Are Ozempic and Wegovy the ultimate weight loss drugs? Image adapted from Freepik.
Ozempic—a drug intended for the treatment of type 2 diabetes—has recently been adopted as an off-label suppressant, offering a seemingly rapid and relatively effortless method of weight loss. Although Ozempic-induced slimming down has proven irresistible both to celebrities and the general public, it is filled with scientific uncertainty and hidden complexities for modern culture’s perception of “thinness”.
Ozempic, produced by the Danish pharmaceutical company Novo Nordisk, contains the active ingredient semaglutide—a glucagon-like peptide 1 (GLP-1) receptor agonist (a chemical which binds to a receptor within the body to elicit a biological response). GLP-1 is a hormone that is naturally released from the gut in response to the intake of nutrients. It stimulates the production of insulin (a protein which decreases blood sugar levels), suppresses the production of glucagon (a protein which raises blood sugar levels), and causes a minor delay in gastric emptying. By mimicking GLP-1, semaglutide-based medications cause delayed gastric emptying and reduced food intake, and indirectly activate the main inhibitory gut motor neurons resulting in further appetite suppression. These signals are also relayed to brain centres involved in the perception of gastric distension and appetite control. A 1 mg weekly injection of Ozempic was approved by the FDA in 2017 for the treatment of type 2 diabetes. A higher 2 mg dose was then approved in 2022. In the UK, Ozempic was approved for the treatment of type 2 diabetes in 2019.
Although Ozempic-induced slimming down has proven irresistible both to celebrities and the general public, it is filled with scientific uncertainty and hidden complexities for modern culture’s perception of “thinness”.
Due to these effects, semaglutide-based drugs are also used for the treatment of obesity. Novo Nordisk’s Wegovy, which contains the same active ingredient as Ozempic but in a different dose, is a GLP-1 agonist that has proven to be more effective than all previously existing anti-obesity medications. In fact, Wegovy resulted in an average 12.4% loss of body weight in over 1,900 obese individuals over 68 weeks. The FDA approved a 2.4 mg weekly dosage of Wegovy for use in adults in 2021 for the treatment of obesity. Then, in March 2023, Wegovy was approved by the National Institute for Health and Care Excellence (NICE) for use in the UK, via specialist NHS weight management services.
Perhaps unsurprisingly, in a culture which has placed thinness on a pedestal, the ability of Ozempic and Wegovy to induce weight loss has piqued the interest of individuals beyond the patients they were initially intended to treat. This wider interest has been further exaggerated by celebrity endorsement and media coverage of Ozempic. The billionaire owner of Twitter and Tesla, Elon Musk, credited ‘fasting and Ozempic/Wegovy’ for the maintenance of his figure, and at the 2023 Oscars, Jimmy Kimmel made a quip about Hollywood’s use of Ozempic for weight-loss. On TikTok, #Ozempic has been viewed over 1.7 billion times. Within the first 6 months of Wegovy’s introduction as an obesity treatment, supplies ran short, causing many individuals using the drug for cosmetic, non-medical weight loss to seek other semaglutide-based drugs from dubious online sellers, or from physicians willing to prescribe Ozempic off-label. This, in turn, limited supplies for diabetic patients.
Perhaps unsurprisingly, in a culture which has placed thinness on a pedestal, the ability of Ozempic and Wegovy to induce weight loss has piqued the interest of individuals beyond the patients they were initially intended to treat.
In the US, Ozempic and Wegovy are generally only covered by insurers when prescribed for diabetes or obesity. Without insurance, a month’s supply of Ozempic or Wegovy costs an average of $892. It is therefore crucial that physicians exercise great care when they prescribe such drugs. That is to maintain adequate supplies and ensure that semaglutide-based medications remain accessible to all patients, particularly as many of those with type 2 diabetes and obesity are in socioeconomically disadvantaged communities.
Alongside ensuring that supplies of Ozempic and Wegovy are maintained for patients requiring the drugs for medical treatment, a further reason to discourage off-label usage is that these drugs have not yet been well-studied in individuals without type 2 diabetes or obesity. There is not yet enough evidence to know if these drugs could be harmful to those falling outside of the treatment criteria. There are abundant side effects to these medications, such as “Ozempic face” (characterised by a gaunt look and hair loss caused by rapid weight-loss), gastrointestinal issues (nausea, vomiting, constipation, diarrhoea), and more severe side effects such as pancreatitis, kidney problems, potential thyroid cancer, and in extreme cases malnutrition due to insufficient food consumption. The hype surrounding Ozempic and Wegovy in the media as miracle weight loss tools turns a blind eye to their potential side effects. This is particularly problematic when individuals are taking the drugs outside of a controlled medical setting and are not being monitored by a physician.
Within the first 6 months of Wegovy’s introduction as an obesity treatment, supplies ran short, causing many individuals using the drug for cosmetic, non-medical weight loss to seek other semaglutide-based drugs from dubious online sellers.
More broadly, off-label usage of Ozempic and Wegovy exacerbates the toxic diet culture which dominates modern society. Despite body positivity and anti-fat shaming movements, thinness is still, largely, considered to be the “ideal”. It is deeply problematic and worrying that individuals are highly willing to subject themselves to weekly injections and potentially extreme side effects in the name of cosmetic weight-loss. In particular, the divulgence of information regarding Ozempic and Wegovy’s use for weight loss by celebrities sets an example for younger individuals, who are already exposed to an unending display of photoshopped and often surgically modified individuals on social media.
The portrayal of such medications online and in the media may also impact individuals suffering from eating disorders or body dysmorphia. The usage of these medications solely for cosmetic purposes reinforces the message that everyone should strive for thinness and pursue this by any means, regardless of physical or mental harm. Additionally, 96% of respondents to a 2021 survey by Beat reported encountering adverts online which were harmful in the context of their eating disorder.
The glorification of weight loss drugs in the media is therefore a cause for concern. It may contribute to disordered eating behaviours worsening or developing in vulnerable individuals through normalising disordered eating and encouraging weight loss at all costs. Clinical trials indicate that ending the use of semaglutide-based drugs results in regain of ~⅔ of the lost body weight within 1 year, meaning that restrictive eating habits, obsessive exercise, or other disordered tendencies may emerge in order to compensate for the lack of drug-induced suppressed appetite.
Clinical trials indicate that ending the use of semaglutide-based drugs result in regain of ~ ⅔ of the lost body weight within 1 year.
Novo Nordisk and the pharmaceutical company Eli Lilly have more than 10 obesity treatments in development, some of which appear to demonstrate superior efficacy to that of Ozempic. Eli Lilly’s retatrutide, for instance, which works as a triple agonist to glucagon, GLP-1, and gastric inhibitory peptide (GIP) receptors, resulted in the majority of participants losing nearly 25% of their body weight. A subset even lost more than 30% after 48 weeks on a high dosage. Though further research using a larger trial is required to confirm the safety and efficacy of retatrutide, the current results indicate that the potential amount of weight loss in those with a BMI above 35 ‘could virtually eliminate the need for bariatric surgery’, a surgical procedure performed to the digestive system to achieve weight loss. A further benefit of retatrutide is that it does not just reduce weight but has other positive impacts on patient health—namely, resulting in a 20% reduction in low-density lipoprotein (“bad”) cholesterol, which is double the improvement typically seen with other GLP-1 agonists.
GLP-1 agonists and drugs that work in similar ways can clearly offer tangible benefits for obese patients. The issue, however, seems to stem from people abusing these medications for cosmetic, superficial weight loss, limiting supplies for those needing treatment of chronic conditions. The worry is that, as these drugs gain popularity, people will begin to associate them with vanity and unrealistic, idealistic thinness, and not as a critical medication for diabetes patients. This may trigger or exacerbate eating disorders. Doctors need to exercise great care in deciding who they prescribe these drugs, to marketing and media advertisement of these drugs should be also closely monitored. Overall, an expert led approach is required to avoid misuse of these medications.