Using Ozempic for weight loss: The good, the bad and the ugly

As more South Africans turn to medical interventions for weight loss, Semaglutide – originally developed as a treatment for type 2 diabetes (T2D) under the brand name Ozempic® – has gained rapid recognition. But is this so-called wonder drug effective and, more importantly, is it safe for those without diabetes?

Dr Marius Wasserfall, a specialist physician at Mediclinic, says medications like Semaglutide can be valuable adjuncts to lifestyle changes like diet and exercise.

“These medications are not a silver bullet,” he notes, “but they can help patients battling obesity make real progress when combined with healthy habits.”

Obesity is a growing concern worldwide, with predictions indicating that by 2030, half of the world’s population will be overweight or obese. In South Africa, this figure has already been reached, with over 50% of adults classified as overweight or obese.

Weight loss requires lifestyle changes, not only medication

“The challenge with obesity is complex. It involves not just willpower, but changes in the brain’s appetite regulation and metabolic processes that make long-term weight loss difficult,” says Wasserfall.

“Semaglutide works by addressing this challenge at the root. It affects hunger and satiety hormones in the brain, helping people feel fuller for longer and reducing their appetite.”

Semaglutide, which belongs to a class of drugs called Glucagon-like peptide-1 (GLP-1) receptor agonists, was only officially approved for treating T2D in 2017. During clinical trials, however, a secondary effect became apparent – patients were experiencing significant weight loss.

This discovery has led to Semaglutide being prescribed off-label for weight management, although it is not approved by the South African Health Products Regulatory Authority (Sahpra) for this purpose. It remains a scheduled product and can only be sold by a pharmacy with a valid prescription from a doctor.

In 2021, the US Food and Drug Administration (FDA) approved a higher dose of Semaglutide, marketed as Wegovy®, specifically for chronic weight management in individuals with obesity or related health conditions. Since then, demand for Semaglutide has skyrocketed, driven by glowing celebrity endorsements and widespread attention on social media platforms.

The risks of using Ozempic and similar products for weight loss

While studies show that Semaglutide users may experience up to 15% weight loss, experts warn of potential risks when it is used without medical supervision or for non-approved purposes.

“Side effects can include nausea, vomiting, and diarrhoea, and long-term safety for non-diabetic users remains unclear,” warns Wasserfall.

“While serious adverse effects are seldom seen, they include acute pancreas inflammation and gallbladder problems. Some studies involving rodents found that this medication resulted in medullary cancer of the thyroid.”

Additionally, there are growing concerns about counterfeit Semaglutide entering the market. “The high demand for the drug, especially for its off-label use, has exceeded forecasts and created opportunities for illegal manufacturers to supply counterfeit products,” says Wasserfall.

“When you purchase from an unlicensed manufacturer, there’s no quality assurance. The product may not contain the active ingredient or, worse, it may include harmful substances.”

The FDA and Sahpra have warned about the dangers of counterfeit versions of these medications.

Sustainability of using Semaglutide for weight loss

Despite its effectiveness, there are also concerns about the long-term sustainability of weight loss achieved through Semaglutide.

Wasserfall emphasises that it is a lifelong treatment: “Stopping the medication will likely result in the majority of the weight being regained.” Studies back this up, showing that patients tend to regain most of their weight after discontinuing Semaglutide or similar GLP-1 receptor agonists.

The reason for this lies in how these medications work. Semaglutide improves the brain’s appetite regulation and alters the body’s biology. However, Wasserfall points out that ‘once you stop using it, your brain biology reverts to its previous state, and you will likely regain the weight’.

Wasserfall says that affordability is, therefore, a major factor. “These medications are expensive, and many medical schemes will not cover them for weight management, only for diabetes.”

This makes it essential for individuals considering Semaglutide or similar drugs to weigh the costs carefully and recognise the commitment required to maintain results.

Availability of medication to diabetic patients strained

“Availability is another concern,” he adds. As demand grows among those seeking weight loss, shortages of the drug are making it difficult for diabetics, who rely on Semaglutide to manage their condition, to access the medication. This has led to calls for caution and more stringent regulations to ensure the drug remains accessible to those who need it most.

Semaglutide’s popularity as a quick-fix weight loss solution highlights a broader societal issue – the pressure to conform to ideal body standards. Healthcare professionals stress that any weight-loss treatment should be approached with caution and always in consultation with a medical professional. Medications like Semaglutide are just one piece of the puzzle and weight management remains a multi-faceted issue that requires long-term lifestyle changes to achieve and maintain results.

While GLP-1 receptor agonists show promising results for weight loss, Wasserfall believes that the focus should shift to prevention.

“We need to prioritise preventing obesity, especially in our youth, to reduce our reliance on costly, lifelong medications like Semaglutide. Encouraging healthy habits is crucial. Ultimately, it comes down to this: You’ll face either the pain of self-discipline or the pain of regret – the choice is yours,” he says.