The Shot (And I’m Not Talking About Vaccines)
You have likely heard of a drug called Ozempic by now. It is also known as semaglutide and is sometimes called “the weight loss shot”. Ozempic and “its siblings” Wegovy and Mounjaro are in a drug class called glucagon-like peptide-1 receptor agonists (GLP-1 RA). GLP-1 is a natural hormone that plays a role in glucose metabolism and insulin secretion. These drugs mimic that hormone and basically stimulate insulin, inhibit glucagon, and slow gastric emptying (which makes you feel full longer).
Ozempic is quite the controversy. Approved for use in type 2 diabetes since 2017, it is praised for its efficacy in blood sugar control, cardiovascular benefits, and weight loss – all three of which it does well. In fact, there has been such an impact of weight loss by the drug that in 2021, the pharmaceutical company who makes Ozempic, came out with Wegovy (marketed more for weight loss). However, Ozempic itself is still very much prescribed “off label” (which just means it is not the approved indication by the FDA) for weight loss. Prescribing “off label” is not the issue as this is done with many medications to the benefit of many conditions. So, what is all the talk about? Could this be the miracle drug so many people want to believe it is for a chronic disease that is becoming or is at the point of being called an epidemic? Many healthcare providers believe that it is, but I should warn you, likely just as many healthcare providers believe it is not. Let’s get into it…
Ozempic is a once weekly injectable medication that improves insulin sensitivity, blood sugar control, and weight loss. Originally indicated for type 2 diabetes, it is also largely used for weight loss. Those opposed to the drug argue that research has shown reversal of type 2 diabetes and obesity with lifestyle modification and behavior change and given the potential side effects and risks, its benefits do not outweigh its risks except for in very specific cases.
As recent as August 2023, the results of a research trial called “The Select Trial” were reported by the drug’s manufacturer. This was a 5-year study that showed promising results in regular weekly dosages of Ozempic and Wegovy reducing the risk of heart attack or stroke in obese or overweight individuals with cardiovascular disease by 20%. However, you should also know that although the cardiovascular health improvements are promising, they are not straightforward. The study even states that the cause for the results is unclear. In other words, the study isn’t saying the drug is directly causing these cardiovascular improvements. It is causing weight loss, and I would argue along with many others that that is most likely the cause of the improved cardiovascular and other clinical markers such as Hemoglobin A1C, liver function tests, cholesterol, triglycerides, etc.
One out of every ten Americans has Diabetes. The obesity rate in the U.S. is at 43% and teenage obesity is at 22%! Type 2 diabetes, heart disease and other chronic conditions are rising fast so weight loss as well as reduction in diabetes is critical. Chronic disease is bankrupting our healthcare system and our nation. So, what is the solution to the obesity crisis? Is it a GLP-1 RA?
As far as cost goes, the cost of Ozempic to the government alone is in the billions. One study in the New England Journal of Medicine (NEJM) found that if just obese Medicare patients were all put on Ozempic, the annual cost would be $267 billion to the U.S. government. That is something the drug manufacturer is lobbying for right now.
The side effects of Ozempic are mostly gastrointestinal and include nausea, vomiting, diarrhea, and stomach pain although can include retinal disorders, fatigue and headaches. However, there are many more very serious side effects to be aware of including: gastroparesis, bowel obstruction, necrotizing pancreatitis, acute kidney injury and even death. Almost all drugs come with potential serious side effects though so what is the big deal? These adverse effects are significant and post marketing reports are showing more and more of them. One in 10 people have serious adverse effects from these medications.
As healthcare providers we look at the risk to benefit ratio when deciding on treatment. In other words, do the benefits outweigh the risks? Not only are the potential adverse effects pretty significant with this drug, but the long-term effects are also simply just not understood enough at this point. The longest study on this drug prior to its FDA approval was only about 68 weeks. So, post marketing reports are continuing to come out and that is where we are seeing a lot of the problems. In a study of over 4,000 patients published in the Journal of the American Medical Association (JAMA), there was a 367% increase in stomach paralysis, the risk for pancreatitis went up by 900%, and bowel obstruction went up by 422%.
In addition to this, we are seeing that at least 40% of the weight loss from this drug is muscle. Muscle is what takes up most of the glucose and keeps your metabolism going. Therefore, when people stop the medication, most of the weight is re-gained, especially given that you don’t have as much muscle to handle your metabolic needs. This is a drug that you are intended to be on for life! FOR LIFE!
How did we get here? How has obesity tripled in the last 60 years from roughly 13 – 43% of the population? Spoiler alert, it’s the toxic food system for the most part and this drug, in most cases is not the answer to fixing the root cause of our metabolic dysfunction.
My stance on this medication is this: I cannot tell you if you should or should not take this drug if you have type 2 diabetes. There are certainly cases where it would be validated – for the right patient and for the right reasons. What I can tell you is to know the facts and all the risks and to have a thorough discussion with your healthcare provider to discuss your health status, potential risks, and benefits for you, and to make an informed decision together. If you do choose to use this medication, you need to discuss with your provider a plan to get off this medicine and when that will be. I would also tell you that it is important that you understand that the proper lifestyle changes such as eating whole nutrient dense foods, getting moderate exercise, and making sure you have quality sleep is the answer to healthy and effective weight loss as well as reversing type 2 diabetes. Get off ultra processed foods, increase your protein, fiber, and healthy fats. Whether you take these shots or not, if you are facing type 2 diabetes or obesity, you can’t afford to not change your lifestyle and behaviors. If you are interested in learning more about changing your lifestyle one step at a time to reduce your risk of chronic disease, follow me on Instagram and subscribe for free at the bottom of any of my website pages (thehealthandwellnessnp.com) to receive weekly blog posts and exciting upcoming news and information. Together, let’s transform your health!