Why is Ozempic (semaglutide) not a good option for most people who want to lose weight? What are the alternatives?

In recent years, Ozempic (semaglutide) has become a popular drug for the treatment of type 2 diabetes. Originally developed as a drug to treat diabetes, its effect on weight loss has gained attention, leading to its increasing use for weight control in people without diabetes. As with any pharmaceutical treatment, it is important to understand the potential side effects associated with its use, particularly in the context of weight loss.

In this article, we will discuss the latest research on the side effects of Ozempic, how it aids weight loss and long-term safety considerations for those using the drug. By examining common and serious side effects, we can better understand its overall impact on health and help people make informed decisions about its use.

What is Ozempic?

Ozempic is a trade name semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist. Initially developed and approved by the US Food and Drug Administration (FDA) in 2017 for the treatment of type 2 diabetes, Ozempic has since gained widespread attention for its effectiveness in promoting weight loss.

Why is Ozempic popular?

Ozempic (semaglutide) has gained considerable popularity for several reasons, notably its effectiveness in treating type 2 diabetes and its growing use in weight loss. Here is why it has become so well known:

1. Effective management of type 2 diabetes

Ozempic is an injectable drug that helps lower blood sugar levels in people with type 2 diabetes.

• Blood sugar control: Ozempic has been shown to significantly reduce HbA1c levels (a long-term indicator of blood sugar levels), making it an attractive option for people struggling with diabetes.

2. Weight loss benefits

One of the most important reasons for its popularity, especially in people without diabetes, is its ability to promote weight loss. Clinical studies have shown that Ozempic can lead to noticeable weight loss, even in people who do not have diabetes.

• Appetite suppression: The drug works by affecting the appetite centres in the brain, helping people to feel fuller for longer periods of time, thus reducing overall calorie intake.
• Approved for weight loss: has been specifically approved by the FDA for the weight loss of obese people or people who are overweight and have at least one weight-related condition, such as hypertension or type 2 diabetes.

3. Dosage once a week

Unlike many other diabetes medications that require daily administration, Ozempic is injected once a week, improving convenience and treatment adherence. This is particularly appealing to people who are looking for a manageable medication schedule.

4. Success stories and social media hype

There has been a lot of media and social media coverage of Ozempic, especially with influencers and celebrities mentioning its benefits. Many users shared their weight-loss successes, which contributed to its growing popularity as a weight-loss drug. This 'celebrity endorsement' has added a layer of social validation, making more people interested in trying the product.

5. Increased awareness of obesity

As obesity rates increase worldwide, more and more people are looking for ways to control or lose weight. Ozempic, as a relatively new tool in the arsenal of weight-loss drugs, is gaining popularity due to the growing awareness of obesity as a chronic condition that requires long-term treatment.

6. Research and effectiveness

Numerous clinical trials have demonstrated the efficacy of Ozempic in both treating type 2 diabetes and aiding weight loss. Its robust clinical data supporting these benefits has led to widespread adoption by healthcare providers.

7. An alternative to traditional weight loss methods

Many people find it difficult to lose weight through diet and exercise alone. Ozempic offers an alternative approach to weight loss, especially for overweight or obese people who have struggled with other methods.

8. Market expansion

As more doctors prescribe Ozempic and insurance coverage for the drug has expanded, it has become more accessible to a wider group of people, further increasing its popularity.

9. Comparison with other drugs

Ozempic's efficacy, ease of use (injection once a week) and relatively lower risk of serious side effects compared to other weight-loss or diabetes drugs make it an attractive choice for many patients.

Mechanism of action:

It works by mimicking the action of a naturally occurring hormone called the glucagon-like peptide-1 (GLP-1), which plays several important roles in blood sugar and appetite regulation. The mechanism of action of Ozempic can be divided into several key effects:

1. Stimulation of insulin secretion

• GLP-1 receptor agonists, such as semaglutide, bind to GLP-1 receptors on pancreatic beta cells. This stimulates the release of insulin in response to food intake, but only when blood sugar levels are elevated (glucose-dependent). This helps to lower blood sugar levels after meals.

2. Inhibition of glucagon secretion

• Glucagon is a hormone that normally raises blood sugar levels by promoting the release of glucose from the liver. Semaglutide reduces the secretion of glucagon when blood sugar levels are elevated, preventing the liver from producing excessive amounts of glucose and thus contributing to better blood sugar control.

3. Delaying gastric emptying

• Semaglutide slows gastric emptying, which helps reduce the rate at which food enters the small intestine. This not only promotes satiety (a feeling of fullness), but also helps to reduce postprandial (after a meal) blood glucose spikes.

4. Reduction in appetite

• GLP-1 receptors are also found in the brain, particularly in areas that regulate appetite. By acting on these receptors, semaglutide helps to reduce hunger and food intake, which is beneficial for weight loss in people with obesity or type 2 diabetes.

5. Improving beta-cell function

• Semaglutide has been shown to improve the function of pancreatic beta-cellswhich are responsible for the production of insulin. Over time, this can help improve the body's ability to control blood sugar levels.

6. Improving cardiovascular outcomes

• In addition to controlling blood sugar levels, semaglutide has been shown to have beneficial effects on cardiovascular health. It reduces the risk of serious cardiovascular eventssuch as myocardial infarction, stroke and death from cardiovascular causes in people with type 2 diabetes.

How Ozempic supports weight loss

1. Appetite suppression

• GLP-1 activation: Ozempic mimics the action of GLP-1, a hormone naturally produced in the gut. GLP-1 plays a key role in appetite regulation, signalling the brain to reduce hunger. By activating GLP-1 receptors, Ozempic helps to reduce appetite, leading to less food intake.
• Effects on the hypothalamus: GLP-1 receptors are present in the hypothalamus, which regulates feelings of hunger and satiety. When these receptors are activated by semaglutide, they help suppress food cravings and increase feelings of satiety, leading to a reduction in overall calorie intake.

2. Slower gastric emptying

• Delayed digestion: Ozempic slows gastric emptying, which means that food stays in the stomach longer. This delay in digestion helps to prolong the feeling of satiety, making people feel satisfied with smaller meals and reducing the desire to eat frequently.
• Reduced postprandial hunger (after a meal): Delayed gastric emptying also reduces post-meal hunger spikes that can lead to overeating.

3. Increased insulin sensitivity

• Regulation of blood sugar levels: By increasing insulin sensitivity and lowering blood glucose levels, Ozempic helps regulate blood sugar levels. This can reduce the risk of insulin resistance, a condition often associated with obesity. Proper blood sugar regulation is key to preventing excessive fat storage and aiding weight loss.

4. Modulation of fat metabolism

• Fat storage and utilisation: Some studies suggest that GLP-1 receptor agonists, such as semaglutide, may affect the body's fat metabolism. They may promote the burning of fat as an energy source and reduce fat storage, which contributes to fat reduction over time.

5. Increased weight loss in clinical trials

• Ozempic has been shown in clinical trials to lead to significant weight loss. For example, the STEP (Semaglutide Treatment Effect in People with Obesity) study showed that people using Ozempic (semaglutide at a dose of 2.4 mg per week) to reduce body weight were able to lose approximately 15-20% of body weight over a period of 68 weeks.
• The STEP study also showed that semaglutide was more effective in reducing body weight compared to other weight-loss drugs such as orlistat or liraglutide.

 Clinical trials supporting weight loss:

• STEP 1 study (2021): This large-scale clinical trial showed that people using semaglutide for weight loss (at a dose of 2.4 mg) lost an average of 15% of body weight, compared to only 2.4% in the placebo group (1).

 

• SUSTAIN study 7: This study showed that semaglutide (0.5 mg or 1 mg) was effective in reducing weight in people with type 2 diabetes, with participants losing more weight compared to those treated with other anti-diabetic drugs (2).

 

Despite its promising effect on weight control, Ozempic is not without risks. Understanding the potential side effects is essential for those considering using the drug as part of a weight loss strategy.

Common side effects of Ozempic

Although semaglutide has been shown to be effective in aiding weight loss, several common side effects have been reported, particularly in the early stages of treatment. These side effects are often related to the gastrointestinal (GI) system, which is a common area of concern for many GLP-1 receptor agonists.

1. Gastrointestinal problems

Gastrointestinal side effects are the most commonly reported during the use of Ozempic. These effects can range in severity from mild to severe and tend to decrease over time as the body adapts to the drug.

• Nausea

Nausea is by far the most common adverse effect associated with the use of Ozempic. In clinical trials, gastrointestinal side effects were among the most commonly reported, particularly in the dose escalation phase. For example, in the STEP study of Wegovy (semaglutide used for weight loss), nausea occurred in 27.8% participants (1).

Nausea usually occurs as the body adjusts to the drug and is often most severe when the dose is increased.

Why this is happening: Nausea occurs because semaglutide slows gastric emptying, which can lead to feelings of fullness and discomfort. In addition, GLP-1 receptor activation in the brain may also contribute to feelings of nausea.

Proceedings: In many patients, nausea subsides within a few weeks as the body becomes accustomed to the drug. Starting at a lower dose and gradually increasing the dose may help relieve nausea. If nausea persists, it may be necessary to reduce the dose or switch to an alternative treatment.

• Vomiting

Although less frequent than nausea, vomiting is another potential side effect. Studies have shown that vomiting occurs in a small percentage of patients, usually along with other gastrointestinal symptoms.

• Diarrhoea and constipation

Semaglutide can interfere with gastrointestinal motility, leading to both diarrhoea and constipation in some users. Diarrhoea is more common in the early stages of treatment and can often be managed by adjusting diet or medication to control symptoms.

On the other hand, constipation can become a problem for some users who experience reduced gastrointestinal motility due to the use of the drug. Adequate hydration and dietary fibre are often recommended to alleviate constipation.

• Abdominal pain

Some users may experience abdominal pain or discomfort. This is usually mild and may be related to slowed gastric emptying or changes in gastrointestinal function caused by the drug.

2. Appetite suppression and weight loss

One of the key effects of Ozempic is its ability to suppress appetite, leading to weight loss. This effect is generally beneficial for those aiming to lose weight, but can sometimes result in a reduced interest in food, which in rare cases can lead to malnutrition or undernourishment.

Managing changes in appetite: It is important that people using Ozempic to lose weight make sure they are consuming the right nutrients, especially if their appetite is significantly reduced. Nutritional counselling or working with a dietitian can help to ensure that weight loss is achieved in a healthy and sustainable way.

3. Hypoglycaemia (low blood sugar)

Although hypoglycaemia (low blood sugar) is more commonly associated with antidiabetic drugs such as insulin or sulphonylurea derivatives, it can occur in people taking Ozempic, especially in combination with other blood sugar-lowering drugs (3).

Symptoms of hypoglycaemia: Symptoms include tremor, dizziness, confusion, sweating and hunger. In severe cases, hypoglycaemia can lead to convulsions or unconsciousness.

Risk factors: The risk of hypoglycaemia is higher in patients who are also taking other diabetes drugs, especially insulin or sulphonylurea derivatives. However, when used alone to reduce body weight, the risk of hypoglycaemia is generally low.

4. Reactions at the injection site

Ozempic is administered by subcutaneous injection, usually once a week. Some people may experience irritation at the injection site, including redness, swelling or itching (4). These reactions are usually mild and resolve spontaneously within a few hours or days.

5. Weight gain after discontinuation of Ozempic

Recent studies have consistently shown that weight regain after Ozempic withdrawal is a common problem due to the cessation of the appetite suppressant and metabolic effects of the drug (5).

Studies show that approximately 30-50% of lost weight can be regained after stopping the drug, highlighting the need for long-term lifestyle modifications to maintain weight loss.

In order to minimise weight gain again, it is important that patients maintain a balanced diet, regular physical activity and receive psychological support if needed. Close collaboration with healthcare professionals is crucial to develop a sustainable weight management plan following Ozempic withdrawal.

Serious side effects of Ozempic

Although most side effects of Ozempic are mild and manageable, there are some more serious risks that patients should be aware of.

1. Pancreatitis

One of the major concerns associated with the use of Ozempic is the possibility of pancreatitis (6). Pancreatitis is a rare but serious condition that can lead to severe abdominal pain, vomiting and other complications.

Risk factors: Patients with a history of pancreatitis or other pancreatic diseases may be at increased risk. In addition, patients with gallstones or who consume large amounts of alcohol may be more susceptible to developing pancreatitis.

Proceedings: If symptoms of pancreatitis (severe abdominal pain, vomiting, fever, etc.) occur, Ozempic should be discontinued immediately and medical attention sought.

2. Thyroid tumours (medullary thyroid carcinoma)

In animal studies, semaglutide has been shown to increase the risk of thyroid malignancies, including medullary thyroid cancer (MTC), which is a rare and aggressive form of cancer (7). Although the risk in humans has not been well established, the prescribing information for Ozempic includes a warning regarding this potential risk.

Reason: The drug's mechanism of action, involving GLP-1 receptor activation, may affect thyroid cells in rodents, although no human cases have been linked to this.

Proceedings: Ozempic is contraindicated in people with a personal or family history of medullary thyroid cancer or in people with multiple endocrine neoplasia type 2 (MEN 2), a rare genetic disorder that increases the risk of thyroid cancer.

3. Kidney problems

There have been reports of kidney problems, including acute kidney injury, in some people taking Ozempic, particularly those who have experienced severe nausea and vomiting leading to dehydration (8). Kidney problems are more likely in people with pre-existing kidney disease or in those who have difficulty staying adequately hydrated.

Reason: Dehydration resulting from gastrointestinal side effects (such as vomiting and diarrhoea) may contribute to kidney burden.

Proceedings: Patients should be monitored for signs of renal dysfunction, especially if they experience persistent gastrointestinal symptoms or dehydration. Ensuring adequate fluid intake is important to minimise the risk of renal complications.

4. Gallbladder disease

The use of Ozempic is associated with an increased risk of gallbladder disease, including gallstones. Gallstones can cause severe abdominal pain and may require surgical intervention.

Proceedings: Users of Ozempic should watch out for symptoms such as severe abdominal pain, nausea and vomiting, which may indicate gallbladder problems. If such symptoms occur, a doctor should be consulted immediately.

5. Retinopathy

Some evidence suggests that GLP-1 receptor agonists, such as Ozempic, may increase the risk of diabetic retinopathy in people with pre-existing diabetes. However, the evidence for this link is inconclusive and more research is needed to understand the long-term effects of semaglutide on eye health.

6. Increased heart rate

A slight increase in heart rate has been observed in some patients taking semaglutide, although the clinical significance of this phenomenon is still under investigation (9).

Reason: The effect of the drug on the autonomic nervous system may lead to a slight increase in heart rate.

 

Long-term considerations and new research

Tolerance to side effects

Many of the gastrointestinal side effects associated with the use of Ozempic, such as nausea and vomiting, tend to subside as the body becomes accustomed to the drug. However, these side effects may persist in some patients, which may affect adherence to treatment.

Mental health impact study

Emerging studies are investigating the potential psychological effects of semaglutide use. Some individuals report experiencing mood swings or depressive symptoms while taking GLP-1 receptor agonists, although this side effect is rare (10). Further research is needed to assess the long-term psychological impact of Ozempic, especially in patients using the drug for weight loss rather than diabetes management.

Justification: GLP-1 receptor agonists, such as semaglutide, have central nervous system effects that may affect mood in susceptible individuals.

Are there safer alternatives?

In our opinion, the number of side effects of semaglutide such as potentially causing depression, ozempic face, or gastrointestinal disorders and the yo-yo effect after discontinuing use is too high to recommend this drug to anyone wishing to lose a few kilos.

Weight loss is a hard process and it is natural that people look for supportive methods.

The basis is to balance your diet appropriately and plan physical activity. To be healthy, this is unavoidable.

If the use of supportive substances is necessary then one of the safer and effective solutions will be to improve mitochondrial function through the use of Methylene blue i NMN. This will allow our body to produce more energy, so we will be more mobile and it will be much easier for us to take up exercise. If we plan, for example, three workouts a week, we will be able to train longer and more intensively and burn more calories with more energy.

If this proves not to be sufficient then you could consider using CJC 1295 without DAC with Impamorelin to increase natural growth hormone output. Higher levels of growth hormone make it much easier to burn fat. Additionally, higher levels of growth hormone speed up recovery, improve sleep and skin quality.

Disclaimer

This article has been written for educational purposes and is intended to raise awareness of the substance under discussion. It is important to note that the article is about the substance in general - it is not a description of a specific product (chemical reagent). We do not suggest using chemical reagents on humans - this is prohibited by law. For a product to be used for treatment, it must be registered as a medicine. The information contained in the text is based on available scientific research and is not intended as medical advice or to promote self-medication. The reader should consult a qualified health professional for all health and treatment decisions.

References

1. Wilding JPH, et al. "Semaglutide administered once weekly in overweight or obese adults". N Engl J Med. 2021.
2. Pratley, Richard E et al. The Lancet Diabetes & Endocrinology, vol 6, issue 4, 275-286
3. Smits, M. M., & Van Raalte, D. H. (2021). Safety of semaglutide. Frontiers in endocrinology, 12, 645563. https://doi.org/10.3389/fendo.2021.645563
4. Safety and efficacy of semaglutide in patients with obesity'. JAMA. 2021
5. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after semaglutide withdrawal: an extension of the STEP 1 study. Diabetes Obes Metab. 2022; 24(8): 1553-1564. doi:1111/house.
6. Novo Nordisk, Ozempic Prescribing Information.
7. 'Semaglutide (Ozempic) in the treatment of type 2 diabetes and obesity: a review of clinical evidence and prescribing information'. J Clin Endocrinol Metab. 2020.
8. "Semaglutide in weight loss: A systematic review and meta-analysis." Obesity Reviews. 2022.
9. Cardiovascular outcomes of semaglutide in patients with type 2 diabetes and high cardiovascular risk: the SUSTAIN-6″ study. Lancet. 2016.
10. 'Neuropsychiatric side effects of GLP-1 receptor agonists: A review of the literature'. Endocrine Practice. 2020.