When 28-year-old Danielle K. gained around 50 pounds during the pandemic, she tried everything to drop the weight: intermittent fasting, working out consistently, and focusing on a balanced diet. But nothing made a difference on the scale or in the mirror.
Danielle’s sister has type 1 diabetes and has started taking a prescription drug called Ozempic that has a known weight loss side effect. While the drug is technically prescribed and FDA-approved to treat type 2 diabetes, Danielle noticed that her sister shed “a significant amount of weight” after a year of injections. So, Danielle started doing her own research, diving into Reddit threads about other people’s experience using the new drug. And then she asked her primary care doctor about it.
Since Danielle was considered obese, her doctor prescribed the semaglutide injection, Ozempic, off-label. That means a doctor prescribes you a drug that has been FDA-approved to treat a different condition than the one you’re using it for. (Doctors say the diabetes drug can be used for weight loss alongside a healthy diet and regular exercise, since it decreases appetite and slows digestion.)
Six months later, Danielle’s down 25 pounds. “I’m somebody who has struggled with binge eating in the past, and who constantly thinks about food, so Ozempic has made it a lot easier to identify when I’m full and not mindlessly eat,” she says. “It’s definitely been really great for me.”
Danielle is not alone. These drugs have been whispered about in elite circles for about a year now, with celebs seemingly “suddenly showing up 25 pounds lighter,” as Andy Cohen pointed out in a tweet in September. “What happens when they stop taking #Ozempic ?????” he asked, making a tongue-in-cheek joke about the drug.
While it’s unclear which, if any, of the rich and famous are actually taking the drug, billionaire Elon Musk was quick to respond to questions on Twitter about his newly ripped physique by crediting “fasting” before adding, “and Wegovy.”
The prescription medications, sold under brand name Wegovy for weight loss, and Ozempic for diabetes (and prescribed off-label for weight loss), have made their way into the mainstream thanks in part to Reddit threads and social media. They’ve even gone viral on TikTok, with #ozempicweightloss racking in 96.9 million views and #wegovy hitting 99.6 million views.
The women interviewed for this article heard about the drug through social or news streams before their own doctors.
Wegovy saw a “huge spike in demand” first, says Sarah Musleh, MD, an endocrinologist who previously worked for Kaiser Permanente in Honolulu, before co-founding Anzara Health, a multi-state concierge endocrinology practice. Now, both drugs are labeled as “currently in a shortage” by the FDA.
And it’s become clear that this popularity hasn’t come without some very real costs.
What is semaglutide?
Injectable semaglutide, called Ozempic or Wegovy depending on its dosage, mimics naturally occurring hormones. The lower 2.0 milligram dose, called Ozempic, is approved by the FDA to treat type 2 diabetes (with a side effect of weight loss). The higher 2.4 milligram dose, Wegovy, is approved and prescribed for long-term weight management. But that hasn’t stopped doctors from prescribing Ozempic off-label to help patients lose weight.
Six months after the FDA approved the once-a-week 2.4mg semaglutide dose, Wegovy, for weight loss in June of 2021, the manufacturer quickly announced a shortage due to “overwhelming demand.”
Not to be deterred, people like Danielle switched to the lower dose Ozempic off-label, despite the fact it’s only approved to treat type 2 diabetes. “It’s obviously the same drug and you’re going to get weight loss associated with it,” explains Joseph Arulandu, MD, an internal medicine physician at Northwest Medical Group who is also board certified in obesity medicine and clinical lipidology.
Ahmet Ergin, MD, an endocrinologist in Florida and the founder of diabetes and lifestyle channel, SugarMD, explains that the drugs are basically identical twins, but the dosage creates “two different individuals” that use different names.
So, the combination of Wegovy shortages and insurance coverage requirements for weight loss medications meant that off-label Ozempic also started to be prescribed for its weight loss benefits, too, says Dr. Musleh. But that also meant those who used Ozempic for diabetes have struggled to get their hands on the drug. Now, both are in a shortage, the FDA says.
Lower doses of Ozempic (the 0.25 mg and 0.5 mg doses) are back in stock, but there’s still a limited supply of the 1 mg dose, and the 2 mg dose is unavailable, according to Dr. Ergin.
Most doses of Wegovy remain on backorder (doctors will often temporarily lower a patient’s dosage to the ones that are still available), but doctors are hoping both drugs will be in better supply by early 2023.
How do Wegovy and Ozempic work?
The medication is made of a molecule called semaglutide that helps the pancreas release the right amount of insulin when your blood sugar is high, says Dr. Arulandu. Semaglutide mimics a gastrointestinal hormone, GLP-1 (glucagon-like peptide 1), which plays an important signaling role during digestion, says Dr. Ergin.
When we eat, food goes through our stomach and intestines, and the GLP-1 hormone’s job is to signal satiety, alerting the pancreas to make insulin that regulates glucose (blood sugar) and breaks down fats and protein.
Studies show that obese people lack these essential gastrointestinal hormones, which skews organ-to-organ communication, says Dr. Musleh. Semaglutide reorganizes and improves the organs’ communication and metabolism, she explains. That’s why it was developed for type 2 diabetes in 2012.
Studies show semaglutide also decreases appetite and slows digestion, says Danielle Belardo, MD, a preventative cardiologist in Newport Beach, California and the co-chair of the American Society for Preventive Cardiology Nutrition Committee.
Within the first week of using Wegovy and Ozempic, people typically lose five to 10 pounds of water weight. And after a few months on the max dose, they lose about 15 percent of their body weight, according to Dr. Ergin.
Total weight loss can range from 5 percent to 30 percent of total body weight. Losing one to two pounds per week is generally considered safe, WH experts say.
Who is a good candidate for the drugs?
Ozempic is technically only FDA-approved for treatment in type 2 diabetics, and Wegovy is only FDA-approved for patients with a body mass index (the measure of body fat based on your height and weight) above 30, or 27 if you have weight-related comorbidities like hypertension (high blood pressure) or hyperlipidemia (high levels of fat concentration in the blood), says Dr. Belardo.
And while the drugs’ needles are the size of an “oversized eyelash,” according to Dr. Musleh, you also have to be willing and able to give yourself an injection once a week.
How does a prescription for off-label use work, exactly?
It’s totally legal for a *licensed* healthcare provider to prescribe Ozempic off-label for weight loss, even if you’re not diabetic. But your doctor must judge whether off-label use is appropriate for your needs, according to the FDA.
So, for someone with a BMI above 30, or who has co-morbidities like sleep apnea or high cholesterol, doctors can prescribe Ozempic off-label since it addresses those issues.
Many patients end up paying out-of-pocket for the medication, since their insurance plans don’t cover weight loss drugs. Ozempic is often cheaper, with a list price around $892 per month compared to Wegovy’s $1,349 per month. The Affordable Care Act and Medicare are not required to cover obesity treatments, and many private insurance providers view obesity as “lifestyle and behavioral” issues. However, some plans do cover weight loss treatments, several doctors said.
“These medicines are expensive, so it’s not like you write the prescription and insurance [automatically] covers them,” says Dr. Musleh. “Sometimes I have to go through a lot of paperwork that really proves a patient needs it.”
If you’re using Ozempic or Wegovy for weight loss, it should be prescribed by a trained physician, stresses Dr. Musleh. Some med spas and online providers try to sell consumers “compounded semaglutide,” where drugs like Wegovy are altered, combined, and mixed to create a “personalized” medication. But these compounds are not regulated (which could make them dangerous), the prescribers are “not trained,” and the semaglutide dose is smaller, Dr. Musleh explains.
What are the risks?
Nausea, cramping, diarrhea, acid reflux, vomiting, and constipation are all common (in addition to suppressed appetite and weight loss), Dr. Musleh says, and the symptoms can range from mild to moderate.
It’s important to work with a doctor and monitor symptoms to ensure correct dosing, Dr. Belardo adds.
So far, Dr. Ergin has not seen major complications in patients, but these drugs are relatively new, and it’s hard to know what effects could look like down the road. “There’s no way of saying long term risks, unless we use the medications for 20 years and then look back retrospectively and find problems,” he says.
What are the side effects?
Twenty-seven-year-old Lynnette B.’s doctor recommended semaglutide after other diets weren’t successful. Wegovy wasn’t covered by her insurance, but Ozempic was. Now down 35 pounds, the experience has been positive, but she’s experienced multiple side effects as her dosage increased.
“Each month I’ve increased the dosage, and once I started 1.0 mg my [nausea] was at its height,” Lynnette says. These days, it’s been hard to fill that dosage because of the shortage, so she went back down to 0.5 mg.
Other users say semaglutide totally kills their appetite. “The day after my first shot, I didn’t feel hungry all day and I had to make myself eat a small dinner in order to not get dizzy,” says Tatyana H., a 50-year-old woman who started on Ozempic six weeks ago for weight loss after seeing how well it worked for a friend.
Initially, the listed side effects made her hesitant to try the drug. “Then I saw my friend who I had not seen since May, and she looked a lot smaller than before,” Tatyana explains to WH in an email. “She told me she was taking Ozempic…That convinced me to try it, too.”
Tatyana has lost six pounds so far.
Although semaglutide is supposed to suppress your appetite, it’s important to keep eating, explains Dr. Arulandu. Women should not consume fewer than 1,200 calories per day, Jonathan Valdez, RDN, owner of Genki Nutrition and spokesperson for New York State Academy of Nutrition and Dietetics, previously told WH.
Others reported less aggressive symptoms. “The only side effect I have experienced has been heartburn, which has been pretty easy to manage with just taking Pepcid,” says Danielle K.
In rare cases, Ozempic can cause serious side effects like pancreatitis, hypoglycemia, and an increased risk of thyroid cancer, says Dr. Musleh. The chances are low, but if you have a history of pancreatitis, research shows these drugs should not be prescribed because they act on the pancreas and may cause swelling, she explains.
Novo Nordisk, the company that makes Ozempic, also warns about the risk of medullary thyroid cancer. However, Dr. Musleh says no humans have reported cancer on the drug. Still, if you or a family member have a history of medullary thyroid cancer, then they should not be prescribed, she explains.
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Dr. Musleh also notes that, while you can get hypoglycemic (low blood sugar) when using Ozempic, research shows it’s more common when using the drug with another diabetes or insulin medication.
Finally, dehydration from Ozempic or Wegovy can cause kidney dysfunction or worsen kidney disease if you have a history of kidney complications, so it’s important to hydrate, adds Dr. Ergin.
Is it problematic to use off-label drugs for weight loss?
The answer is complicated. Increased demand for Wegovy meant off-label Ozempic was over-prescribed, which means diabetic patients couldn’t get their necessary medication, says Dr. Ergin.
“We still have limited resources, especially after COVID, and physicians should be more careful [about prescribing Ozempic to non-diabetics],” Dr. Ergin explains. Plus, it’s “a very labor intensive, high-technology medication [to be manufactured], and it needs to be used carefully.”
So, diabetics should be “the first priority,” says Dr. Musleh. “It’s very unfortunate when you need a medication to treat your diabetes and you can’t get your hands on it.”
Should you rely on a drug for weight loss?
While these drugs are effective and doctors say they’re relatively safe, they’re not a permanent cure-all, says Dr. Arulandu.
“I tell all my patients that if after six months you have not changed the way you eat or your activity, you are going to gain weight back,” he explains. Ozempic and Wegovy should be used *in combination* with diet changes or nutritional counseling, exercise, and lifestyle modifications. Dr. Belardo adds that lots of factors contribute to obesity, which means “there is no one-size-fits-all approach.”
These drugs can only serve as kick-starters to eating healthy and exercising. “To rely on a drug purely for weight loss is going to end up in failure,” says Dr. Arulandu. “It has to be the drug plus lifestyle modifications.”
Still, the medications can be beneficial, and it’s a misconception that relying on a drug for weight loss is always dangerous, adds Dr. Belardo, who called these meds a “game changer” for helping patients safely lose weight.
You just have to be willing to pay the price, literally and physically. “My only real fear as I take [Ozempic] long term is that some people go off the medication and then start to gain the weight back,” says Danielle K. “I know a lot of people end up being on Ozempic for long periods of time at a lower maintenance dose, but I don’t know if I can continue to justify paying for it once I meet my goal weight.”
Andi Breitowich is a Chicago-based writer and graduate student at Northwestern Medill. She’s a mass consumer of social media and cares about women’s rights, holistic wellness, and non-stigmatizing reproductive care. As a former collegiate pole vaulter, she has a love for all things fitness and is currently obsessed with Peloton Tread workouts and hot yoga.