Fact or fiction: Is Ozempic a weight-loss wonder drug?

No doubt you’ve heard of Ozempic, the diabetes drug that blew up the internet. After TikTok users began touting the medication as a wonder for weight loss and celebrities reported using it with great success, the demand for Ozempic increased to the point that it resulted in a global shortage, to the detriment of those who desperately needed it as a chronic medication.

But what is it and why has the weight-loss industry hijacked what is essentially diabetic medication?

The active ingredient in Ozempic is semaglutide, a drug that was developed in 2012 to treat type 2 diabetes. It’s been released in the form of Ozempic, a once-weekly injectable, and Rybelsus, a daily tablet. In 2021 the US Food and Drug Administration (FDA) approved Wegovy, a higher dose of semaglutide administered as an injectable, for weight loss in obese and overweight individuals.

As Prof Joel Dave, an endocrinologist and the head of the division of endocrinology at Groote Schuur Hospital and the University of Cape Town, explains: “Though semaglutide marketed as Ozempic has not yet been approved for weight loss, semaglutide marketed as Wegovy has, so the active ingredient has been approved.”

HOW DOES IT WORK?

To better understand how semaglutide works and why it’s being used for weight loss, we turned to the Society for Endocrinology, Metabolism and Diabetes South Africa (SEMDSA). According to the society, Ozempic belongs to a class of medications called glucagon-like peptide-1 receptor agonists (GLP-1RAs).

“This group of medications stimulates GLP-1 receptors, which are present in the pancreas, gastrointestinal tract, brain and heart. They have significant benefits for managing blood sugar in patients with type 2 diabetes.”

Additionally, semaglutide has been proven to be beneficial for weight loss as GLP-1RAs can also decrease one’s appetite, hunger and cravings, and slow the rate at which the stomach empties, which helps you feel satisfied after meals for longer.

In South Africa, Ozempic has only been approved for the treatment of type 2 diabetes. It is a schedule 4 medicine that can only be prescribed. But because of its potential for weight loss, doctors have been prescribing it off-label, or for a use it was originally not intended, to patients who are desperate to lose weight. As the Ozempic website states: “Ozempic may help you lose some weight. Ozempic is not for weight loss.”

“Prescribing a drug off-label is not illegal or unethical,” Dave explains. Although he doesn’t promote the off-label use of any drug, he explains that doctors do it regularly with a variety of drugs when there is no other option for treating their patient. “The patient must be clearly educated that the drug is being used off-label and the reasons why this drug is being recommended for them, with the potential side-effects and costs clearly explained.”

WHAT ABOUT THESE SIDE-EFFECTS?

“The most common side-effects experienced with Ozempic include nausea, vomiting, diarrhoea, abdominal pain and constipation,” says SEMDSA.

“The side-effects are the same for people with diabetes or those using the drug only for weight loss,” Dave adds. “But this usually resolves after one to two months.” 

According to information on the Ozempic website, serious side-effects may include thyroid tumours and cancer, inflammation of the pancreas, changes in vision, low blood sugar, kidney problems and failure, gallbladder problems and allergic reactions.

As SEMDSA warns: “Anyone with a personal or family history of medullary thyroid cancer should alert their medical practitioner before taking Ozempic. These side-effects may occur in anyone taking Ozempic, regardless of the reason for its use.” 

And then there are the unofficial side-effects, such as “Ozempic face”, a term coined by New York-based dermatologist Dr Paul Jarrod Frank. It refers to the aged and sagged appearance of your face due to the wrinkly, loose skin caused by fat loss in the facial area. You might be getting rid of weight by taking this medication, but end up looking gaunt.

IS IT FEASIBLE THEN?

Yasmin Tayag, a staff writer at The Atlantic, recently wrote: “Semaglutide can lead to 15 to 20% weight loss in about 30% of people who take it, but that means 70% have lower levels of weight loss.”

Dave confirms this. “Not everyone will lose weight on Ozempic and it is imperative that lifestyle issues are addressed while the person is taking Ozempic.”

But he also says the GLP-1RA class of drugs has given hope to many who have previously struggled to lose weight as they are reasonably safe, mostly effective and convenient as a weekly administration — if you’re willing to stick with it.

The effects on blood sugar, appetite and weight loss will only last as long as you’re taking the medication, meaning unless you implement drastic lifestyle changes to keep the weight down, you’ll likely regain the weight once you stop taking Ozempic.

And the cost adds up. According to SEMDSA, Ozempic is an expensive medication and patients should consider the financial feasibility of long-term treatment. “The cost is in the region of R1,300 to R2,500 per month, depending on the dose that is prescribed.”

Patients are required to meet certain criteria before medical aids will agree to fund the use of Ozempic for the treatment of type 2 diabetes. Use outside this treatment will need to be paid for out of pocket.

THE VERDICT?

At this time, SEMDSA doesn’t recommend the off-label use of medications that are not registered for weight loss. “SEMDSA advises the use of registered medical therapy for weight loss in carefully selected patients who have been appropriately educated and counselled on the benefits and risks of treatment.”

Dr Kumari Naidoo, an endocrinologist in Durban, adds that medications aimed specifically at weight loss are required. “We do await the arrival of newer formulations, specifically licensed for weight loss, which will alleviate the concerns related to off-label prescribing and preserve critical supplies for patients living with type 2 diabetes.”

Dave agrees that Ozempic should not be used off-label for treating obesity, however, often, it is the only option that the patient can afford.  He says that in this context Ozempic is a good choice for weight loss, but insists that there must be clear communication between the doctor and the patient regarding the off-label use of the medication, the potential side-effects, the costs and the requirement that lifestyle modification must continue for the changes to be sustainable. “The doctors must also ensure the benefit of weight loss to the patient is likely to significantly benefit them in reducing their morbidity and mortality."

And an important point: “Obesity, especially in someone with other comorbidity, such as hypertension and high cholesterol, is a major cause of morbidity and mortality, most of which is preventable if the person is able to lose weight.