Ozempic Craze (part 1 of 2)

It's everywhere, and it's not going anywhere, so what's up with Ozempic?! Stay tuned for part 2, in your inbox next Thursday.

What do Elon Musk, Mindy Kaling, Girl with No Job, and Remi Bader have in common? They’ve all been on Ozempic, and they’ve all talked about it.

I’m sure you’ve heard about it, I’m sure you know of someone who’s using it or has considered starting to use the injections, and I’m sure it’s not new to you that Ozempic is all over the place. And though the craze’s peak seems to have “gone down a bit, it’s not going anywhere,” as one of the attending physicians I work with put it this past Tuesday morning.

Sunday afternoon I drove past a billboard for weight loss drugs and saw a post online featuring Ozempic at the NYC marathon (see below), yesterday I saw an ad for Ozempic on Instagram, and Tuesday morning I heard the attendings talking about it, so naturally I joined their conversation and decided I’d write about it for STCO, because of course, your girl has some thoughts.

The doctors and I talked about how they have had many patients asking for it; one of the attendings only prescribes it to their patients with diabetes and uses phentermine for weight loss, “it just hasn’t been getting approved,” to which the other attending responded with a list of insurances she is sure will approve it from personal experience. “I only prescribe after seeing they meet criteria, like having a BMI of 27 and having a comorbidity,” she added. It’s not going anywhere we agreed, and stock prices seem to agree with us too.

The manufacturer Novo Nordisk of diabetes drug Ozempic has a market cap of $454 billion and continues to grow rapidly. Experts say this growth will impact the healthcare sector and food sector; from snack and alcohol companies to kidney treatment, stocks will drop as more people buy fewer snacks and booze, and research on semaglutide use with other conditions such as kidney disease and heart failure starts to rise.

As Bloomberg puts it, “Ozempic is Bad for Business,” and Walmart CEO John Furner agrees, stating that customers on GLP-1 agonists are buying “less units, slightly less calories.” But I came across this other interesting rebuttal on Substack by Josh Barro you can take a look at, arguing to an extent it might be good for business and the economy through improvements to population health and worker productivity.

What is Ozempic?

Ozempic is a weekly injection for patients with type 2 diabetes that has an active ingredient called semaglutide. Semaglutide is also the ingredient in the weight-loss approved medication called Wegovy also manufactured by Novo Nordisk, but provides the active ingredient at a higher dosage.

Once demand surpassed the supply of Wegovy early this year, doctors began prescribing Ozempic off-label for weight loss. This then led to a shortage of Ozempic not only for folks looking to lose weight, but also for patients with diabetes who had been on it for years.

Why the sudden spike in interest? Probably celebrities, social media testimonials, people looking to lose “pandemic weight,” and the fact that these drugs do work, and you do get what you’re marketed.

Before the popularity of these drugs, other weight loss drugs were on the market but had undesirable side effects, such as Orlistat and its oily stools, Phentermine and concern for its effect on cardiovascular health, among others who also showed a similar 5-8% weight loss like semaglutide. Enter Mounjaro, Ozempic’s cousin with active ingredient tirzepatide, which shows weight loss of ~7-13%, and preliminary evidence now suggests it may result in up to 20% to 25% body weight loss.

How does it work?

Ozempic, Wegovy, and Mounjaro, today’s three musketeers, are all glucagon-like peptide 1 agonists (GLP-1 agonists), they basically act like our body’s natural GLP-1 hormone, which slows down digestion leading to early satiety, regulates insulin and blood sugars, and helps communicate your fullness from your tummy to your brain. Mounjaro is interesting in that it is both a GLP-1 agonist and a GIP agonist (glucose-dependent insulinotropic polypeptide agonist), meaning it mimics both hormones and has a more intensive action profile, leading to greater weight loss.

So, the three musketeers all enhance these bodily processes and lead to weight loss by significantly suppressing hunger, making sticking to a caloric deficit much easier. Studies have shown ~25-35% of caloric intake reduction thanks to a decrease in hunger sensation with medication use.

Weight Loss, Medication Efficacy, and Side Effects:

Our bodies aren’t designed to sustain weight loss. When we go on a diet or lose weight, our body fights it by ramping up hunger hormones and decreasing satiety hormones, because it wants to get back to “homeostasis,” or its “normal.” The body feels like it won’t have enough energy to do its daily activities, it thinks you are starving it and will do everything in its power to stop this. This is just one tactic of metabolic adaptation that makes sustainable weight loss difficult.

These hunger adaptations might even last for years after you stop dieting, so the use of these medications kinda cuts that process by suppressing hunger even as you continue to shed pounds and decrease your intake. These medications don’t burn fat, as I’ve been hearing people say, but help you lose weight by helping override your body’s natural way of jeopardizing weight loss.

With dieting and weight loss also comes a lot of cravings from restriction, another mechanism that makes adhering to weight loss strategies in the long run difficult. With these medications people have reported feeling “more in control around food” and having less “food noise,” and “food chatter,” or constant cravings and ruminating thoughts about food when on medication.

Obsessive ruminating thoughts about food have been attributed to starvation and restriction, guilt/shame, having a negative relationship with food/body, and can be influenced by genetics, environmental factors, or learned habits. These thoughts might be worth exploring with a mental health professional prior to starting the medication.

Medication Side Effects:

Though successful in helping people lose weight, things aren’t always rose-colored, and these medications do have some side effects. Mild side effects like nausea, vomiting, and diarrhea, should subside over time. Possible pancreatitis, increased risk of thyroid tumors, low blood sugars, and gallstones are more serious side effects to keep in mind, and a couple of months ago the FDA also added intestinal blockage, or ileus, to the label as a potential side effect. More reports of its effect on mental health and the loss of lean muscle mass are being studied as well.

Sensational headlines have also come out zooming in on patients with gastroparesis and stomach paralysis; even though it’s scary, honestly, any drug has risks. Think about birth control for a second, it’s widely used, it revolutionized women’s health, but carries a huge list of scary side effects including blood clots and the development of certain tumors. It’s about talking to your healthcare team and weighing the risks/benefits, asking all the questions, and advocating for yourself and your needs.

Shortages and Counterfeit Drugs:

Hence my concern when I see these medical spas, online apps, and other “back-door pharmacies” prescribing the drug. These places don’t have doctors or adequate personnel to handle these side effects, monitor tolerance, and manage dosage increments appropriately.

The weight loss drug shortages have also led to many “weight loss cocktails” or counterfeit drugs being sold as semaglutide compounds, leading to serious side effects and hospitalizations. These unregulated, untested “cocktails” at times are even being sold at a lower price range, and I worry that not only could they be ineffective, but also dangerous and frankly not worth the risk. But desperation for the drug keeps driving smaller clinics and places that provide health/aesthetic services to take advantage and sell these compounds for profit.

Though compounded medicines are not FDA-approved, they are allowed to be made during official drug shortages. Now the federal agency warned against them after receiving said reports of counterfeit drugs being made and is investigating the fraudulent schemes selling “fake” semaglutide. 

---

Stay tuned for part 2 for thoughts on the Ozempic craze, things to keep in mind if Ozempic is part of your healthy journey, and some red flags to look out for.

Keep chewin’ :)