The Ozempic controversy: Why there are no shortcuts for weight loss

Ozempic has become a household name — I bet you’ve heard of it, even if you’re not a nutrition expert. The drug, which was originally intended for diabetic patients, is now being used for weight loss. But does it really live up to its magical claims? Is it the holy grail of weight loss? Does it work at all? These are the questions my patients ask me almost every day, and some demand a prescription without so much as a blood test.

True story: one of my patients went for a regular check-up with her gynecologist, who diagnosed an insulin resistance condition without looking at her lab tests. Perhaps he was a shaman, someone with supernatural insight into things unseen — like lab tests. But no, he let his anti-obesity bias get the best of him and was quick to assume that her insulin resistance was due to her size. He couldn’t shake his stubborn belief that weight loss was the ultimate cure-all. As if shedding a few pounds could solve any problem, regardless of the diagnosis.

Ozempic has been getting a lot of buzz lately. Hollywood stars have been turning to this medication, not because they’re all diabetic, but because of its surprisingly fast weight loss results. Even Twitter’s owner, Elon Musk, can’t help but brag about his svelte physique thanks to Ozempic. It’s been a trending topic ever since.

Ozembic’s active ingredient is semaglutide, which regulates blood sugar levels. It lowers them and enables control over blood glucose by increasing the amount of insulin released in response to food intake. That’s why it’s indicated for Type 2 (non-insulin-dependent) diabetes. This medication, available in rechargeable pens, is injected into the abdomen, leg or arm. It’s advisable to begin with a low dose and gradually increase it. Initially developed solely for Type 2 diabetes, the medication received further authorization by both the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in June 2022 for facilitating weight loss. The pharmaceutical industry doesn’t give up easily.

The medication requires a medical prescription, although people desperate to lose weight can buy it illegally. The high demand for Ozempic, combined with alleged supply and distribution issues, has occasionally deprived diabetics who truly need the drug.

As with all medications, there are downsides and side effects associated with GLP1 peptide analogues, which bind to receptors in the intestine, leading to increased sensation of fullness and slower gastric emptying. These effects may produce symptoms like upset stomach, dehydration, dizziness, fatigue, severe constipation or diarrhea, nausea, vomiting, decreased appetite and continued fullness even after consuming small portions of food.

This sounds awful to me, but it’s an alluring siren song for plenty of people, despite all the unpleasant side effects. They say things like, “I can handle it for a while,” and “It’s not as bad as I thought.” And then there are some who declare, “I’ll do whatever it takes to lose those extra pounds!”

This medication could well be another tool to improve health, but I don’t endorse its use solely for weight loss. For people who already live healthy lifestyles in terms of diet, exercise and sleep, this medicine can be an extra boost for weight loss. But for someone who doesn’t have a healthy diet, it’s just a passive way to lose weight that brings a lot of physical discomfort. In such scenarios, providing nutrition education coupled with psychological support can be very effective. It’s a fallacy to believe that recommending a generic diet and exercise is the panacea. It’s about ingraining awareness and education in the patient, and instilling healthy and sustainable habits that endure. Focusing on weight loss as the be-all and end-all of good health is misguided since wellness is not equivalent to weight loss. Since this medication has an anorectic (hunger suppressing) effect, it warrants a thorough evaluation before prescribing to preclude exacerbating an existing eating disorder. And yes, some body types can mask the existence of an eating disorder.

No medication, operation or technique can sustain weight loss without nutrition education and lifestyle changes. Even procedures like gastric banding are insufficient. Losing weight is often framed as equivalent to quitting smoking — the answer is to “just stop.” But unlike smoking, we can’t just stop eating. A sustainable healthy lifestyle requires learning healthy habits and making them stick.

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