The big fat truth about Ozempic, the diabetes drug that became famous for weight loss

“Dr Dre is here. Hold off on asking him for your Ozempic prescriptions, he's not that kind of doctor." You'd think it strange for a drug prescribed for Type 2 diabetes to make it to the 2024 Grammys. But then you can trust the award ceremony’s host, Trevor Noah to casually bring up a global hot topic—Ozempic, or the diabetes drug that makes you lose weight, and was listed by the Food and Drug Administration in a supply shortage. 

Manufactured by Novo Nordisk in Denmark, Ozempic was approved in 2017 by the FDA to treat Type 2 diabetes. Four years later, in 2021, a higher dose of its active semaglutide was approved by the FDA for obesity with at least one weight-related condition like diabetes or high blood pressure. The injectable solution was rebranded as Wegovy. Its infamous status as a weight loss drug quickly reached a mammoth target audience through the Internet. From before and after results of people on social media to the drug’s contribution behind celebrity weight loss journeys—some speculated, some self-proclaimed—everyone from Oprah Winfrey and Elon Musk, to TikTok influencers were talking about it.

According to data provider IQVIA, more than 1.9 million people had Ozempic prescriptions, and 4,28,000 had Wegovy prescriptions in July 2023 in the US. In February 2023, the Danish manufacturing company warned the US of supply constraints due to unexpectedly high demands of the drug.

The truth about Ozempic 
Let’s be clear: generally, Ozempic is considered safe if prescribed by or taken under the guidance of an expert. Its multiuse started with a paradox. “Until 10-15 years ago there existed the KgA1c paradox in traditional medicine, which meant that while trying to control glucose levels in diabetic patients, their weight went up,” says Dr Sanjay Kalra, endocrinologist at Bharti Hospital, Karnal, Haryana. When semaglutide came in the picture, he explains, it was able to bring down both the glucose level and weight. “The paradox is that obese people without diabetes need a higher dose than obese people with diabetes.” 

Prescribed to patients with Type 2 diabetes, Ozempic (which is currently not available in India but can be legally imported) is formulated from the active ingredient semaglutide. It works by lowering blood sugar levels and regulating insulin, while also mimicking the hormone glucagon-like peptide-1 produced in our intestine, that curbs your appetite by making you ‘feel full’. Thus leading to weight loss. Ozempic is not approved by the FDA as a prescription drug for weight loss, but it’s taken off-label anyway because it does aid the process. Both Wegovy and Ozempic are meant to be injected once a week in the stomach, thigh or arm. “Even though a higher dose of semaglutide is needed to treat obesity, you have to start low and gradually go up,” explains Dr Kalra. That and intolerance to higher doses may make Ozempic the first choice of those seeking treatment for obesity, despite the availability of Wegovy. 

Common side effects of the drug include transient nausea and loss of appetite. “Usually this is short-lived and self-limiting. But any rapid weight loss can lead to complications like gallstones. It is also advisable to not use it in people with history of a particular type of thyroid cancer, called MTC or Medullary Thyroid Cancer,” warns Dr Kalra. 

Understanding obesity
The problem begins when one starts using a drug made to treat a chronic health condition to lose weight quickly and conveniently. “Obesity is much more than a lifestyle disorder, it’s a disturbance of hormones,” says Dr Kalra, and adds that while semaglutide has been proven to prevent cardiovascular disease by preventing complications of obesity, using it for weight loss should always be done under the supervision of an endocrinologist or hormone specialist. Ozempic isn’t a magic drug either. 

“The drug automatically reduces appetite, but we must exercise to prevent loss of muscle mass. If taken alone, Ozempic can worsen physical conditioning,” says Dr Kalra, who emphasises on the importance of a comprehensive diet and exercise plan, alongwith following the seven S’s—sensible sustenance, structured physical activity, stress management, sleep hygiene, substance abuse avoidance, spirituality, and sunshine—to prevent medical complications of obesity such as high blood pressure or high cholesterol. Prescription of semaglutide or any weight-loss drug comes at an intervention stage when the above doesn’t work, and after considering a number of factors and comorbidities. “A drug that is correct for one person may not necessarily be good for another. Make an informed decision,” says Dr Kalra. And the best person to help you with that would be the endocrinologist.