Ozempic and Weight Management

There are different approaches to weight loss and management. Some methods promise fast results (7), but others focus on sustainable lifestyle changes (6). The unfortunate truth is that neither the temporary solutions nor the long-term remedies effectively manage weight (1–6). Given that obesity and the resulting cardiovascular complications are among the primary causes of death (8), it is evident that we must find a sustainable weight management solution.

Ozempic, a medication specifically for Type 2 Diabetes Mellitus, has become popular  (4–6) and is labelled as the next best thing for weight loss (9,10). The Weight Watchers franchise, known for its sustainable approach to weight loss, announced that members of the program can now receive Ozempic prescriptions through their telehealth platform (9). Weight Watchers has always promoted sustainable, healthy eating practices. However, the recent inclusion of prescription drugs in their programme has raised questions about the validity of this approach.

Let’s start by discussing Ozempic, the brand name for semaglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist. This drug was originally developed to manage individuals with type two diabetes (4–6).  Other versions of the drug are Rybelsus (oral) and Wegovy (injectable) (11).  Semaglutide stimulates insulin production, helping balance blood glucose levels and reducing appetite. This results in reduced caloric consumption and weight loss (6). The injectable versions of semaglutide (Ozempic and Wegovy) have a long half-life and need to be administered weekly, while Rybelsus is administered in a daily tablet (11).

So, does it really work? To our knowledge, many studies have been conducted on Ozempic, all of which have shown successful results in weight loss when paired with lifestyle interventions (3–6). Lifestyle interventions alone have been proven effective for weight loss. They include exercise and calorie deficit (1,2). Out of the studies conducted on the drug, we were unable to find studies comparing the efficacy of Ozempic on weight loss with the efficacy of a lifestyle intervention. However, a 2021 study compared weight loss after using the drug or placebo (6). This study had  750 participants from 10 different countries. For 20 weeks all participants were given Ozempic as well as lifestyle intervention coaching. The average weight loss was 10.6%.  Lifestyle intervention coaching included increasing exercise minutes to 150 minutes per week and reducing daily calorie consumption by 500 kcal per day.

From week 20 to week 68, the participants were randomly split into two groups, with one group continuing to take Ozempic, and the other group was given a placebo. Both groups continued with the lifestyle intervention coaching. The group that continued taking Ozempic experienced a further 7.9% decrease in weight, while the group that received the placebo showed an increase in weight of 6.9% (see figure 1). Another study conducted in 2022  (4) had similar results, once again showing Ozempic to be effective in losing weight, but once stopped, had no effect on weight maintenance. The authors claimed that “once (participants were) in withdrawal, most of the weight lost was regained within one year” (4).

*Figure 1: Adapted from the study conducted 2021 by Rubino, et al  (6). The figure shows the mean percent change in body weight during the entire trial, comparing the continued use of semaglutide versus a placebo (week 0-68).

The use of Ozempic is clearly effective in weight loss, but weight gain may occur once administration of the drug stops (4,6). And regaining all the lost weight is possible within one year (4). So why use it? Like most quick fixes, the question of sustainability needs to be answered. Is it safe for someone to take this medication for the remainder of their life? The safety of Ozempic has been discussed, and the chances of developing severe side effects are low (5). The most common side effect is gut discomfort, such as nausea, vomiting, or diarrhoea (6).

Despite receiving a green light on safety, the price of Ozempic in South Africa raises a sustainability concern. One injection pen of Ozempic costs between R1200 – R1500 and can last an individual anywhere between one – eight weeks depending on their dose (10). It is important to note, the above studies proving the efficacy of the drug were conducted using a high dose of 2.4mg, with less efficacy seen on lower doses (4,6).  This raises the question of whether a temporary potential weight loss is worth it? Repeated studies have shown that healthy eating and exercise are effective for weight loss and management (1,2). But low rates of adherence mean that these too, are not often sustainable for long term weight management (5). Would it not better to focus on implementing healthy lifestyle changes that target long term eating and exercise behaviours instead of relying on drugs that have questionable long term efficacy, are costly, and have potential negative effects?

References:

1. Jensen SBK, Janus C, Lundgren JR, Juhl CR, Sandsdal RM, Olsen LM, et al. Exploratory analysis of eating- and physical activity-related outcomes from a randomized controlled trial for weight loss maintenance with exercise and liraglutide single or combination treatment. Nat Commun. 2022 Dec 1;13(1).
2. Bellicha A, van Baak MA, Battista F, Beaulieu K, Blundell JE, Busetto L, et al. Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies. Obesity Reviews. 2021 Jul 1;22(S4).
3. Singh G, Krauthamer M, Bjalme-Evans M. Wegovy (Semaglutide): A New Weight Loss Drug for Chronic Weight Management. Vol. 70, Journal of Investigative Medicine. SAGE Publications Inc.; 2022. p. 5–13.
4. Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug 1;24(8):1553–64.
5. Smits MM, Van Raalte DH. Safety of Semaglutide. Vol. 12, Frontiers in Endocrinology. Frontiers Media S.A.; 2021.
6. Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity. JAMA. 2021 Apr 13;325(14):1414.
7. Richter A. Medical News Today. 2023. How to naturally lose weight fast.
8. Bray F, Laversanne M, Weiderpass E, Soerjomataram I. The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. 2021 Aug 15;127(16):3029–30.
9. Jones C. Rolling Stone. 2023. Weight Watchers Is Pivoting to Ozempic. Influencers Aren’t Following.
10. Kunene Z. News24. 2023. Ozempic: A hashtag and a helpful effect collide, draining global stocks of a diabetes drug.
11. Suran M. As Ozempic’s Popularity Soars, Here’s What to Know About Semaglutide and Weight Loss. JAMA Network. 2023 May 1;