Ozempic is a drug for diabetes, but it's also being used off-label for weight loss. Its active ingredient has inspired a new class of weight-loss drugs.
Pop culture continues to shine a light on Ozempic, a diabetes drug, and its weight-loss counterpart, Wegovy. Because of society's jagged relationship with diet pills, some people are asking questions about the medications -- whether they're safe enough, if they're even ethical to take and who should be using them in the first place.
The answers might depend on why you started taking them, and if you're able to keep taking them. Injections of semaglutide (the ingredient in both drugs) are currently on the US Food and Drug Administration's list of shortages. Compared to earlier drugs marketed for weight loss, Ozempic and Wegovy appear to be safer, despite common side effects like nausea and vomiting, said Dr. Christoph Buettner, professor of medicine and chief of the endocrinology division at the Rutgers Robert Wood Johnson Medical School.
"It seems like there isn't really anything comparable out at the present time," Buettner said, with the exception of Mounjaro, which is currently approved for diabetes but expected to be approved for weight loss soon.
Ozempic and Wegovy are both relatively new on the market, and have rare, more serious side effect risks on their labels, including thyroid cancer and pancreatitis. Like drugs for other health conditions, Ozempic and Wegovy are intended to be chronic medications -- ones that only work while you're taking them. With this comes both benefits and risks.
"There's no free lunch, so to speak," Buettner said.
Ozempic and Wegovy are similar drugs that contain the same active ingredient, semaglutide, though Wegovy contains a higher amount of it and is FDA-approved specifically for weight loss. Ozempic was approved first for the treatment of type 2 diabetes, but in some cases it's also being used off-label as a weight loss drug. Both are injected drugs for weekly use that you administer similar to how you'd use an EpiPen, and both are manufactured by the same drug company, Novo Nordisk.
Semaglutide works by interfering with insulin production and stabilizing blood sugar levels. This also causes food to move slower as it leaves your stomach and decreases your appetite, changing the body's response to hunger and fullness.
The bodies of people with type 2 diabetes can't process insulin correctly, and the main goal of Ozempic is to control blood sugar levels, while also reducing the risk of heart disease, stroke and other health events people with diabetes are more likely to experience. In terms of managing blood sugar – the goal of type 2 diabetes treatment – semaglutide has proven very effective in trials.
Wegovy is also effective within its approved use as a weight loss drug for adults with a body mass index over 27 and at least one health condition, such as high blood pressure, as well as adults with a BMI over 30. Compared to individuals who received a placebo, the FDA said in its approval notice, those taking Wegovy without diabetes lost an average of 12.4% of their body weight.
But the growing popularity of Ozempic and Wegovy has ignited decades-old concerns around weight loss drugs and weight stigma, and has also had other unintended consequences, including a drug shortage.
High demand for Wegovy turned into more demand for Ozempic, as some people who couldn't get Wegovy turned to the lower-dosed sister drug meant for treating diabetes, prescribed off-label by their doctors.
It makes sense that many people are able to get these prescriptions: According to the US Centers for Disease Control and Prevention, about 73% of US adults had BMIs in the overweight or obese range as of 2017-18. BMI is an imperfect, and often inaccurate, indicator of health, but it is used to define obesity, which the CDC considers a chronic disease.
That high demand, similar to other drug shortages, has caused trouble for some diabetes patients when trying to get their prescribed Ozempic. Mounjaro, another popular drug with the active ingredient tirzepatide, is also approved to treat type 2 diabetes, but it too is being used off-label in some cases for weight loss.
There are other treatments available for patients with diabetes, such as insulin, Buettner said. Though comparing insulin to semaglutide is a bit of a "loaded question," he added, because while semaglutide may carry a lower risk of hypoglycemia, or low blood sugar, some patients really do need insulin. This may make it hard to compare. As always when finding a medication substitute, talk to your doctor or pharmacist first.
There's another drug for diabetes treatment with the same active ingredient, called Rybelsus, but it's taken orally. Other drugs include Vicoza, Trulicity and Bydureon, and these may be options if people with diabetes are having a hard time filing their medication prescriptions, as Everyday Health reports.
The popularity of semaglutide is all too familiar to Tigress Osborn, chair of the National Association to Advance Fat Acceptance. Osborn, like many fat rights and body neutrality activists and some health providers, rejects the idea of obesity as a disease. Some of the same medical framing being used now for Ozempic and Wegovy were also in play during waves of earlier weight loss pills, Osborn said, including Fen-Phen, a nickname for an appetite suppression drug that was eventually pulled from the market in the late 1990s because it caused heart damage in many people who took it.
"We've heard this from you before," Osborn said of the widespread support for the current wave of weight loss drugs. "'This is safe, it's OK, it's gonna make you healthier,'" she said.
In addition to causing heart problems, some earlier pills caused psychiatric side effects, such as depression, according to Buettner. Rimonabant, which was approved in Europe and also taken off market, was found to induce harmful mental health side effects.
"When you give drugs that work in the brain, effects on depression or suicidal ideation are common," Buettner said. Ozempic and Wegovy also work in the brain, hence their appetite suppression properties, but "they signal very differently" as GLP-1 receptor agonists in specific areas of the brain, he said.
Common side effects of Ozempic and Wegovy include stomach pain, nausea, vomiting, diarrhea and other gastric symptoms. While rare, serious side effects including pancreatitis have also been reported. Because weight loss also causes you to lose fat stored in your face, some people report "Ozempic face," or a loss of some of the facial fat that's associated with a younger or more youthful look.
Weight stigma and its continuous health effects are also real factors. Research on weight calls into question whether prescribing weight loss for health based on BMI alone is valid to begin with. The deeply rooted biases against bigger bodies and the constant pressure to be thin puts people in a hard position between trying to lose weight with new tools or choosing to stay as they are, Osborn said.
"Anti-fatness breaks our heart – your drugs actually alter our hearts," she said. "How will we make a choice between those things?"
Those who do choose to use these drugs face another issue: continued access. Beyond the current shortage, part of the future of these medications depends on what insurance companies are willing to cover. Many patients have reported trouble getting prescribed medications covered by insurance when they're labeled for obesity – one example of how health care for bigger bodies is complicated by cultural biases, even when weight loss is the goal. That could change in the future as the catalog of weight loss drugs grows, putting more pressure on Medicare and insurance companies to change their policies.
For people who aren't celebrities or don't have deep pockets, and who need semaglutide for their health, access is an issue. Wegovy costs about $1,400 a month out of pocket, according to NPR. A patient who can't refill their semaglutide prescriptions could face health challenges, either from a lack of treatment for diabetes or from gaining weight back quickly.
Most patients will regain the weight they lost taking semaglutide when they stop it, meaning that it has to be taken continuously to remain effective. Weight cycling, when people repeatedly lose and regain weight due to dieting or other methods, is linked to various health risks, including increased mortality. Meanwhile, if you take medication to keep your blood sugar levels stable, and then you quit cold turkey, the return to high blood sugar could increase your risk of other health problems, such as stroke.