By: Kinga Balogh, Registered Dietitian, Reviewed & Edited by JM Nutrition Team

In this post:

• History of Ozempic

• Why is Ozempic so popular?

• Its effects on various organs

• Pros and cons of Ozempic

• Final verdict on the pros and cons of Ozempic use

In recent months, an increasing number of our clients have sought the opinion of our registered dietitians about the pros and cons of Ozempic use. And, unless you’re an extraterrestrial, it is safe to assume you no doubt have heard of the newfangled blockbuster Medication. After all, Hollywood celebrities, social media influencers and even the billionaire, Elon Musk, have widely promoted and endorsed the product to help get rid of unwanted weight.

So are they all onto something? To help answer this question we’ll take a deeper dive into the pros and cons of Ozempic.

A bit of history about Semaglutide/Ozempic

A new medication under the brand name of Ozempic and generic name of semaglutide is gaining huge popularity in Canada and beyond. Novo Nordisc, the manufacturer of this injectable drug, has released the medication for the management of Type 2 Diabetes back in 2018. In recent years medical professionals have prescribed it for off-label use given the large demand for weight-loss solutions.

In 2021, Health Canada approved Wegovy, technically a semaglutide, to be used at higher dosages for weight-loss support. By 2022, Wegovy also received approval to be used in adolescents 12 and older. This injectable is not yet available in Canada due to unprecedented demand.

Unsurprisingly, in early 2023, Weight Watchers partnered with a telehealth provider to offer clients access to weight-loss drugs, such as Ozempic and Wegovy, in conjunction with lifestyle management.

With ads popping up on TV, social media, giant billboards, sport games and virtually every surface devoted to marketing, Canadians may feel bombarded with the omnipotent and omnipresent Ozempic craze. For this reason we felt compelled to address the topic in some detail by analyzing the pros and cons of Ozempic use. So here it goes. 

What makes Ozempic 2023’s buzziest drug?

The answer to the question requires us to gain more appreciation and understanding around the hormone’s action in our body.

Semaglutide belongs to a class of medications called GLP-1 (glucagon-like peptide 1). This is a hormone that our body naturally makes in our digestive system in response to Food consumption. Our pancreas, intestines and brain have receptors to receive the hormone. The organs mentioned play a role in weight loss. Hence the use of semaglutide extends to obesity management.

Semaglutide is administered through a weekly injection in the abdomen. It also acts very similarly to the GLP-1 hormone our body makes.

Semaglutide has different effects on various organs:

Pancreas

In the pancreas it affects insulin production and optimizes blood sugar levels. This class of medication was actually approved by Health Canada in 2018 for the management of blood sugars for folks impacted by Type 2 DM.

Digestive system

The digestive system is affected as well.

When in our digestive system, Ozempic curbs appetite by slowing down the passage of food in the stomach, making us feel full for longer.

Brain

Our brain is also sensitive to semaglutide. Here, it modulates hunger levels, satisfaction and impacts the reward value certain foods demonstrate during our eating experiences.

Furthermore, it is believed it alters food reward systems and can change taste preferences. We know from brain scan studies that peoples’ brains light up markedly from rewarding foods. These include foods such as high-fat, high-salt and/or high-sugar options.

What’s more, it is well established that people following diets or self-imposing dietary restrictions are particularly sensitive to high-reward foods (usually high in sugar, fat and/or salt), often reporting challenges with portion control.

Moreover, client testimonials from those taking weekly Ozempic shots reveal changes in food preferences, beginning to favour healthier and more wholesome foods over more processed options.

Impressive results from taking a once-weekly injectable medication, right?

Metabolic rate

In addition, some evidence suggests that semaglutide impacts one’s metabolic rate. That is, it increases the breakdown of fat stores for energy thereby contributing to weight loss.

Related: Metabolism 101

Liver

Lastly, Ozempic discourages the liver to release stored sugar into our bloodstream for energy production, thereby keeping our sugar levels more optimal.

Consequently, the combined effect on the organs mentioned above tends to orchestrate a multitude of changes in the body, contributing to weight regulation as suggested by our current understanding of GLP-1 based on research studies.

As mentioned, our body does make GLP-1 in our intestine, a hormone 94% similar to semaglutide, yet it is believed that folks living in larger bodies may produce less and can potentially benefit from a boost through this medication, typically administered weekly in a variety of dosages as prescribed by a medical professional.

Pros of Ozempic Use

There exist a number of benefits or pros of Ozempic use. Let’s examine these. 

1. Documented weight loss

Weight loss is certainly one of the pros of Ozempic use.

A review of recent publications in the medical literature offers promising results, when it comes to observing weight loss results in people enrolled in studies lasting anywhere from 12 weeks to  2 years.

A study published in the Journal of Diabetes, Obesity and Metabolism in 2017, confirms that study participants receiving a weekly injection of semaglutide for 12-weeks reported lower total caloric intake, appetite suppression, less hunger and fewer food cravings. They also reported lower preference for high-fat foods and experienced an average of 5 kg or 11-pound weight loss in three months.

Another study, the STEP-3 Clinical Trial, published in 2021 in the Journal of the American Medical Association also supports benefits of Ozempic with weight loss efforts. Participants living in larger bodies receiving once-weekly injections of semaglutide, in addition to intensive behavioral therapy and initial low-calorie diet, achieved a cumulative weight loss of 10-15% of their total body weight during the 68 weeks of being in the study.

Moreover, the STEP-5 Trial, published in 2022 showed a 15.2 % average weight change for participants on semaglutide, while enrolled in a study for two-years.

Note

It’s also important to note that both studies demonstrate a plateau-effect around the one-year mark. This is a phenomenon typical of weight loss studies where participants notice no additional weight change.

Equally worthwhile to acknowledge is that most studies are funded by pharmacological companies producing the medication being investigated. This certainly raises the risk of conflict of interest and transparency. As such, it’s important to keep in mind. 

2. Effects on appetite and beyond

Ozempic also affects appetite. As a result, many consider this to be one of the pros of Ozempic use.

People who diet actively often complain of hunger pain, craving items forbidden on their meal plans and finding it challenging to stay within portion-controlled meals.

In a study, published by Dr. Blundell et al., they set out to observe how taking Ozempic impacts food preferences and intake when in comes to clients living in larger bodies. The findings are quite encouraging. That is, participants showed a decrease in food intake by 24% even though they were not offered portion-control meals. They also felt less hungry, had fewer food cravings and demonstrated lower preference for high-fat and more energy-dense foods.

One thing to consider, however, is that due to the action of this medication, most people have a harder time tolerating fatty foods. They also experience notable nausea.

Is it then partially the resulting nausea discouraging dieters to shy away from energy-dense foods?

Arguably, Ozempic contributes to food aversions which then force drug users rely on smaller, lighter, and more simple meals in the end, rendering this one of the pros of Ozempic.

3. Another tools of weight management

Another one of Ozempic pros is that it may help with weight management.

The weight loss and diet industry continue to have an insatiable appetite for diet plans and lifestyle regimens. Medications, too, are used to offer a variety of solutions in their war on obesity.

Aside from invasive and often irreversible procedures, such as bariatric surgery, many people are looking for novel approaches with less risk and more efficacy. Ozempic fits in this area. 

Cons of Ozempic Use

It’s no doubt important to carefully evaluate possible risks and side-effects when going on a medication to make a fully informed decision. So is the case when deciding if Ozempic is right for you or a loved one. At this stage the pros and cons of Ozempic use should be analyzed in some detail. And risks or cons of Ozempic use certainly exist.

1. Side effects

What are some common side effects of Ozempic use?

According to the manufacturer’s website, Novo Nordisk, side effects exist. The most common side effects include nausea, diarrhea, vomiting, decreased appetite, headaches, respiratory tract infections and constipation. Surely, these are all significant Ozempic cons. 

In general, healthcare providers start patients off on a low dosage and titrate up amounts gradually to help prevent and manage side-effects.

It’s also noteworthy that digestive side effects are the most common. This occurs because semaglutide slows down the passage of food through digestive system, decreases acid production and increases mucous in the bowels as well.

When it comes to gut health, more digestive health experts warn that this could have negative implications. The longer food lingers in the stomach, the more nausea. The longer waste from food breakdown stays in the digestive tract, the higher likelihood of toxic waste reabsorption into the bloodstream.

Related: Gut Health Basics

How common are the side effects of Ozempic use?

Although serious side effects are rare, one needs to factor the potential risks when considering going on the medication. This applies to all medications, ot just Ozempic.

It is worthwhile to note, that the medication has been on the Canadian market for about five years, thereby limiting the availability of long-term research findings that monitor the development of complications. This factor alone is worthy of serious consideration. 

Furthermore, serious side effects can include inflammation of the pancreas, changes in vision, low blood sugar values, kidney and gallbladder problems, serious allergic reactions, thyroid cancer, stomach paralysis and suicidal behaviours. These are undoubtedly serious risks or cons of Ozempic use. As such, the decision to take medication of this nature should not be taken lightly.

Further investigation into Ozempic

Additionally, Health Canada is currently doing further investigation on the possible impact of semaglutide on mental health, following suit with the European Medicines Agency. Looking at the risk of suicidal thoughts, self-harm and suicide is key priority, as we know receptors in the brain are impacted by this injectable medication.

Related: Mental health nutrition support

Lastly, Ozempic is contraindicated for pregnant and breastfeeding moms, people affected by diabetic retinopathy (an eye disease that may arise as a complication of diabetes). It is also contraindicated for those affected diseases that impact the liver, pancreas, kidneys or the thyroid gland.

In summary, decisions around taking Ozempic, should not be taken lightly as considerable cons of Ozempic use are clearly evident. 

Related: Pregnancy dietitian

Recommendation

Doctors can prescribe Wegovy for patients with a BMI of 30 or higher or those at a BMI of 27 with obesity-related complications, including sleep apnea, high blood pressure, or blood sugar abnormalities. The onus is also on the prescribers to discuss the safety (including lack of long-term safety data), efficacy, cost and the implications once coming off the medication, particularly as it pertains to weight regain.

In 2021, FDA approved Wegovy, as a treatment for obesity in people aged 12 or older. It is well-known that school aged children are bullied for many reasons. Body size being a prime candidate. Providing this medication with lack of long-term safety data to children, whose bodies are still developing raises further alarms worth attending to. 

2. Cost

When analyzing the pros and cons of Ozempic use, we simply cannot overlook the cost factor.

Ozempic was developed for blood sugar management, targeting people living with diabetes. Doctors prescribing Ozempic for weight loss are opting for off-label use. Private insurance companies do not cover the medication for weight management at present. As a result, the cost of Ozempic ranges depending on the prescribed dosage and tends to come in at a hefty price.

3. Ethical debate over accessibility to Ozempic

Accessibility is one of the cons of Ozempic.

As the popularity of this class of medication increased, and off-label use took off, shortages became a sad reality. Semaglutide was originally developed for people affected by diabetes. Creating shortages of a life-sustaining medication for the primary audience of this drug raises the issue of fair accessibility. 

Pharmacists have been advised to give out only one-month worth of supplies to patients, to avoid stockpiling the drug and allow for equal access. Should people with diabetes be prioritized over people seeking relief from excess weight?

Aggressive marketing campaigns are to be partly blamed for shortages in pharmacies. Kerry Bowman, a bioethicist at the University of Toronto, said that the marketing is “disturbing”. Even though pharmaceutical companies stay within marketing parameters set out by Canadian law, the “saturation of the ads is incredible”.

Hence, this begs the question if technically obeying marketing laws, yet not acting in the spirit of them is moral. He feels the campaigns are not about public health and well-being, but more so fuelled by pharmaceutical profit hunger.

4. Beyond the hype: weight regain after coming off Ozempic

No Ozempic pros and cons list will be complete without analyzing what happens after you come off the drug.

According to the Journal of Diabetes, Obesity and Metabolism, published in April of 2022, one year after withdrawal from once-weekly semaglutide administration, participants regained two-thirds of their prior weight loss and their health gains reversed. Accordingly, they only experienced a temporary improvement in blood pressure, blood sugar and cholesterol values while on the medication.

This result, unfortunately, is in line with most weight management studies. What the weight loss industry does not want prospective clients to know is that over 90% of people who intentionally lose weight regain the lost weight. What’s more, two-thirds of those will ultimately regain more weight than they originally lost.

Obesity Canada, the leading authority in obesity research and clinical practice guideline development, also states that 80% of people regain the weight they initially lost within 5 years of achieving intentional weight loss.

Such abysmal findings certainly discourage patients and healthcare professionals looking for weight management solutions. Medications such as Ozempic offer a light of hope, yet enthusiasm over the efficacy of this medication needs caution.

As described, weight rebounding is the norm for most people attempting weight loss. Stopping the administration of a hormone that helps with appetite regulation and food intake will have similar effects.

People considering this medication need to be made aware of the prospects of being on the drug long-term if they are hoping for weight maintenance. This is certainly a con of Ozempic use that needs to be taken into account.

5. Perpetuating diet culture

Furthermore, Ozempic use has permeated various strata of the society.

Rumour has it that many Hollywood stars are on Ozempic to achieve the relentless thin idea perpetuated by today’s appearance focused society.

Continuing to drive down acceptable body weight “targets” sets the stage for more unachievable and unsustainable goals. As many people struggle with body dissatisfaction, treating weight loss as a form of self-actualization certainly adds fuels the insidious nature of diet culture. As a result, this could create the perfect breeding ground for more disordered eating. 

Isn’t it time to work more proactively towards weight stigma prevention and body size diversity acceptance?

Could it be that the weight loss industry has overpromised, yet underdelivered?

Tough questions to ponder, certainly. But pondered they should be. 

Final verdict on the pros and cons of Ozempic use

Undoubtedly, there is more to the picture here than just an analysis of the pros and cons of Ozempic use. The matter is fraught with many layers.

As a health professional and registered dietitian, I have worked in the traditional weight-loss paradigm for over ten years, assisting patients with lifestyle modification to achieve weight loss. I certainly understand that in our appearance focused society, the pressure to conform to weight norms is palpable and the possibility of relying on a drug to help achieve weight loss is desirable to many.

I have also seen weight bias in medical establishments, societal weight-based discrimination and personal hurdles impacting physical and mental health in my patients.

It is then my goal to weigh in on this topic to the best of my current knowledge and understanding of the literature and clinical experience, and respecting people’s autonomy to chose to care for themselves in ways that resonate wholeheartedly with their values and beliefs. That includes decisions around weight managements strategies, inclusive of medication use.

What is required

What we may fail to acknowledge is that weight management requires a biopsychosocial and more holistic approach. Frequently, patients have disordered eating patterns, rely on food to cope with mental health issues, experience food insecurity or gain weight secondary to limitations in physical movement, due to a medication side effect or medical condition impacting their body’s ability to metabolize foods effectively.

What’s more, 70-80% of our body weight is determined by genetics. Just as one is not tempted to change the size of their feet, one’s body weight is also not as amenable to change as the diet, fitness and pharmacological industry wants us to believe.

Our body is hard wired to bring us back to our set weight range. A multitude of mechanisms are activated during times of food deprivation. In essence, at a weight-suppressed stage, our body increases energy conservation by holding on to food and decreases energy expenditure or calories burned. Therefore, once caloric restrictions are lifted, our body will gradually return us to a weight maintained prior to intentional weight loss attempts.

Same old tool with new packaging?

Being on Ozempic in essence is no different from engaging in any other traditional weight management strategy. Once one parts ways from the drug and/or diet, body weight regain typically is inevitable.

In working with people affected by chronic diseases, such as diabetes, I also noticed going on medications often leads to attributing less significance to the fundamental value of health promoting behaviours, that prove effective even in the absence of weight loss.

Additionally, some studies that describe significant weight loss with semaglutide involved participants receiving intensive behavioural therapy (for example 30 counselling sessions over 68 weeks). Patients who are prescribed this expensive medication will rarely be offered such robust care or have finances to invest in nutritional therapy and/or counselling offered by a dietitian and/or mental health professional. 

Related: Diabetes dietitian

Band-aide solution versus holistic care?

As with most weight loss strategies (including gastric banding, bariatric surgery, traditional weight management programs or pharmacological therapy geared to weight management), clinicians may miss addressing the person holistically.

Weight regain is the norm with most interventions. Dishearteningly, studies show that people who can maintain weight loss longer may engage in higher levels of disordered eating. They may even go on to develop full blown eating disorders, such as anorexia, bulimia or binge eating disorders.

Alarmingly, many clients who seek weight management solutions have preexisting disordered eating or full-blown eating disorders. Their symptoms often go unacknowledged in traditional weight managements clinics.

Accordingly, this begs the question whether we should shift our focus from weight management to weight-neutral health promotion. When you discuss weight loss goals, you tend to increase weight stigma. Consequently, this can lead to poorer health outcomes. Frequently, clients avoid routine medical exams for fear of being reprimanded for living in a larger body.

It’s important to focus on health promoting behaviours instead. These include mindful eating, increased physical activity, optimized sleep, cultivation meaningful social relationships, and addressing chronic stress. All of these promote health, which is of paramount importance after all.

Furthermore, it’s vital to encourage self-esteem, body acceptance and normalization of body size diversity as it tends to promote better self-care and well-being in patients. Isn’t it time to focus on health, not weight?

Ozempic Pros and Cons Conclusion

In the end, we hope that through the analysis of the pros and cons of Ozempic use, we shed some important light on the matter that will guide you to making an informed decision. That is, of course, should you consider taking the medication. 

Should you require personalized nutritional care with dietitian Kinga Balogh, or another practitioner, book a free consultation or contact us for an appointment.

References and Resources

Anti-Diet: Why Obsessing over What You Eat is Bad for Your Health: Reclaim Your Time, Money, Well-Being,and Happiness through Intuitive Eating. Christy Harrison, MPH, RD. (2019).

Eat What You Love, Love What You Eat: A Mindful Eating Program to Break Your Eat-Repent-Repeat Cycle. Michelle May, MD. (2013).

Reclaiming Body Trust: A Path to Healing and Liberation. byHilary Kinavey, MS, LPC, and Dana Sturtevant, MS, RD (2022).

The Body Image Workbook: An Eight-Step Program for Learning to Like Your Looks by Thomas F. Cash, Ph.D.

The Intuitive Eating Workbook: 10 Principles for Nourishing a Healthy Relationship with Food. Evelyn Tribole and Elyse Resch (2017). 

Vancouver Coastal Health: The Focus is on Health, Not Weight

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Kinga Balogh is a registered dietitian specializing in disordered eating. She is a weight-neutral HAES dietitian, combining dietetics and coaching strategies to enable clients achieve fulfilling lives. She also works with clients to help them make peace with food and their bodies. In addition, she works towards achieving self-liberation from unrealistic body ideals and develop body acceptance.

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JM Nutrition is a nutritional counselling service by registered dietitians and nutritionists in Ontario and Nova Scotia. Main office: dietitian and nutritionist Toronto.

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