Hello loves!

I pray you are having a wonderful week and making time to nourish your bodies through food, exercise, and spending time with people who fill your cup.

Last week we chatted about body weight and just how much it matters. This week, we're going to chat about something that continues to pop up in all of my social circles right now: Ozempic. Buckle up because we have a lot of information to cover and I'm going to try to make it as digestible as possible. However, the information won't be exhaustive because there is just so much that can be said about this topic.

Ozempic and other weight loss medications like Wegovy, Mounjaro, Trulicity, and Rybelsus have been in the headlines for years at this point. We've seen many celebrities attribute their weight loss and body transformations to these drugs. If you go see your doctor for a health concern or regular check-up and weight is brought up, they are quick to suggest one of these drugs as the solution. These drugs were originally prescribed for patients with diabetes but some are being prescribed off-label for weight loss so often that there was a national shortage for them in the recent past. Driving along main roads, you may see signs in the grass with advertisements for a clinic offering semaglutide or GLP-1 agonists, the active ingredient in Ozempic, and the class of medications they fall into, respectively.

But what's the real deal with these drugs? Are they safe? Do they work? Are they a sustainable option? What are the risks and benefits?

Let's chat and grow some brain gainz!

What is GLP-1?
​These weight loss medications fall into a class of medications called GLP-1 agonists, or Glucagon-Like Peptide 1 agonists. The word agonist means that it acts similarly to our body's naturally made hormone GLP-1. The role of this hormone is to help slow down food absorption in the stomach so that you feel fuller longer. It also helps to regulate insulin and blood sugar but mainly it tells the brain that you are full.
​Basically, what these medications do is significantly suppress hunger. Why is hunger suppression important? Weight loss only occurs if the calories you consume are less than the calories you burn, creating a calorie deficit. (Does this information feel like a foreign language to you? I highly suggest my course, Nutrition 101, that you can enroll in below! A perfect starting point for anyone interested in nutrition but unsure where to start!)
These drugs make a calorie deficit much easier, and in fact, have been shown to result in a reduction of calorie intake by 35% while also reducing cravings, which can help patients feel more in control of their food intake. These drugs are not magic. They still require a calorie deficit to work, but because of the impact on physical satiety and psychological satisfaction, they make obtaining that deficit much easier.

Why are these drugs useful for patients with diabetes?
​In patients with diabetes, their natural GLP-1 effects are reduced by about 30%, which leads to higher blood sugar levels and difficulty controlling them. GLP-1 agonists help control blood sugar and lower A1c levels, which measure your average blood sugar levels over the last three months. Studies have shown that these medications can help lower A1c levels by 1-2.4% and reduce the risk of cardiac events, regardless of weight changes.
​
Wegovy, which contains higher levels of semaglutide when compared with Ozempic, became FDA-approved for weight loss in 2021 and quickly went into a shortage, preventing patients with diabetes from getting the health care they needed. It was shortly after that they began to prescribe Ozempic off-label (prescribed for something other than what it is FDA-approved for) for weight loss and then Ozempic shortages quickly followed suit.

What should you know about Ozempic, Wegovy, and other GLP-1 agonists?

1. Weight loss may or may not occur. Once you stop taking it, you will likely gain the weight lost (and sometimes more) right back. It's important to start that not everyone loses weight who takes these medications.
   The research on semaglutide for weight loss largely comes from the STEP trials, which are randomized controlled trials (RCTs) which are funded by the pharmaceutical company that makes this drug, Novo Nordisk. Just look at the STEP trials show that 85% of people taking these medications lose some amount of weight, which means around 15% of people don't lose any weight at all. The lowest reported weight loss was 5% of their body weight, which is about 10lbs for someone who weighs 200lbs.
   Around half of the patients who took this medication saw a more moderate weight loss, about 10-15% of body weight, which would be about 20-30lbs for someone weighing 200lbs. Around 33% of patients taking this medication saw a fairly substantial weight loss of 20% or more body weight, which would be around 40lbs for someone who weighs 200lbs.
   These trials were not only funded by the maker of the medications but also had exclusion criteria attached. You could not join the study if you were depressed, had any existing cardiovascular issues, or were a female of childbearing age without a highly effective birth control method.
   Looking at other trials for semaglutide, without the pharma funding and exclusion criteria, the results were less impressive. Only 40% of patients lost 5% of body weight.
   ​The most important thing to note is that studies have looked at what happens when you take someone off semaglutide and replace it with a placebo. They found that weight regain happens very quickly. Within a year, people regain almost off of their weight loss, even while still doing behavioral interventions like nutrition, exercise, and cooking classes.
2. The side effects are unpleasant, and in some cases, life-threatening. Studies have shown that a range of 60-93% of patients taking these meds will experience some side effects with the most common being gastrointestinal distress. This may include nausea, vomiting, diarrhea, constipation, GERD, and abdominal pain, though these tend to resolve in a few days to several weeks. Studies have shown that when this medication was used on mice, they developed tumors. These medications come with a black box warning that they can increase the risk of thyroid tumors. Human studies are being conducted now but we won't know the results of these until 2035 at the earliest. These medications are contraindicated for those with a family of thyroid tumors.
   Other side effects that should be noted are pancreatitis, gallbladder disease, kidney injury, suicidal ideation, and ileus (this occurs when your bowel stops functioning and you can't remove waste. It can only be treated with surgery and can be fatal).
   The aesthetic reported side effect has been deemed "Ozempic face." As a result of rapid weight loss and not getting adequate nutrition, patients report having loose skin on their faces and a hollowing under the eyes and near the temples. This appearance is also seen in those suffering from malnutrition. This is because a large portion, around 39% according to one study, of weight loss while taking these medications is lean muscle mass
3. We have no long-term data on Ozempic. Semaglutide was only approved by the FDA for diabetes treatment in 2017 and the longest study done so far has been two years. What this means is that we just don't know what the long-term side effects of these drugs are or if weight loss is maintained when you stay on it long-term. This gives me Fen-Phen and Ephedra vibes, which were hailed as miracle weight loss drugs with no long-term data and then were eventually taken off the market because of irreversible serious adverse side effects like fatal hypertension, heart valve problems, heart attack, stroke, and death. When deciding to take these medications, this is such an important consideration as it is likely you will have to stay on these drugs long-term to maintain your weight loss.

What are MY personal thoughts on it as a dietitian? As with anything in the health and fitness world, there is nuance.
On one hand, these drugs can be incredibly beneficial for those with severe diabetes. They can also be helpful for those who are obese for their overall health and psychological benefits after other alternative efforts have been exhausted. This is where I believe the helpfulness stops.

We live in a world of instant gratification and one where our healthcare system doesn't prioritize nutrition and fitness education starting from an early age. The medication might be easier, but do the benefits outweigh the risks and benefits? And who is capitalizing on your insecurities about your body or the need to look like the Instagram influencers flooding your feed? What if the long-term data shows that these medications contributed to the further downfall of our nation's overall health?

People see these drugs as a replacement for physical activity and a balanced, nutrient-dense diet. Most patients who take these drugs are not supported with a protein-rich diet and resistance training exercises, which means they're trying to make themselves more metabolically healthy in one way at the expense of another.

Bottom line... these drugs are important for folks who have obesity or diabetes which puts them at greater risk of health complications and for whom lifestyle changes alone have not been successful. I do not see this as the solution to drop the last bit of baby weight or look good on your Hawaii vacation. These drugs should be considered as nutrition medical therapy for those with chronic diseases and intended to be used for life. The use of these drugs is lining the pockets of pharmaceutical companies with plenty of money while depleting patients' overall health. Ozempic is also not a quick-fix invitation to never exercise or eat a vegetable again. Lifestyle support is critical for long-term success and muscle preservation, so if you decide to go this route, I highly recommend working with a Registered Dietitian on your journey.

Lifestyle support for any health-related goal is superior and that is a hill I'm willing to die on. And guess what? If you're looking for that kind of support, that's what I'm here for!

Before you go...

March 1, 2025, marks THREE YEARS since the launch of Arrow Strong and we are still going STRONG!

To celebrate, we're starting a tradition! Use code STRONG2025 to receive your first month of Arrow Strong for FREE! ​

​Can't wait to see you there!​