Should you take Ozempic? It’s a question I’m asked by friends and it’s also a hot topic among my scientific colleagues. The answer is complicated.
Ozempic is being touted as a new miracle weight loss solution that can help those who have struggled for years to shed pounds successfully lose weight with a single weekly injection.
The jab contains a drug called semaglutide, originally developed to help manage type 2 diabetes, helping the body produce more of the hormone insulin and thus control blood sugar levels. Then it was noticed that there was a side effect – weight loss. The rest, as they say, is history. The drug is in such high demand that shortages have been reported worldwide.
The weight loss occurs because semaglutide mimics the effect of the fullness hormone GLP-1, which is naturally produced in your intestines when you eat, signaling your brain that you are full.
The appeal of this synthetic version of GLP-1 is that it lasts longer and is more potent because it does not break down quickly in the body. Therefore, it can be taken as a weekly injection. It not only reduces your appetite, but also slows the movement of food through the intestines, helping you feel full longer.
Other GLP-1 agonists that act like semaglutide have suggested that they can significantly alter the gut microbiome, reducing microbial diversity.
For most people, this leads to significant weight loss – and here’s my first ‘but’, as even this ‘miracle’ solution won’t work for everyone.
Plus, it’s worth noting that its success still depends on eating fewer calories than you need. Without this it won’t work.
In a trial published in 2022 in the journal Nature, 152 participants with a BMI of 27 (that’s overweight – 30 or more is obese) and higher took semaglutide for two years (in addition to a low-calorie diet and monthly support from a dietitian, and were encouraged to do at least 150 minutes of exercise per week) and lost an average of 15 percent of their body weight, compared to a 3 percent loss in a placebo group.
Impressive numbers, yes, but while the study found that 77 percent of participants lost at least 5 percent of their original weight (presumably leading to benefits such as improved blood sugar levels, lower blood pressure and less strain on the heart), 23 percent does not achieve this crucial 5 percent weight loss.
And to set the context, losing 5 percent of your body weight is about the amount you achieve through calorie counting or a more traditional diet over a two-year period, according to a 2008 study published in the New England Journal of Medicine.
Then there are the side effects, which usually include nausea, vomiting, diarrhea and constipation (since semaglutide slows the passage of food through the intestines). For some, these can be so bad that it becomes difficult to live a normal life, even leaving the house. I’m often asked whether the drug could damage the gut microbiome (the community of microbes that live in your gut and play a role in so many different elements of your health).
We know that many medications interact with the gut microbiome. For example, a 2018 study published in Nature found that about a quarter of more than 1,000 commonly used medications (not including antibiotics) can affect gut bacteria, but not all in a negative way. (Some can even reduce the number of harmful bacteria.)
We still have a lot to discover about semaglutide. A handful of studies of other GLP-1 agonists that act like semaglutide have suggested that they can significantly alter the gut microbiome, reducing microbial diversity (and diversity is beneficial to our health).
Dr. Emily Leeming says: ‘Semaglutide is a serious drug, far from the easy option it is made out to be. It’s not for thin people who want to lose a few pounds
Ozempic is being touted as a new miracle weight loss solution that can help those who have struggled for years to shed pounds successfully lose weight with a single weekly injection.
Specific to semaglutide, earlier this year a study in mice published in the journal Biochemical and Biophysical Research Communications suggested the opposite: that the drug increased levels of certain “good” gut bacteria and supported gut barrier health. However, I must emphasize that the findings from mice do not always apply to humans, and little research has been done on them so far.
While the future of semaglutide seems hopeful, it has only been on the market since 2017 and not enough time has passed to know for sure what it does long-term, although it does appear safe for now.
There have been weight-loss drugs before, although many of them, such as the amphetamine-based fen-phen and Meridia – heralded as the next wonder drug that was only withdrawn because it had dangerous side effects – fell at the last hurdle when problems arose. arise in the longer term.
But my point is that semaglutide comes with side effects – some of which we already know about, and some of which we may yet discover. We should reserve this drug for those who really need it, those who fall into the obese BMI category, 30 and above. For some of them, the drug could potentially be lifesaving.
In Britain, national guidelines recommend that it can be prescribed to people with a BMI of 35 or above and at least one weight-related health condition, such as high cholesterol or type 2 diabetes (or a BMI of 32.5 for people from South Asian , Chinese, other Asian, Middle Eastern, Black African or African Caribbean backgrounds – who are often at greater risk of weight-related health problems) as part of a specialist weight management service, in addition to a reduced-calorie diet and exercise.
It can also be prescribed to people with a BMI between 30 and 34.9 if they meet specific criteria.
I welcome this as an alternative option for people whose weight problems are putting their health at risk. We must recognize that losing weight is difficult for most people.
It’s not just about exercising more and eating less; there are complex genetic and environmental reasons why one person can be taller than the next person. Even your gut microbiome may play a role, as some people’s bacteria may be more efficient at harvesting energy from food than others.
Some people have health problems or take medications that make them more likely to gain weight. The human body is well prepared for weight loss, which is probably a necessity for survival in our caveman days during periods of famine.
If you have been prescribed semaglutide and are experiencing side effects, it may help to eat smaller meals more often, follow standard anti-nausea advice, drink peppermint or ginger tea, and stay hydrated if you experience vomiting or diarrhea.
In the longer term, it’s important to remember that once you stop taking it (and at this point prescriptions can only be issued for two years), your hunger signals return to normal so the weight can gain back on within a few months. That is why retraining is necessary. your eating habits – besides taking the medicine – are so important.
Semaglutide is a serious drug, far from the easy option it is thought to be. It is not for thin people who want to lose a few pounds.