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A registered dietitian’s deep dive into the reality about Ozempic. Let’s dive into the science to have a look at how efficient at weight reduction it truly is and simply how unhealthy the unintended effects truly are. We additionally cowl implications of the remedy scarcity and issues for these with a historical past of an consuming dysfunction or disordered consuming. 
Set off warning: discussions of weight reduction numbers, consuming dysfunction behaviors
Ozempic and different weight reduction drugs like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching subject proper now.
Celebrities are publicly attributing their weight reduction to those drugs (Oprah being the most recent one as I’m scripting this). Docs are prescribing them left and proper for weight reduction (and every other ailment you may convey to the physician that they suppose is correlated to your weight). Sufferers with diabetes (for whom these drugs had been initially developed) can’t entry these meds as a result of there are shortages throughout the nation and their well being is struggling because of this.
From information headlines to TV commercials to water cooler speak, Ozempic is in all places. As a non-diet, weight-inclusive dietitian, I wish to make it possible for I’m empowering my shoppers and my group with all of the evidence-based info we have now (and spotlight what we don’t have) to be able to make an knowledgeable determination on whether or not or to not take these drugs. It’s not my function to steer you (as a result of I consider in your company and physique autonomy) however it’s my function to coach and inform, which I hope to do right here.
I might by no means, ever disgrace or choose somebody who decides to take these drugs. It might make sense should you select to take them or are eager about taking them given the anti-fat tradition we stay in and the strain from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve discovered about these drugs on this publish and am highlighting what the analysis exhibits us on weight reduction (how a lot weight you’re truly more likely to lose – trace: it’s not as a lot as you may suppose), what the identified unintended effects are, and why try to be cautious about the place you’re accessing these meds from.
What’s GLP-1?
These weight reduction drugs fall into a category of medicines referred to as GLP-1 agonists. GLP-1 is glucagon-like peptide, also called an incretin. Incretins are secreted within the small gut and assist to extend insulin, lower glucagon and decelerate gastric emptying (i.e. digestion), all of which assist to handle blood sugar. With incretin, glucose can slowly enter the bloodstream as an alternative of being flooded with it.
It additionally stimulates satiety and fullness and helps you keep full longer, which is why the remedy is now getting used to regulate urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic title for the lively ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the therapy of diabetes, and in 2021, Wegovy turned FDA-approved for the therapy of weight reduction. Each are basically the identical remedy solely Wegovy has larger doses of semaglutide.
As soon as Wegovy turned FDA-approved for weight reduction, it shortly went into scarcity after which medical doctors started prescribing Ozempic off-label (which means prescribing it for one thing apart from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages shortly adopted go well with.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes therapy aren’t attending to the individuals who want them probably the most and may have critical well being ramifications for these with diabetes.
Semaglutide continues to be in scarcity as of scripting this weblog publish in December 2023.
How do GLP-1 agonists assist these with diabetes?
In of us with diabetes, incretin’s results are diminished (by about 30%), which results in larger blood sugars and poorer blood sugar management. GLP-1 agonists assist management blood sugar and decrease A1c ranges, which measure your common blood sugar ranges over the past three months. Research present these drugs can assist decrease A1c ranges by 1 – 2.4 proportion factors and may cut back the chance of cardiac occasions, no matter weight adjustments.
5 issues you need to learn about Ozempic and Wegovy (and different GLP-1 agonists)
1. Chances are you’ll or could not shed extra pounds with Ozempic and when you cease taking it, you’ll possible achieve the burden proper again.
Not everybody loses weight taking these drugs, which is essential to notice, in any other case individuals who don’t shed extra pounds on these meds are left feeling like failures.
The analysis on semaglutide for weight reduction largely comes from the STEP trials, randomized managed trials (RCTs) that are funded by, you guessed it, the pharmaceutical firm that makes this drug, Novo Nordisk.
When trying solely on the STEP trials, outcomes present that 85% of individuals taking these drugs lose some quantity of weight. So about 15% of parents who take these meds gained’t lose any weight. For many who do shed extra pounds, on the very least, they’re dropping about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).
Roughly half of the parents who took this remedy noticed a extra average weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of parents taking this remedy noticed a fairly substantial weight lack of 20% or extra physique weight (about 40 lbs weight reduction for somebody weighing 200 lbs). This extra substantial weight reduction is in fact what’s driving all of the hype and media protection on these drugs.
However let’s remember the fact that these trials weren’t solely funded by the maker of the drugs but additionally had a variety of exclusion standards. Individuals couldn’t be a part of these research in the event that they had been depressed, had any present cardiovascular points, and in the event that they had been females of childbearing age with out a extremely efficient contraception methodology, simply to say a couple of.
While you take a look at different trials on semaglutide, with out the pharma funding and intensive exclusion standards, the outcomes are much less spectacular. Solely 40% of parents are dropping a minimum of 5% of physique weight. a meta-analysis (evaluation) of RCTs, most weight reduction totals hovered round a mean of 8-10 lbs, with a couple of research exhibiting extra vital weight reduction, round 25-40 lbs.
In case your aim is to lose about 5-10% of your physique weight then these drugs may make it easier to get there however if you’re searching for extra dramatic weight reduction, these meds in all probability gained’t make it easier to meet your targets.
It’s additionally essential to acknowledge what occurs once you cease taking the drugs. As a result of possibly your insurance coverage will cease masking it, or you’ll be able to now not afford it, or there’s a scarcity, and so forth.
Research have checked out what occurs once you take somebody off semaglutide and substitute it with a placebo and located that weight regain occurs in a short time. Inside a yr, folks regain nearly all of their weight misplaced, even whereas nonetheless doing behavioral interventions like diet, train, and cooking courses.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a eating regimen (you achieve it again).
2. Ozempic comes with very disagreeable unintended effects.
Research present {that a} vary of 60% as much as 93% of individuals taking these drugs will expertise some unintended effects – the most typical being gastrointestinal misery. These unintended effects could embody nausea, vomiting, diarrhea, constipation, GERD, and stomach ache. For most individuals, extreme GI signs ought to resolve inside a couple of days and extra delicate GI unintended effects normally resolve inside 8-12 weeks.
These drugs additionally include a black field warning that they will enhance the chance of thyroid tumors. That is primarily based purely on research completed in rodents so we don’t understand how that extrapolates to people, but. There are human research being carried out now however we gained’t know the outcomes till 2035 on the earliest. Due to this these drugs are contraindicated for these with a household historical past of thyroid tumors.
There are different very uncommon unintended effects like pancreatitis, gallbladder illness, kidney harm, and suicidal ideation. The FDA additionally just lately added ileus to the listing of unintended effects on the label, which is when your bowel stops functioning and you’ll’t take away waste – it may solely be handled with surgical procedure and could be deadly.
After which there’s the aesthetic reported facet impact persons are speaking about, “Ozempic face”. Because of speedy weight reduction (for some) and certain not getting enough diet, folks report having unfastened pores and skin on their face and a hollowing beneath the eyes and close to the temples. This look can also be seen in these affected by malnutrition.
3. There’s a scarcity of those weight reduction medication, which is main compounding pharmacies to create variations that aren’t accepted or regulated.
When a drug goes on the FDA drug scarcity listing, the FDA permits compounding pharmacies to combine up their very own model of the drug with none FDA approval or screening.
However, right here’s the catch. Novo Nordisk has a has a patent on the semaglutide molecule and solely they will produce it till 2032 so compounding pharmacies don’t have entry to this lively ingredient.
If you wish to take a weight reduction remedy, get a prescription out of your physician and safe it from a licensed pharmacy. Keep distant from wellness facilities, spas, or telehealth suppliers touting these drugs at a low price.
4. There’s no long-term information on Ozempic.
Let’s not overlook that we have now NO long run information on these medication. Semaglutide was accepted by the FDA for diabetes therapy in 2017 and the longest examine I discovered was follow-up with just a little over two years. We simply don’t know if there are any long-term unintended effects. We additionally don’t know should you preserve your weight reduction once you keep on this drug long-term.
It’s an eerily related image to previous weight reduction meds like Fen-Phen and Ephedra, each of which had been hailed as miracle weight reduction medication with no long-term information and had been finally taken off the market due to irreversible critical opposed unintended effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and loss of life.
It’s essential to weigh this when deciding to take the remedy – you merely can’t know what the security or efficacy is of taking Ozempic long-term. What we do know is that if you wish to have a shot at sustaining your weight reduction, you’ll have to keep on it long-term.
5. Ozempic could be harmful for these with a historical past of an consuming dysfunction or disordered consuming.
This remedy finally places you out of contact together with your physique’s pure starvation and fullness cues, which is counterproductive to consuming dysfunction restoration and the intuitive consuming framework. It causes you to eat much less, which might exacerbate and gasoline already restrictive consuming patterns, and result in potential nutrient deficiencies.
For these with binge consuming dysfunction or who wrestle with episodes of binging, coming off the remedy may end up in vital upswings in starvation, which can make you extra vulnerable to binges.
After which there’s the affect of weight adjustments in your psychological well being. In case you don’t shed extra pounds taking the remedy, you could go to extremes to limit your meals consumption. Or reducing weight could set off you to wish to lose much more, fueling extra restriction. Or should you lose vital weight after which achieve all of it again when you come off the remedy, that change in physique look could trigger emotional misery and result in disordered consuming.
In the identical method I wouldn’t suggest a eating regimen or intentional weight reduction to of us with an lively consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t suggest these weight reduction drugs both. It reinforces the concept skinny is finest and ends in insufficient nourishment and diet.
If you’re struggling to get enough diet whereas taking considered one of these drugs or are debating on taking considered one of these drugs and would love extra individualized diet assist, our group would love that will help you. Guide a diet evaluation immediately.
References:
https://pubmed.ncbi.nlm.nih.gov/32441473/
https://pubmed.ncbi.nlm.nih.gov/33567185/
https://dom-pubs.onlinelibrary.wiley.com/doi/pdfdirect/10.1111/dom.14863
https://pubmed.ncbi.nlm.nih.gov/35441470/
https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic
https://www.frontiersin.org/articles/10.3389/fendo.2021.645563/full
Consuming Issues & Diabetes: A Give attention to Diabetes Drugs Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
For extra weblog posts like this try:
Methods to Set Sustainable Well being Objectives For the New 12 months that Are Really Sustainable
Am I Consuming Sufficient? 8 Indicators You’re Undereating
Is Intuitive Fasting Actually Intuitive or Is It Simply One other Weight loss plan?
What Is Orthorexia? When Wholesome Consuming Turns into Obsessive
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