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What Is Ozempic and Why Is It Getting So Much Attention?

www.nytimes.com | Dani Blum, Mon Jul 24 2023

More people are turning to a diabetes medication to induce weight loss — but experts say it’s not a miracle drug.


Ozempic, a drug used to treat diabetes, keeps gaining attention as celebrities, a tech mogul and TikTok influencers have described taking it to lose weight in short time frames.
The Food and Drug Administration first approved the injectable medication for treating diabetes in 2017; the agency approved a drug with a higher dose of the active ingredient in Ozempic, called semaglutide, to treat obesity in 2021, under the brand name Wegovy. Since then, talk of the drug has popped up across the internet. Elon Musk, when asked about how he looked “fit, ripped and healthy,” tweeted that he was taking Wegovy. Andy Cohen posted about Ozempic’s growing popularity. In September, Variety reported that actors and producers “are quietly singing the drug’s praises” on Signal, an encrypted messaging app. On TikTok, the hashtag #Ozempic has been viewed over 273 million times, with people alternately expressing shock over their supposed medication-induced weight loss and swapping stories about side effects. Thousands of people in Britain will soon be able to access Wegovy as well.
She worries that, as the drug becomes increasingly popular, people will associate it with “vanity,” not as a critical medication for diabetes patients.

Ozempic and Wegovy are not the only medications gaining popularity for their weight loss effects. Demand is mounting for Mounjaro, a diabetes medication, as Eli Lilly, the company that manufactures it, touts dramatic weight loss results for people with obesity and diabetes in trials using tirzepatide, the active ingredient in Mounjaro. Other drugs that use a similar mechanism to Wegovy and Ozempic are being developed.

It’s not unusual for doctors to prescribe medications for “off-label” use, or for a different purpose from what the medication is explicitly intended for, said Dr. Disha Narang, an endocrinologist at Northwestern Medicine Lake Forest Hospital. As interest in Ozempic has increased, some doctors believe that more people have sought ways to take the drug for weight loss — either by finding a physician who will prescribe it to them off-label, or by seeking the drug out online. Dr. Narang herself has seen patients “who have somehow gotten their hands on this,” taking the medication off-label, she said. (Dr. Narang previously served on an advisory panel for Novo Nordisk, a common practice for experts in the field.)

Here’s what we know about what the medication can, and can’t, do, and who should take it.

How does Ozempic work?

Ozempic and Wegovy are both designed to be injected once a week in the stomach, thigh or arm.

Semaglutide lowers blood sugar levels and regulates insulin, which is crucial for people with Type 2 diabetes. The drug also imitates a hormone called glucagon-like peptide-1 that we naturally produce in our intestines, limiting appetite by signaling to our bodies that we feel full and prompting our stomachs to empty more slowly. As a result, people with obesity and accompanying health concerns have lost weight while taking it. People feel fuller faster, said Dr. Janice Jin Hwang, chief of the division of endocrinology and metabolism at the University of North Carolina School of Medicine. For patients taking the medication, “foods that used to be really exciting to them are no longer exciting,” she said. Some people report that their “food noise,” or ruminations about food, disappear after taking drugs like Ozempic. The medication has not been significantly studied in people without diabetes or excess weight.

The medication can also reduce the risk of cardiovascular disease for people with diabetes, said Dr. Robert Gabbay, chief scientific and medical officer of the American Diabetes Association.

The F.D.A. has not approved Ozempic for weight loss, noted Dr. Andrew Kraftson, a clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine. But after the F.D.A. authorized Wegovy for weight loss, there was such demand for the drug that some providers turned to Ozempic when they couldn’t get Wegovy, he explained.

Just as some people are prescribed medications to treat high blood pressure or high cholesterol indefinitely, some patients with obesity may be prescribed medications like Wegovy for a continuous period of time, Dr. Kraftson said. Those who discontinue taking the medication may regain weight lost while on Wegovy, he added.

“These drugs were not designed for normal-weight people who want to get down to be super thin,” Dr. Hwang said.

Who is supposed to take Ozempic and Wegovy?

After the F.D.A. approved Ozempic for people with Type 2 diabetes, the agency approved Wegovy for adults with obesity or excess weight with at least one “weight-related condition,” which the agency considers to be issues like high blood pressure, Type 2 diabetes or high cholesterol. The F.D.A. defines obesity and overweight using the Body Mass Index, an entrenched but widely debated metric.

The medication is expensive without insurance — the list price for Wegovy is over $1,300 for a 28-day supply, and Ozempic can cost around $892 for a monthly supply without insurance — and people who don’t meet the F.D.A.'s criteria will likely have trouble getting insurance to cover it.

Despite those obstacles, the rise in people using Ozempic off-label may be exacerbating the shortage, Dr. Narang said, noting that patients with diabetes and obesity are struggling to access it.

“It’s been really, really terrible — patients don’t know where to turn,” she said. “We’ve been like hamsters in a wheel trying to figure this out.”

“While we recognize that some health care providers may be prescribing Ozempic for patients whose goal is to lose weight, it is up to the clinical discretion of each health care provider to choose the best treatment approach for their patients,” a representative from Novo Nordisk wrote in a statement, adding that the company does not “promote, suggest or encourage off-label use of our medications.”

What are the side effects?

People taking Ozempic and Wegovy for both F.D.A. approved and off-label use may experience nausea and dehydration. They might also feel fatigue and malaise. Their bowel movements might change, with some patients having diarrhea and others becoming severely constipated. “It can be so bad that people go to the E.R.,” Dr. Kraftson said. “It’s no joke.” Patients should be monitored while taking these drugs, he said, and doctors may prescribe anti-nausea medications and laxatives or stool softeners. In rare cases, the medication could increase the risk of pancreatitis, a painful condition that inflames the pancreas. Some patients might also form gallstones. Dr. Gabbay said he had seen some patients with such severe vomiting that they had to stop taking the medication. There is also a risk that, in extreme instances, patients could become malnourished because of how little nutrients they are able to consume.

Doctors typically start patients on a lower dose of medications like Ozempic and Wegovy and then gradually build up, to minimize these side effects, Dr. Gabbay said.

Is off-label use of these medications dangerous?

Doctors say there isn’t enough evidence to know whether these drugs might be beneficial or dangerous for people who fall outside of the F.D.A.’s criteria. As tempting as the prospect of a drug for weight loss may be, experts cautioned against people seeking out the medication for off-label use. People who take Ozempic and Wegovy should be closely monitored, Dr. Kraftson said. “If you’re just getting this online, there’s not going to be the same layers of protection,” he said. “I don’t want to see people playing roulette with their health.”

The drug has not been systematically tested in people with lower body weights, Dr. Hwang said, and it’s possible that patients outside of the group the drug is intended for could experience more intense side effects. Without more research, it’s unclear just how damaging those side effects could be.

“Marching into the unknown is associated with some potential risk,” Dr. Gabbay said. “And we don’t know what that is.”

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