Ozempic: Weight loss, side effects and the possibility of treating addiction

Ozempic and Wegovy are the brand names of the drug semaglutide. Many countries have approved Wegovy for weight loss in obese or overweight people and Ozempic for people with type 2 diabetes.

How do these drugs work?

Drugs such as semaglutide mimic the actions of a hormone called glucagon-like peptide-1, or GLP-1. These so-called GLP-1 analogues have several effects, including slowing stomach emptying, acting on the brain to reduce appetite, and stimulating insulin release, which helps regulate blood sugar. .

For more than a decade, GLP-1 analogues have been used to help people with type 2 diabetes control their blood sugar, and some users have experienced modest weight loss. “These drugs reinforce a system that already exists in the human body, the role of which is to suppress the appetite after the ingestion of a meal”, explains Simon Cork of Imperial College London.

Why are they making headlines now?

GLP-1 analogues began to be prescribed for weight loss in people without type 2 diabetes. They also became available in more potent and easier to use formulations.

Initially, GLP-1 analogs were approved for use at a lower dose and were to be given by injections twice a day. In the latest formulations, these are weekly injections, with the full dose of Wegovy being 2.4 milligrams for weight loss and Ozempic being used at a maximum dose of 2 milligrams for type 2 diabetes.

How widely available are they?

In 2021, Wegovy was approved for weight loss in several countries, including the United States and Canada. The praise of some famous users has won it wide publicity.

Manufacturing issues meant that its maker, Novo Nordisk, was struggling to keep up with global demand, so some doctors began prescribing Ozempic, which had been approved for people with type 2 diabetes in some countries several times. years earlier. This led to shortages for people who needed it for diabetes control.

In the UK, Wegovy was approved in 2021, but only gained approval from England’s medical guidelines body, the National Institute for Health and Care Excellence, in March 2023, when it said that the drug is expected to be administered by weight loss clinics within the country’s national health service. . Wegovy is expected to be available in the UK this year, while Ozempic has been available for type 2 diabetes since 2019.

How effective are they?

Very. It’s a cliché, but obesity doctors are talking about a paradigm shift in the field of obesity management. Previously, a loss of around 5% of body weight was considered a good outcome for any weight loss intervention outside of stomach surgery and is considered a gold standard in obesity drug trials.

Wegovy results in approximately a 15% reduction in body weight over one year, when combined with exercise and a healthy diet.

In fact, some people seem to think that GLP-1 analogs have made them too skinny, as evidenced by the rise of the search terms “Ozempic face” and “Ozempic butt”. “Ozempic doesn’t do anything specific to the skin,” says Alexander Miras of the University of Ulster, UK. It’s the weight loss that causes these apparent side effects, with similar results often occurring after bariatric surgery, he says.

Do the drugs have side effects?

Side effects can be mild, such as nausea, constipation, and diarrhea, which tend to happen as people get used to the drug. The most concerning side effects include inflammation of the pancreas, although this is relatively rare.

What about hair loss?

Hair loss has been reported by some semaglutide users. This is also sometimes seen after significant weight loss from other causes, such as stomach surgery, Miras says.

Hair loss after bariatric surgery is thought to be due to physiological stress on the body, causing an increased number of hair follicles to enter their “resting” phase, resulting in hair loss within a few months later. It stops when the weight loss levels off, however, the hair doesn’t always grow back, Miras says.

Do these drugs also help with addictions?

Maybe. There have been many anecdotal reports of people taking these drugs for diabetes or weight control losing their desire to drink alcohol or seeing the decline of other habits that could be described as “behavioral addictions”, like compulsive shopping.

This is supported by animal research which has shown that GLP-1 analogues reduce the consumption of alcohol and addictive drugs. A small trial in humans hinted at a similar effect of a GLP-1 analogue called exenatide, which reduces excessive alcohol consumption, but only in obese people.

The explanation could be related to how drugs work on the brain to reduce food cravings, but the exact mechanism is unclear. We are only at the beginning of understanding how these treatments could help people with alcohol and drug addiction, says Daniel Drucker of Sinai Health in Toronto, Canada. “The clinical trial data is not there yet to back up the stories.”

What happens to the weight of a long-term user?

Wegovy’s longest trial lasted two years and found that people’s weight largely plateaued by the second year.

In most countries, Wegovy has been approved for use for two years, but if people stop taking the drug they usually regain the lost weight – two-thirds after a year, according to one trial.

“Weight loss is only maintained as long as the drug is taken, because as soon as you stop the drug, all of these physiological processes that try to bring your body weight back up kick in again,” says Cork.

This suggests that after two years of use, consumers will ask doctors to continue prescribing the drug “off label”. “I think there will be a lot of pressure to try to change those guidelines,” Cork says.

Ozempic can be prescribed long-term for type 2 diabetes, as the disease is usually lifelong.