Understanding Ozempic: A Guide to Weight Loss Medications

For many people, losing weight can feel like an uphill battle. But the health benefits can be well worth the effort. Being overweight can lead to serious problems, including diabetes, high blood pressure, heart disease, and even certain cancers. Nearly 50% of U.S. adults are considered obese (defined as having too much body fat for your weight) according to the National Health and Nutrition Examination Survey.

"It's not about willpower or self-control. Our bodies are programmed to hold on to fat, essential for survival during times of scarcity. Now, this same survival mechanism is contributing to the obesity epidemic, increasing the risk of diseases like diabetes," says Jacqueline Lonier, MD, an endocrinologist at Columbia University and the Naomi Berrie Diabetes Center.

Weight Loss Medication Basics

An increasing number of medications are becoming available to help patients control their weight. Researchers have discovered that glucagon-like peptide-1 (GLP-1) medications, initially used to treat type 2 diabetes, can also help with weight loss. GLP-1 is a naturally occurring hormone produced in the small intestine that regulates blood sugar and appetite. It prompts the pancreas to release insulin after meals and slows down stomach emptying, helping you feel fuller longer.

“The glucose-lowering effect of these medications in type 2 diabetes can be different from the weight loss effect,” Dr. Lonier points out. “I have seen people with type 2 diabetes who have struggled to control their blood glucose start treatment with a GLP-1 agonist and come back to the office with beautiful blood sugars, sometimes despite losing little or no weight. These medications work differently for each person. So, just because they improve a patient’s blood sugars doesn’t mean they’ll lose significant weight.”

Semaglutide (which is prescribed under several brand names, including Ozempic) is a popular GLP-1 medication that has become well-known for lowering blood sugar and promoting weight loss. In 2021, the FDA approved semaglutide for weight loss in adults with a high BMI, even if they don't have diabetes.

GLP-1 medications include the following:

• Ozempic: An injectable form of semaglutide taken once a week for blood sugar control in people with type 2 diabetes.
• Wegovy: A higher-dose version of semaglutide that is FDA-approved to treat obesity, also injected once a week.
• Rybelsus: An oral form of semaglutide taken daily for type 2 diabetes.
• Mounjaro: A medication generically called tirzepatide, injected weekly, that mimics both GLP-1 and a similar hormone called GIP (gastric inhibitory polypeptide). This combination helps lower blood sugar in people with type 2 diabetes and promotes weight loss.
• Zepbound: An obesity-treatment version of tirzepatide, FDA approved in 2023.

The Unexpected Benefits

Medications like Ozempic, Wegovy, and Mounjaro show some surprising health benefits beyond weight loss, including heart health, kidney function, and even addiction recovery.

Medicare now covers Wegovy as a treatment for heart disease, not just weight loss. Clinical trials have shown that Wegovy reduces the risk of heart problems by 20% in people who are overweight. Another large study found that patients with type 2 diabetes and a high risk of cardiovascular disease had fewer heart attacks, strokes, and cardiovascular deaths when treated with semaglutide compared to those on a placebo.

Semaglutide has also been shown to reduce the risk of kidney disease by 24%. People taking the drug are less likely to need dialysis, lose kidney function, or die from kidney-related issues, according to a study in the  New England Journal of Medicine.

A study in the journal Addiction found that people with alcohol addiction who used Ozempic or similar medications were 50 percent less likely to binge drink compared to those who didn't. The same study found a 40 percent lower rate of opioid overdose among people with opioid use disorder who took these medications.

“Anecdotally, patients have told me that these medications quiet their ‘food noise;’ They no longer wake up thinking about food, nor are they spending time between meals thinking about when and what they will eat next,” says Dr. Lonier. “Although most people experience this as a positive, I have occasionally seen people struggle emotionally as their relationship with food changes significantly.”

The Side Effects

While Ozempic and similar medications offer many benefits, they can cause some side effects, including:

• Nausea and vomiting
• Stomach pain
• Diarrhea or constipation
• Pancreatitis (inflammation of the pancreas)

These side effects may lessen as the body adjusts to the medication, but some may persist. Many GLP-1 medications are injectable, which can be uncomfortable for some patients. However, oral options like Rybelsus are available for those who prefer not to inject.

The cost of these medications can also be a concern, mainly since some newer drugs may not be covered by insurance and could result in high out-of-pocket costs.

Part of a Healthy Lifestyle

Dr. Lonier’s patients often ask if they can discontinue the medication after they have lost their desired amount of weight, but most people will regain weight upon stopping the medication. This phenomenon is true of essentially all weight loss interventions.

“These are remarkable medications and have been life-changing for many of my patients. It is important to note that they are meant to be taken chronically and are not a quick fix. Most people who take these medications lose at least some weight, and some lose a lot of weight, says Dr. Lonier.  “However, some people cannot tolerate the gastrointestinal side effects. Weight loss should be part of a team approach. It's not just about taking a medication. Lifestyle changes, including a healthy diet and exercise, are key to long-term success."