The pursuit of weight loss has led to the development and popularity of various medications, including semaglutide, known under the brand names Ozempic and Wegovy. While these drugs have demonstrated effectiveness in weight management and offer potential health benefits, it’s crucial to understand their mechanisms, potential risks, and the broader context of weight management. This article explores the benefits and risks associated with medical weight loss interventions like Ozempic and Wegovy, while emphasizing the importance of addressing underlying health issues and promoting a holistic approach to well-being.
Understanding GLP-1 Receptor Agonists
Ozempic and Wegovy contain semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist. These medications mimic the effects of the naturally occurring GLP-1 hormone, which plays a crucial role in regulating appetite and blood sugar levels. GLP-1 receptor agonists work by:
- Curving Hunger: Stimulating GLP-1 receptors in the brain's hypothalamus, which regulates appetite.
- Slowing Digestion: Slowing down the movement of food from the stomach to the small intestine, promoting a feeling of fullness.
- Increasing Insulin Production: Enhancing insulin production, which helps lower blood sugar levels.
Benefits of Medical Weight Loss
Weight Management and Metabolic Improvements
The Food and Drug Administration (FDA) approved Wegovy, a brand name for semaglutide, for weight loss in adults who have high cholesterol, type 2 diabetes, or high blood pressure. Clinical trials have demonstrated that GLP-1 receptor agonists can lead to significant weight loss. Obese patients lost roughly 12% of their body weight on Wegovy (semaglutide) and about 18% on Zepbound (tirzepatide, which targets GLP-1 and another gut hormone, GIP). Losing 5% to 10% of your total weight and keeping it off can have important health benefits.
Cardiovascular Benefits
Studies suggest that semaglutide can lower high blood pressure and reduce the odds of heart attacks or strokes in people with obesity. A study coming out in the next month or so is expected to show a 20% reduction in heart attacks, strokes, and death from a cardiovascular cause.
Potential Neurological and Behavioral Health Benefits
Research indicates potential benefits to neurological and behavioral health, with reduced risks of seizures and addiction to substances such as alcohol, cannabis, stimulants and opioids. GLP-1RA drugs act on receptors that are expressed in brain areas involved in impulse control, reward and addiction - potentially explaining their effectiveness in curbing appetite and addiction disorders.
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Risks and Side Effects
Common Side Effects
There are many side effects of taking Ozempic as a weight loss medication, including:
- Gastrointestinal issues like nausea, vomiting, and diarrhea
- Constipation
- Stomach pain
- Headache
- Excessive burping
- Heartburn
- Fatigue
- Flatulence
- Gastroesophageal reflux disease
These most common side effects of Ozempic aren’t usually dangerous and may dissipate as you grow used to the medication.
Serious Adverse Effects
There is potential for more serious adverse effects, such as:
- Vision problems
- Swelling in the extremities
- Dizziness or fainting
- Reduced urination
- Rash
- Rapid heart rate
- Swelling of the throat, tongue, mouth, face, or eyes
- Problems swallowing or breathing
- Fever
- Yellow eyes or skin
- Chronic upper stomach pain
Wegovy, another brand name for semaglutide, may also cause damage to the retina, suicidal ideation, gallstones, pancreatitis, and acute kidney damage. Moreover, taking semaglutide can increase the chance of developing thyroid tumors, including medullary thyroid carcinoma.
Overdose Risks
The maximum recommended dose of Ozempic is 1 mg, injected once per week. Using too much Ozempic or taking it too frequently can lead to an overdose and increase the risk of harmful side effects. Signs of low blood sugar may include:
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- Dizziness
- Weakness
- Confusion
- Irritability
- Anxiety
- Excessive sweating
- Trembling
- Rapid heartbeat
- Hunger
Severe hypoglycemia may result in vision or coordination problems, extreme confusion, and even seizures.
Risks for Individuals with Eating Disorders
Some people with eating disorders or patterns of disordered eating may misuse semaglutide (and other weight loss medications) for weight management since this medication can reduce appetite and caloric intake. However, this can be risky, especially for those with anorexia nervosa who may already significantly restrict their food intake-it could increase the likelihood of undernutrition and its many dangerous consequences. Ozempic is commonly prescribed for people with type 2 diabetes, and type 2 diabetes is associated with eating disorders, especially binge eating disorder (BED). In this case, while being prescribed Ozempic or Wegovy may help people lose weight, it won’t address the underlying factors that can lead to binge eating disorder in the first place.
Discontinuation and Weight Regain
Research has shown that stopping use tends to result in regaining the lost weight. Once you start taking GLP-1s, the drugmakers suggest you stay on them. People who go off the drugs eventually regain much of their lost weight.
Gastrointestinal Issues
GLP-1 agonists can slow digestion to a problematic degree. Patients have sued the drugmakers after developing dangerous conditions, such as stomach paralysis and bowel obstructions.
Important Considerations
Medical Supervision and Comprehensive Assessment
It's important to get therapy in order to address the underlying causes of an eating disorder. Before choosing a medicine for you, your health care provider thinks about your history and health challenges. Your doctor will also look at your full health history, including past and current medical conditions, family history, previous weight loss attempts, and medications. Nagata suggests that patients taking GLP-1s check in regularly with a physician or nutritionist who can monitor their progress and flag unhealthy behaviors.
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Lifestyle Modifications
All the clinical trials that showed these medications working also included education on eating and exercise. Patients taking GLP-1s should prioritize fruits and vegetables; whole grains; lean protein; and the healthy fats found in olive oil, nuts, and seeds.
Addressing Weight Stigma and Diet Culture
Using this prescription medication for the sole purpose of losing weight medicalizes fatness and fails to address the real issue: weight stigma. The so-called “obesity epidemic” harms people living in larger bodies, contributes to anti-fatness and body weight bias, and can lead to mental health problems and eating disorders, such as binge eating disorder, anorexia nervosa, or bulimia nervosa.
Insurance Coverage and Affordability
Weight-loss drugs can be expensive and aren't always paid for by insurance. Shortages aside, many insurers still won’t pay for GLP-1 agonists unless the patient has been diagnosed with diabetes or cardiovascular disease. A 2003 law currently prohibits Medicare from covering drugs for weight loss alone. Meanwhile, states get to decide whether to cover the drugs under Medicaid. A lot of people struggling with obesity can’t afford the most effective treatment.
Long-Term Effects
Khan says the drugs work, but they are hard to find, expensive-around $700 a month without insurance for Wegovy which is prescribed for weight loss-and need to be taken forever to maintain weight loss and improve cardiovascular health when researchers don't yet fully understand their long-term effects.