortunately, Ozempic currently does not have a generic alternative, Tchang says. While some websites may offer knockoff versions of the drug, don’t be fooled: Faux pharmaceuticals are not a safe bet.
Some specialized pharmacies offer compounded semaglutides. These custom-made meds combine the active ingredients of Ozempic with other medications tailored to individual health needs. But Tchang says this option doesn’t have the safety backing of the branded drug. “Compounded semaglutide has not undergone the same clinical trial rigor as brand-name Ozempic, so a patient choosing this route is taking on more risk and must rely on their own research to ensure safety and efficacy.”
If you can’t afford name-brand Ozempic, Tchang says there are other possibilities for weight loss meds. “If Ozempic is inaccessible, patients should speak with a board-certified obesity medicine physician who can discuss other options, such as other GLP-1s or oral anti-obesity medications, which are typically more cost-feasible.”
13. How Do You Use Ozempic?
Ozempic is a once-a-week injectable drug. As for how to inject Ozempic? It’s actually simple. The drug comes in a prefilled pen that is injected under the skin. The question of where to place the injection is largely up to you: You can use it on your abdomen, thigh, or upper arm.
Prior to your first use, you should store Ozempic in the fridge. After you’ve used it, you can store your pen for 56 days at room temperature between 59 and 86 degrees F or in the refrigerator between 36 and 46 degrees F. Don’t freeze Ozempic — and be sure to keep the cap on the pen when you’re not using it.
14. I’ve Heard Mounjaro Is Even More Effective Than Ozempic. What Are the Main Things I Need to Know About This Drug?
Mounjaro, like Ozempic, has been shown to reduce blood sugar in people with type 2 diabetes, as well as promote weight loss. In a study published in the New England Journal of Medicine, participants who took tirzepatide lost an average of 15 percent of their body weight on a 5 mg weekly dose, 19.5 percent on a 10 mg dose, and 20.9 percent on a 15 mg dose over 72 weeks. This compares favorably with other research that showed a 2.4 mg weekly Ozempic dose reduced body weight by an average of 14.9 percent over 68 weeks.
Similarly, studies have revealed that Mounjaro reduces A1C in people with diabetes. In research, people on this drug saw A1C reductions ranging from 1.87 to 2.59 percent.
Determining which drug is best for you may be a matter of assessing your health goals. One primary difference between Mounjaro and Ozempic is that Ozempic is FDA-approved to reduce the risk of heart attack and stroke in people with type 2 diabetes, while Mounjaro is not. Talk to your doctor about whether Mounjaro or Ozempic is more appropriate for you.
15. What Happens When You Stop Taking Ozempic?
Ozempic’s effects last only while you’re taking it — so getting off the medication generally results in a rebound of weight gain, Washington says. “The issue is that because obesity is a chronic disease, our bodies resist changes to weight and will start to work to get back to the higher set point. This is where anti-obesity medications help prevent weight gain if you continue to take them.” In one study, within a year, people who got off the drug regained two-thirds of the weight they had lost.
Palinski-Wade says this is likely to be the reality for tirzepatide drugs as well as semaglutides. “In general, weight regain after stopping weight loss medications is always a possibility. It is important to note that these medications are a tool when it comes to weight management, not a quick fix or a cure.”
Even if you stop taking your weight loss drug, though, you can always continue to make healthy choices that promote weight loss. “To help decrease the rebound weight gain, people can continue the lifestyle changes that they hopefully learned while taking semaglutide,” Washington says.
Everyday Health‘s Weight Loss Reframed Survey queried 3,144 Americans nationwide ages 18 and older who had tried losing weight in the previous six months. The study was fielded between July 10 and August 18, 2023, across demographic groups, genders, and health conditions. Survey recruitment took place via an online portal, in app, and via email. The margin of error for the sample size of 3,144 is +/-1.7 percent at a 95 percent confidence level.
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