The Cost of Weight Loss with Ozempic

Ozempic and similar drugs are touted as miracle cures for obesity. What if they aren’t?

By Diyya Ganju

The newest trend in popular wellness culture is Novo Nordisk’s weight-loss injection Ozempic. This drug has risen to new heights of popularity, evident from stories of friends who lost miracle amounts of weight, celebrities sighted with the infamous “Ozempic face,” and rumors of a drug shortage. A darker reality exists behind its promise of easy weight loss.

There are significant, often overlooked consequences tied to the use of Ozempic and similar drugs. The medication’s misuse for non-medical weight loss has led to shortages that jeopardize care for diabetic patients who depend on it. Long-term health effects have also not been fully researched yet. As such, GLP-1 agonists, such as Ozempic, should not be prescribed for weight loss in those without diagnosed obesity due to severe gastrointestinal side effects, impacts of shortages for diabetes patients, and the lack of long-term efficacy. 

Ozempic belongs to a class of drugs known as Glucagon-like peptide-1 receptor agonist drugs. These GLP-1 drugs are designed to mimic a hormone of the same name stimulates the pancreas to release insulin and suppresses glucagon, the liver hormone that releases glucose into the bloodstream. Increased levels of insulin slow digestion, which leads to reduced food intake/appetite, often resulting in weight loss.

The first GLP-1 drug for diabetes treatment, Victoza, containing the drug liraglutide, received FDA approval in 2010. Patients with Type 2 diabetes benefit greatly from these GLP-1 drugs. The maintenance of a healthy insulin and glucagon balance is key to help controlling blood sugar levels, which those with diabetes cannot do naturally. Researchers noticed side effects such as reduced appetite and weight loss in clinical trials, which led to further research of using GLP-1 drugs for weight management purposes. This further research was so monumental that it eventually won researchers Lotte Bierre Knudsen and Richard DiMarchi the 2023 Mani. L Bhaumik Breakthrough of the Year Award for their revolutionary discovery. 

Today’s GLP-1 drugs such as semaglutide have been improved to contain a chemical structure that makes it easier for the drug to reach brain areas involved in food regulation. These potent drugs are extremely popular. Between 2021 and 2022 alone, prescriptions increased by 259%. About 25% of these prescriptions were written for weight management, not for the original GLP-1 purpose of treating diabetes.

“Slow gut motility – yes that’s how it works,” says Professor Heather Whitley, Clinical Professor in the Department of Pharmacy Practice at Auburn University Harrison School of Pharmacy. “It works by making your body feel full faster. It presents the food you eat at a slower rate to your small intestine,” she adds. 

More users, more side effects

To many, these GLP-1 drugs seem like a miracle. Something as simple as a daily injection could finally help to shed that beer gut just in time for summer. More and more negatives of their use are coming to light, however, as their popularity grows. 

For example, researchers reported that the use of GLP-1 drugs was associated with an increased risk of gastrointestinal adverse events, such as pancreatitis and bowel obstruction, in an October 2023 study published in the Journal of the American Medical Association. Celebrities such as Chelsea Handler and Sharon Osbourne have spoken publicly about starting GLP-1 drugs for weight loss but stopping them due to gastrointestinal side effects such as nausea and stomach pain. 

In more extreme cases, patients can experience gastroparesis, in which the stomach’s ability to empty its contents into the small intestine is impaired. Patients with gastroparesis struggle with malnutrition, weight loss, nausea, and vomiting, all due to their inability to properly digest food. The condition can significantly impact daily living, leading to frequent hospitalizations and ongoing medical care. There is no cure for gastroparesis. Some patients may experience a return to normal after stopping GLP-1 drugs, while others are afflicted with this condition for life.

Researchers reported an elevated risk of gastroparesis in a May 2024 study for the Digestive Disease Week Conference. Researchers found that people taking GLP-1 drugs were 66% more likely to be diagnosed with gastroparesis than those who were not. Patients on GLP-1 drugs experienced gastroparesis at a rate of 0.53%. This proportion may seem small, but it amounts to nearly 750 out of 150,000 patients.

Depriving those in most need

The FDA has had several GLP-1 drugs on a shortage list since 2022, which only recently ended in the fall of 2024. Over-prescription of these drugs for weight loss means that diabetes patients who rely on their prescriptions for crucial blood sugar regulation suffer. Diabetics forced to go without their medication can experience complications, such as kidney and eye issues, due to uncontrolled blood sugar levels. 

A report published in the July 2024 issue of Diabetes Research and Clinical Practice highlights the consequences of GLP-1 shortages on diabetes management. The study tracked the outcomes of 811 patients throughout the shortage. Researchers documented a significant average increase of 0.3% in Hemoglobin A1C levels in this cohort, a critical marker for long-term blood glucose control. This change emphasizes the importance of these medications for maintaining diabetes stability and preventing complications. Clinics face increased challenges in managing disease severity, potentially increasing risks for complications, without consistent access to GLP-1 therapies.

“When we have these shortages, my gosh, it is such a challenge,” says Professor Whitley. “There are so many months I’ve had appointments where patients come in to see me and we spend it re-working their therapeutic regimen for diabetes”. 

The shortage has sparked ethical concerns over the use of GLP-1 drugs. These medications are a critical tool for managing diabetes, but their widespread prescription for weight loss has diverted supply away from diabetic patients. This raises questions about the prioritization of aesthetic or lifestyle goals over life-sustaining medical needs, exposing systemic flaws in how medications are allocated.

The misuse of GLP-1 therapies as a weight loss tool highlights broader issues of equity and healthcare ethics. It underscores the need for policies ensuring that patients with the greatest medical necessity are given priority access. The practice of overprescribing these drugs for non-critical use greatly affects diabetic populations who rely on them for survival. This ethical imbalance calls for stricter guidelines and education around the responsible use of life-altering medications.

Very little information is available on the long-term side effects and efficacy of GLP-1 drugs due, in part, to their recent boom in popularity. The little information we do have does not suggest favorable results. 

Unknown long-term consequences

A study on the optimal use of GLP-1 drugs, published in October 2024 in the Journal of the American Medical Association, details concerns with long-term use for weight management. Researchers discuss growing concern about the tapering or withdrawal, also known as “off-ramping”, of GLP-1 drugs after treatment and suggest exploring alternative evidence-based strategies to maintain weight loss. 

Tapering or “off-ramping” involves gradually reducing or withdrawing the use of these drugs after the treatment period while new strategies are introduced to maintain weight loss. This process can be problematic because many patients experience significant weight regain after discontinuing their GLP-1 drugs, undermining the long-term benefits of the treatment. The lack of clear, evidence-based guidelines for transitioning off these medications adds to the challenge, as it remains uncertain how to maintain the metabolic and weight-control benefits they provide without ongoing use.

“People need some kind of help, but does everybody need a full obesity dose in the case of semaglutide? For their whole life, forever and ever? Or is there a world in which some people, depending on their obesity phenotype, can do other things or be on some form of weight maintenance regimen,” says Dr. Jennifer Manne-Gohler, an adult infectious disease physician at Massachusetts General Hospital and the Brigham and Women’s Hospital and the senior author on the paper. 

“The alternatives—think about other classes of anti-obesity medications—are being used for obesity management but don’t have the same impressive impact,” she adds. 

Many patients find that the severe side effects of GLP-1 drugs are not worth the potential for weight loss. Stopping the drugs to reduce side effects may end up negating their whole experience, especially if they regain back the weight they lost. GLP-1 drugs may not be the miracle that many believe in if it lacks the potential for long-term sustainable weight loss.

Some experts argue that GLP-1 drugs could be prescribed for obesity without causing catastrophic shortages for diabetes patients. A 2023 NIH Special Report outlines potential strategies for treating patients affected by shortages of GLP-1 drugs. Researchers describe strategic approaches such as prioritizing patients with critical medical needs, promoting alternative therapies, and ramping up production capacity. Additional policy recommendations include ensuring fair distribution, leveraging government support to regulate pricing, and incentivizing manufacturers to expand supply. Yet, there is no room to include patients using GLP-1 for quick weight-loss without harming those who are medically dependent, even with these measures. 

Ozempic and similar GLP-1 drug misuse presents serious consequences despite offering promising benefits for weight loss and diabetes management. The medication’s over-prescription for non-medical purposes exacerbates drug shortages, harming diabetic patients who rely on it for survival. Additionally, the severe side effects and unknown long-term health impacts highlight the risks of using these drugs for superficial outcomes. Restricting their use to individuals with genuine medical need is essential to safeguarding public health, ensuring equitable access, and preserving their intended therapeutic value.