Semaglutide Weight Loss Drugs: Pros, Cons, and Considerations
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Celebs such as Chelsea Handler and The Real Housewives of New Jersey star Dolores Catania have touted the use of Ozempic, a diabetes drug, as a highly effective weight loss aid. Although the drug is not approved for weight loss by the U.S. Food and Drug Administration (FDA), it is increasingly being prescribed off-label for that use, and not entirely without reason.
Some research suggests that semaglutide (which is marketed as Ozempic and another brand, Wegovy) and tirzepatide (a drug sold under the brand name Mounjaro for type 2 diabetes and Zepbound for weight loss) really do work as a way to trim down. A large study published in The New England Journal of Medicine in March 2021 found that people who took semaglutide lost an average of 14.9 percent of their body weight over 68 weeks. A small earlier study of 30 people that was published in Diabetes, Obesity, and Metabolism in September 2017 found that people who received injections of the drug once a week for 12 weeks ate 24 percent fewer calories than people in a control group.
All these medications work essentially by mimicking the natural hormones that regulate hunger and feelings of fullness. Semaglutide like Ozempic, which was first FDA-approved for diabetes treatment in 2017, contains an active ingredient that lowers blood sugar levels by helping the pancreas produce more insulin, thus preventing the liver from releasing too much sugar, and slowing the rate at which food travels through the digestive system. These actions can be useful to treat diabetes, in which an inability to make or properly use insulin can leave blood sugar unchecked, according to the American Diabetes Association. But these drugs also have other metabolic benefits, including weight loss.
For many who have struggled to lose weight their entire lives, drugs like Ozempic have been nothing short of miraculous. But if you’ve been considering asking your doctor for a prescription, there are some things you should know first.
Here’s what experts have to say about when to consider semaglutide for weight loss.
The Realities of Weight Loss
If you’ve attempted weight loss in the past, only to find pounds creeping back onto your frame, you know that it’s rarely easy. A 2023 poll found that 95 percent of Americans surveyed reported trying to lose weight in the previous five years, and 44 percent actually ended up gaining weight (21 pounds, on average) as a result.
“Obesity is a complex condition — so many factors contribute to its occurrence (and reoccurrence) over time, and these factors are not the same for all people,” says Kimberly Gudzune, MD, MPH, medical director of the American Board of Obesity Medicine, who is based in Baltimore.
When someone repeatedly fails at weight loss or loses only to regain, it can be frustrating and discouraging. These new classes of drugs have been giving those people hope. “For people who have not had success with lifestyle alone or have been previously unsuccessful with other medications, these medications offer a new option that may support their health goals,” Dr. Gudzune says.
But the newer weight loss medications are also being used somewhat inappropriately by celebrities and people who may not really need them. While these folks may talk a lot about their success with Ozempic for weight loss, it’s important to remember that no one strategy is a magic bullet for shedding pounds.
How They Work
Many weight loss drugs of the past have had questionable results — but semaglutide could be a game changer for the future of weight control. “These newer medications work on a different physiologic pathway than some of the other medications,” says Gudzune. Whereas previous anti-obesity drugs may decrease the amount of dietary fat absorbed by the body, semaglutide affects hormones involved in hunger and fullness. In the previously mentioned poll about weight loss, 27 percent of respondents cited hunger as an obstacle to their weight loss goals.
Semaglutide essentially mimics a hormone that stimulates the pancreas to produce more insulin, in turn lowering blood sugar, reducing cravings, and slowing digestion. All these mechanisms keep you feeling satiated and prevent you from overeating, ultimately leading to weight loss. Patients of Gudzune who have taken semaglutide have reported feeling full on smaller portions, and many describe a reduction in “food noise” — ever-present thoughts about eating and food.
Evidence also shows that medications like Ozempic, Wegovy, Mounjaro, and Zepbound are much more efficacious, meaning that they lead to a higher total body weight loss more quickly than other medications that have been historically used to treat obesity, says Rekha Kumar, MD, the chief medical officer at the medically assisted weight loss program Found, and an endocrinologist in New York City. Mounjaro’s manufacturer, Eli Lilly, released results of a study in 2023 that found that study participants who took the drug lost nearly 16 percent of their total body weight in 16 months.
While semaglutide is quite effective for weight loss, it’s not intended for everyone. In fact, semaglutide as Ozempic is meant to be prescribed for diabetes, but when sold under the name Wegovy it is FDA-approved to treat overweight and obesity. A similar drug (tirzepatide) is sold as Mounjaro for diabetes and won FDA approval in November 2023 to treat obesity under the name Zepbound.
A recent study, published in Nature Medicine, showed that tirzepatide helped people lose more than 60 pounds, or at least one-quarter of their body weight, when used along with intensive lifestyle changes
Gudzune notes that most of the medications, including Ozempic and Wegovy, are injectables, but there is one in pill form called Rybelsus that is approved to treat diabetes. That means these medications require patients to use a needle to inject themselves regularly at home. (The frequency varies, but for Ozempic and Wegovy, it’s once a week.)
Who Should Use Ozempic?
It’s technically legal to use the drugs for weight loss in the absence of a health condition (aka off-label), but that doesn’t mean it’s a good idea — and it’s only FDA approved for weight loss in that scenario if your body mass index (BMI) is over 30. “Normal-weight patients without diabetes might lose weight if they take [these drugs], but the risks of the medication outweigh the benefit of weight loss just to be thin (versus treating a disease),” Dr. Kumar says. “[These drugs] have not been studied in this population and we will likely see more side effects with this type of inappropriate use.”
In addition, if you use semaglutide or tirzepatide, that doesn’t mean you can forget about following a healthy lifestyle. “People should always pursue a healthy diet for their overall cardiometabolic health and for adequate nutritional status,” says Kumar. “There is no medication or supplement that can counteract the effects of a bad diet.” Regular exercise, good hydration, and high-quality sleep are other habits crucial for overall health and better weight loss results.
As for who is a good candidate for these drugs, there are no official criteria. “Right now, we use BMI combined with other medical conditions to determine eligibility for a medication,” says Gudzune. She says that anyone with a BMI of 30 or greater, or anyone who has a BMI of at least 27 and also has another weight-associated medical condition such as high blood pressure, is a potential candidate for medication. In all cases, however, discussing your options with a knowledgeable healthcare provider is important.
Side Effects and Other Concerns
If you do decide to give Ozempic or another similar medication a try, be aware that while they may seem like miracle drugs, they are not without downsides. Some things to consider:
Cost Depending on your insurance coverage, semaglutide can be quite expensive. According to NovoCare, a medical resource for people with diabetes, the list price for a 0.25, 0.5, 1, or 2 milligram (mg) injection pen is $935.77. Fortunately, some insurance plans may bring this cost down (and may even cover off-label use). Zepbound for weight loss costs over $1,000.
Availability According to Kumar, you may run into issues with availability: “The trend of medi spas, boutique weight loss practices, and illegitimate telehealth businesses liberally prescribing to people who don’t meet criteria is not only irresponsible, but could interfere with getting the medication to those who need it the most.”
Delivery Afraid of needles? Most of these medications are delivered via injection, not a pill.
Longevity Once you get on Ozempic, you’ll need to stay on it to maintain results. “Patients considering any anti-obesity medication as a treatment option should be prepared to take these medications long-term — we see the best outcomes in the scenario for achieving and most importantly sustaining all the health benefits achieved,” says Gudzune.
Side effects You may also experience some unpleasant side effects while on Ozempic, Wegovy, Zepbound or Mounjaro. These may include nausea, diarrhea, bloating, constipation, stomach pain, depression or thoughts of suicide, and pain or redness at the injection site. Tell your doctor if you have had problems in the past with your kidneys or pancreas, a history of diabetic retinopathy, or are pregnant or breastfeeding. These conditions may affect whether you can use this drug, according to Ozempic’s website.
As prescription drugs go, Ozempic and other semaglutide are relatively new, so there’s a lot we still don’t know about them. The effects of years- or decades-long use are largely undocumented.
There is, however, evidence that people with certain medical conditions should avoid these drugs. “People who have a history or family history of a rare thyroid cancer (medullary thyroid carcinoma) should not use this medication,” says Gudzune. Similarly, anyone with a history of pancreatitis should discuss the safety of these medications with a healthcare provider.
Gudzune also cautions anyone who is pregnant or breastfeeding to avoid using these medications, and says anyone who plans to become pregnant should have a discussion with their doctor about whether and how to use these medications.
Finally, individuals with a history of disordered eating should discuss the drugs with their doctor and therapist before starting.
Kumar points out that there’s minimal research on their effects on people with normal weight. “While it is true that taking [these drugs] may benefit those with overweight or obesity, Ozempic hasn’t been tested in those without obesity — meaning people who want to lose those extra ‘vanity pounds.’ So there’s no way to know what sort of weight loss or side effects can happen with inappropriate use.”
Remember, too, that as effective as these medications may be, they can’t solve emotional issues related to eating and weight. Depending on your relationship to food, it may be best to approach weight loss from a more comprehensive perspective that addresses the physical and the emotional.
Related: What Is Emotional Eating? The Good, the Bad, and the In Between
Summary
If you’re curious about whether semaglutide or tirzepatide weight loss drugs are right for you, it’s worth a conversation with your healthcare provider, who can best help you assess the pros and cons, such as cost, long-term use, effectiveness, and whether the state of your health indicates you’re a good candidate.
Kumar says these drugs are generally for use in people with diabetes, significant overweight, or obesity. Gudzune agrees that a health assessment is critical before starting any weight loss medication. “During a comprehensive obesity medicine evaluation, the physician will typically seek to understand your weight history, lifestyle (such as nutrition, eating habits, physical activity, sleep, and stress), history of weight-related health and mental health conditions, screen for disordered eating and mood changes, and conduct a physical exam and check any needed lab tests.” For the best care, Gudzune recommends seeking out a physician trained in obesity medicine.
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