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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 really is and simply how unhealthy the unintended effects really are. We additionally cowl implications of the treatment 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 matter proper now.
Celebrities are publicly attributing their weight reduction to those drugs (Oprah being the newest one as I’m penning this). Medical doctors are prescribing them left and proper for weight reduction (and some other ailment you would possibly deliver to the physician that they assume 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 be sure that I’m empowering my shoppers and my group with all of the evidence-based info now we have (and spotlight what we don’t have) in an effort 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 imagine in your company and physique autonomy) however it’s my function to coach and inform, which I hope to do right here.
I’d by no means, ever disgrace or choose somebody who decides to take these drugs. It might make sense when you select to take them or are enthusiastic about taking them given the anti-fat tradition we reside in and the stress from medical suppliers to “do one thing about your well being, aka your weight.”
So I compiled what I’ve realized about these drugs on this put up and am highlighting what the analysis reveals us on weight reduction (how a lot weight you’re really more likely to lose – trace: it’s not as a lot as you would possibly assume), what the recognized unintended effects are, and why you need 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 known as GLP-1 agonists. GLP-1 is glucagon-like peptide, also referred to as 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 treatment is now getting used to regulate urge for food and produce weight reduction.
What’s semaglutide?
Semaglutide is the generic identify for the energetic ingredient in Ozempic and Wegovy. Ozempic and Wegovy are simply the model names. Ozempic is FDA-approved for the remedy of diabetes, and in 2021, Wegovy grew to become FDA-approved for the remedy of weight reduction. Each are basically the identical treatment solely Wegovy has greater doses of semaglutide.
As soon as Wegovy grew to become FDA-approved for weight reduction, it shortly went into scarcity after which medical doctors started prescribing Ozempic off-label (that means prescribing it for one thing aside from what it’s FDA-approved for) for weight reduction. After which Ozempic shortages shortly adopted swimsuit.
The issue with that is Ozempic and different GLP-1 and GIP agonists FDA-approved for diabetes remedy aren’t attending to the individuals who want them essentially the most and might have critical well being ramifications for these with diabetes.
Semaglutide remains to be in scarcity as of penning this weblog put up in December 2023.
How do GLP-1 agonists assist these with diabetes?
In of us with diabetes, incretin’s results are lowered (by about 30%), which results in greater 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 may help decrease A1c ranges by 1 – 2.4 proportion factors and might scale back the danger of cardiac occasions, no matter weight modifications.
5 issues it’s best to learn about Ozempic and Wegovy (and different GLP-1 agonists)
1. You might or might not drop some pounds with Ozempic and when you cease taking it, you’ll seemingly achieve the load proper again.
Not everybody loses weight taking these drugs, which is essential to notice, in any other case individuals who don’t drop some 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 wanting solely on the STEP trials, outcomes present that 80% of individuals taking these drugs lose some quantity of weight. So about 20% of oldsters who take these meds received’t lose any weight. For many who do drop some pounds, on the very least, they’re shedding about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).
Roughly half of the oldsters who took this treatment noticed a extra reasonable weight reduction, about 10-15% of physique weight (about 20-30 lbs for somebody weighing 200 lbs) and roughly one third of oldsters taking this treatment 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 after all 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 whole lot of exclusion standards. Folks 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 number of.
Once you take a look at different trials on semaglutide, with out the pharma funding and in depth exclusion standards, the outcomes are much less spectacular. Solely 40% of oldsters are shedding at the very least 5% of physique weight. a meta-analysis (assessment) of RCTs, most weight reduction totals hovered round a mean of 8-10 lbs, with a number of research displaying extra important weight reduction, round 25-40 lbs.
In case your objective is to lose about 5-10% of your physique weight then these drugs would possibly make it easier to get there however if you’re on the lookout for extra dramatic weight reduction, these meds most likely received’t make it easier to meet your targets.
It’s additionally essential to acknowledge what occurs whenever you cease taking the drugs. As a result of perhaps your insurance coverage will cease masking it, or you possibly can now not afford it, or there’s a scarcity, and so on.
Research have checked out what occurs whenever you take somebody off semaglutide and exchange it with a placebo and located that weight regain occurs in a short time. Inside a yr, folks regain virtually all of their weight misplaced, even whereas nonetheless doing behavioral interventions like diet, train, and cooking lessons.
Sounds similar to all of the analysis on what occurs to your weight when you cease doing a food plan (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 commonest being gastrointestinal misery. These unintended effects might embody nausea, vomiting, diarrhea, constipation, GERD, and stomach ache. For most individuals, extreme GI signs ought to resolve inside a number 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 improve the danger of thyroid tumors. That is based mostly purely on research accomplished in rodents so we don’t know the way that extrapolates to people, but. There are human research being carried out now however we received’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 damage, and suicidal ideation. The FDA additionally just lately added ileus to the record of unintended effects on the label, which is when your bowel stops functioning and you’ll’t take away waste – it will probably solely be handled with surgical procedure and will be deadly.
After which there’s the aesthetic reported aspect impact individuals are speaking about, “Ozempic face”. Because of speedy weight reduction (for some) and sure not getting ample diet, folks report having free pores and skin on their face and a hollowing underneath the eyes and close to the temples. This look can 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 record, 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 energetic ingredient.
If you wish to take a weight reduction treatment, 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 value.
4. There’s no long-term knowledge on Ozempic.
Let’s not neglect that now we have NO long run knowledge on these medication. Semaglutide was accepted by the FDA for diabetes remedy in 2017 and the longest research 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 when you preserve your weight reduction whenever you keep on this drug long-term.
It’s an eerily comparable 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 knowledge and had been ultimately taken off the market due to irreversible critical adversarial unintended effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and dying.
It’s essential to weigh this when deciding to take the treatment – you merely can’t know what the protection 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 will be harmful for these with a historical past of an consuming dysfunction or disordered consuming.
This treatment in the end places you out of contact along 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 may exacerbate and gas already restrictive consuming patterns, and result in potential nutrient deficiencies.
For these with binge consuming dysfunction or who battle with episodes of binging, coming off the treatment may end up in important upswings in starvation, which can make you extra prone to binges.
After which there’s the affect of weight modifications in your psychological well being. If you happen to don’t drop some pounds taking the treatment, chances are you’ll go to extremes to limit your meals consumption. Or shedding pounds might set off you to wish to lose much more, fueling extra restriction. Or when you lose important weight after which achieve all of it again when you come off the treatment, that change in physique look might trigger emotional misery and result in disordered consuming.
In the identical manner I wouldn’t suggest a food plan or intentional weight reduction to of us with an energetic 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 that skinny is finest and ends in insufficient nourishment and diet.
In case you are struggling to get ample diet whereas taking one in every of these drugs or are debating on taking one in every of these drugs and would love extra individualized diet help, our crew would love that will help you. E-book a diet evaluation as we speak.
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 Concentrate on Diabetes Drugs Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional
For extra weblog posts like this take a look at:
How one can Set Sustainable Well being Objectives For the New Yr that Are Truly Sustainable
Am I Consuming Sufficient? 8 Indicators You’re Undereating
Is Intuitive Fasting Actually Intuitive or Is It Simply One other Eating regimen?
What Is Orthorexia? When Wholesome Consuming Turns into Obsessive
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