By: Rachel Dodson, M.S. RD. LDN.
This blog is for informational and educational purposes only. This is not a substitute for medical advice. Consult your individual medical providers for your individual needs.
Gaining popularity and attention in the media are weight-loss drugs like Ozempic and Wegovy. These drugs are manufactured by Novo Nordisk and are part of a class of medications known as GLP-1 agonists. Semaglutide is the active ingredient in drugs like Ozempic and Wegovy. These weekly injections help regulate insulin and hormones that control our hunger and satiety signals. Ozempic is prescribed for diabetes and Wegovy is prescribed for weight loss.
What is Ozempic and how do these drugs work
Ozempic is a relatively new drug. We only have 2 years of research of these drugs at the dosage for weight loss, so we don’t know what will happen if you take this dose for the rest of your life. Ozempic was initially tested and approved by the FDA to, along with nutrition and exercise, lower hemoglobin A1C levels in Type 2 diabetics. Hemoglobin A1C measures your average blood sugar levels over a 3 month period. When taking the drug, food will sit in your stomach for a longer amount of time, leading to feeling physically fuller for a longer time. It also may grow more of the cells that produce and release insulin. For those with diabetes, these medications have been significantly helpful in managing blood glucose and reducing A1C.
Doctors have begun prescribing off-label Ozempic for weight loss because of the semaglutide. GLP-1s (glucagon-like peptide-1 receptor agonists) are a drug class that helps diminish appetite and create a feeling of fullness. The injection of the drug activates the GLP-1 receptors in the pancreas and insulin is released in order to lower blood sugar. Glucagon, which raises blood sugar, is also suppressed. We have GLP-1 receptors in our brain and on our GI tract. These are activated, reducing appetite and hunger levels. So GLP-1 drugs effectively inject that sense of satiety, and also slow the rate at which food empties out of the stomach.
Possible side effects of Ozempic, as listed on the drug’s website, include:
Possible thyroid tumors, including cancer; “In studies with rodents, Ozempic and medicines that work like Ozempic caused thyroid tumors, including thyroid cancer. It is not known if Ozempic will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.”
Pancreatitis
Changes in vision
Hypoglycemia (low blood sugar)
Kidney failure
Allergic reactions; Symptoms may include swelling of your face, lips, tongue, or throat; problems breathing or swallowing; severe rash or itching; fainting or feeling dizzy; or very rapid heartbeat
Gallbladder problems
Nausea
Vomiting
Diarrhea
Abdominal pain
Constipation
Some people don’t lose weight on the drugs and some people lose weight but gain it back when they stop using the drug. Weight loss can be maintained while taking the drug but the long-term safety of the drugs is not known. What we do know is one study found that more than 17% of patients taking this class of drug developed masses of undigested/partially digested foods in their GI tracts. This puts someone at risk for GI obstructions. Gastroparesis is a more common side effect of GLP-1 agonists when compared to other diabetic and weight loss treatments. In 2023 as the popularity of these drugs increased, medical professionals said GLP-1 patients were experiencing severe gastroparesis. Because of these side effects, makers of the drug are getting hit with lawsuits and surgeons wonder about the long-term effects of delayed gastric emptying. Epic research recently conducted a review finding that of 12 million diabetic patient records, researchers found delayed gastric emptying happened more often for those taking GLP-1s compared to those not prescribed GLP-1s.
3 other studies done on large groups of patients showed that those taking GLP-1 agonists are at a greater risk for gastroparesis in comparison to those who are not. Studies have revealed that the risk of gastroparesis is consistent - those taking GLP-1 medications had about a 50% higher risk of being diagnosed with gastroparesis. Doctors stated that usually gastroparesis improves after stopping the medication, but there were some cases where even after coming off of the medication, people’s symptoms did not improve, even months later. Those taking GLP-1 medications were more likely to have their gallbladders removed, GERD, nausea and vomiting, and experience pancreatitis from the drug. One doctor said, “although these drugs do work and should be used for the right reason, we just want to caution everyone that if you do decide to start this, be prepared that you have a 30 percent chance that you may have GI side effects, and then the drug may have to be discontinued.”
Weight Loss Drugs
Weight loss attempts make people vulnerable to weight cycling. Weight cycling, the repeated gaining and losing of weight, may increase the risk of developing heart disease, inflammation, high blood pressure, insulin resistance, and type 2 diabetes. The research supports that dieting promotes weight gain:
Up to ⅔ of people regained more weight than they lost according to a review on 31 long-term studies on dieting
A 5 year study done on teens, who weighed the same at baseline, observed dieting teens had twice the risk of gaining more weight than the non dieting teens
One study conducted on sets of twins ages 16-25 years old found that dieting, independent of genetics, is associated with accelerated weight gain when comparing a dieting twin to their non dieting twin counterpart
Biologically, your body experiences dieting as starvation. Your body doesn’t know the difference between a self-induced restrictive diet and a world-wide famine, so your cells go into survival mode. Your metabolism slows down and food cravings increase. As your body is adapting from each diet it embarks on, rebound weight gain is a result. Remember, weight is not a behavior. So in order to improve health outcomes, it’s important to focus on behavior changes and not changing your body size.
The Risks of Ozempic for People with Eating Disorders
All of the hype and pressure surrounding Ozempic has the potential to be very triggering for anyone struggling with an eating disorder, the leading cause of death of any mental illness
Again Ozempic was originally intended to treat Type 2 diabetes, but now as a weight loss drug, it reinforces the narrative of the thin ideal. The thin ideal is the push for a thin body type as being the ideal, even though it is naturally unattainable for many people in society. In addition, the risk of weight cycling when stopping the drug puts someone at risk for disordered eating. Some of the undesirable side effects and consequences of the medication can exacerbate eating disorder symptoms. There is a lot of pressure on people to shrink our bodies in our cultural moment, and these drugs are marketed to prey on your vulnerabilities and insecurities.
Much more could be discussed on the shortages of the drug due to the increase in prescribing it for weight loss, or the conflicts of interest in the research of the drug that is being funded by Novo Nordisk, but we will end here - whatever your opinion is on these drugs, please remember, you are not your body - you have a body and it’s important to steward it and care for it well. Your relationship with food and your body are not problems that need to be solved. But your relationship with food and your body may be areas in your life that have been wounded and need healing.
References used throughout this blog / helpful educational resources:
https://www.cnn.com/2024/02/26/health/semaglutide-weight-loss-eating-disorders-wellness/index.html
https://christyharrison.com/foodpsych/9/the-truth-about-those-new-diet-drugs
https://podcasts.apple.com/us/podcast/ozempic/id1535408667?i=1000630805156
https://dietitiansondemand.com/ozempic-the-new-frontier-or-something-to-fear/
https://untrapped.com.au/channel-7s-spotlight-special-the-ozempic-revolution/
https://edition.cnn.com/2024/05/20/health/glp-1-drugs-stomach-paralysis/index.html
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