Ozempic: Good? Bad? My Thoughts

Let me quickly note that I am obviously not a medical professional. This is not medical advice. This is simply my own personal online findings and opinions on said findings.

I have never been asked about a drug more than I have been asked about Ozempic. This drug is clearly on the rage; to the point that there are currently supply line shortages. Crazy.

‍

This drug came on the scene recently and has spread like wildfire. It was approved for weight loss in 2021, and since then many folks have used this as their weight loss therapy. 

And that brings us to today.

Weight loss is something I discuss a lot with clients, and is a popular goal when starting to go to the gym. The fact of the matter is that weight loss is incredibly difficult and requires a great amount of effort and lifestyle changes in order to occur.

Weight loss is something that is earned with proper nutrition and exercise.

Until now when there is a drug that seemingly has weight falling off of everyone who takes it.

In my opinion- and this applies to basically everything in life- nothing comes without a cost. Traditionally, that cost was not eating cheeseburgers and fries everyday and getting in 10k steps per day. Now, the cost is the known and unknown side effects of these drugs like Ozempic.

I am about to get a little in the weeds, so feel free to skip over this. Although, you should know all this info, so you might as well keep reading:)

Ozempic is a part of a class of drugs called Semiglutides. These are Glucagon Like Peptide-1 Receptor Agonist (GLP-1RA) drugs. These drugs are an exogenous version of GLP-1 which is a peptide created by L cells in the intestine.

What does GLP-1 do?

GLP-1 helps regulate appetite through a variety of mechanisms. Endogenously it is secreted from the expansion of your intestine. When food enters the intestine and it begins to expand; the L cells release GLP-1 which will do the following things.

Basically, it tells your body to stop eating, and forces your pancreas to upregulate insulin.

GLP-1 specifically works by binding to GLP-1 receptors in the intestine, brain, and pancreas.

GLP-1 affects the intestinal tract by slowing food motility (movement) and making you feel “full”.

It affects the brain by binding to the receptors in the hypothalamus and (through a variety of pathways) modulates the nervous system to let your body know it's full.

It affects the pancreas by downregulating glucagon and upregulating insulin.

Okay so what are these GLP-1RA drugs like Ozempic?

These drugs are made to act like GLP-1, however, they have been modified in order to have a longer half life. Half life in this context refers to the amount of time a compound is effective. 

Endogenous GLP-1 has a functionality timeline of a few minutes. However, these new drugs have a functional capacity of days.

These drugs bind to the same receptors and in turn, lead to all of the same outcomes listed above.

Sounds great, right? Just take a drug and feel full without eating anything?

Well, that's basically how it works. Because you are on this drug you will feel full while eating significantly less food.

The Results From Studies

In the flagship study of these drugs there were incredibly positive findings.

The study took place over a year with over a thousand participants who were obese without type 2 diabetes.

Both groups received weight loss counseling and resources (whatever that means).

The control (placebo group) lost an average of 2.4% body mass

The drug group lost an average of 14.9% 

Massive difference and super promising!

Another study looked at the effects of when you stop taking the drugs. It was found that people who take the drugs for 20 weeks on average gained all of the weight they lost back.

People who took the drug for over a year would gain over 70% of their weight they lost back in the next year.

Not so great…

The side effects of the drugs (from a clinical standpoint) actually aren't all that bad. Typically stuff like nausea, diarrhea, upset stomach, stuff like that. More severe side effects are potential increase in risk of thyroid and pancreatic cancer, pancreatitis, and depression/suicidal thoughts.

The non-clinically relevant side effects (the ones that non medical folks look at) are more concerning to me. In the studies done looking at body composition they took notice of lean body mass (muscle) and bone density along with weight loss.

Typically, weight loss achieved through nutrition and exercise will lead to a decrease of 20% of muscle. On these drugs (with the encouragement and resources to exercise) there was an average loss of over 36% lean body mass.

It was also found that bone density decreases when using these drugs is similar to gastric bypass patients.

The reason for excessive muscle and bone loss compared to regular nutrition and exercise weight loss tactics I think can be easily explained. These drugs cause a disproportionate undereating compared to traditional weight loss methods.

Let's talk about all this…

Here are my personal thoughts on all the data listed above. Based on my comments you can probably see that I am not pro these weight loss drugs.

HOWEVER, I do think that these drugs could play a crucially beneficial role in certain populations. For people who are severely overweight, I think these drugs could be a great alternative to gastric bypass. 

The drugs are obviously not surgically invasive or permanent. I also think that when paired with proper nutritional counseling and practices as well as exercise; all the downside can be mitigated (aside from gastric side effects).

Now for what I don’t like.

My gut reaction to anything that is a “quick fix” or “miracle drug” I am immediately skeptical. Nothing comes without cost; especially pharmacological innervations. 

Let’s talk about those costs.

Firstly, many people are taking these drugs as their main source of losing weight. No lifestyle changes; eating the same diet and not exercising.

Aside from the obvious ramifications listed above (muscle and bone loss); this is a bad mental space to be in. You are reliant on a drug to do all the work for you. So, when you get off the drug; you are still the same person with all the same habits that led to your weight problem in the first place.

Like I said before, I can see this drug having a use for some people. AS LONG AS those people are also making lifestyle changes to ensure their success after stopping the drug.

The final thing that I do not like about this is the length of time it has been studied and the little research there has been on the other mechanism of actions.

Drugs like Ozempic really haven't been studied for a lengthy period of time. Their long term effects are still a mystery and will be for years to come.

The other mechanism of actions that GLP-1RA drugs have on the body is also something that has not been extensively looked into.

As I said above, endogenous (made in the body) GLP-1 has an effective timeline of a few minutes. Its effect on the body is extremely short-lived and might not even act upon other areas in the body where there are receptors because of concentration and half life constraints.

Due to these drugs having a half life of several days; it is (mostly) unknown the effects these drugs might take on different parts of the body and different mechanisms.

Again, I am not a doctor. However, I have been asked about these drugs so much that I felt compelled to do some deep dive research into these drugs. 10 hours and a pot of coffee later, I had this blog!

I know that I have a stake in what I am about to say, but I truly believe these drugs should not even be considered for 90% of the people I come into contact with.

I think that lifestyle changes, a better relationship with food, and exercise are the things that lead to lifelong success with weight management. If you really need to lose weight and can do these things while on the drug; I think that is a good option. IF and only if you truly make these changes and you are on the drug short term.

However, for the other 90% of people; I think you can make lifestyle adjustments that will lead to better and more sustainable outcomes.

We as humans are powerful. We are usually capable of more than we think and possess greater restraint and dedication. 

I am nowhere near perfect, and I am not saying you need to be. What I am saying is that for most of us, all we need's a little help and encouragement. We need to believe we can make a change and actually put in the effort to change.

Great changes come with greater effort. 

Yours in strength,

Nate

‍