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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 dangerous the negative effects really are. We additionally cowl implications of the treatment scarcity and concerns for these with a historical past of an consuming dysfunction or disordered consuming. image with white bottle and various medications with text that says "5 things you should know about Ozempic (from an RD)"Set off warning: discussions of weight reduction numbers, consuming dysfunction behaviors

Ozempic and different weight reduction medicines like Wegovy, Mounjaro, Trulicity and Rybelsus are a scorching subject proper now.

Celebrities are publicly attributing their weight reduction to those medicines (Oprah being the newest one as I’m scripting this). Docs are prescribing them left and proper for weight reduction (and another ailment you may carry to the physician that they assume is correlated to your weight). Sufferers with diabetes (for whom these medicines 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 in consequence.

From information headlines to TV ads to water cooler discuss, Ozempic is all over the place. As a non-diet, weight-inclusive dietitian, I wish to ensure that I’m empowering my purchasers and my group with all of the evidence-based data now we have (and spotlight what we don’t have) as a way to make an knowledgeable choice on whether or not or to not take these medicines. It’s not my position to influence you (as a result of I imagine in your company and physique autonomy) however it’s my position 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 medicines. It might make sense if you happen to select to take them or are fascinated about taking them given the anti-fat tradition we stay in and the strain from medical suppliers to “do one thing about your well being, aka your weight.”

So I compiled what I’ve realized about these medicines on this put up and am highlighting what the analysis exhibits us on weight reduction (how a lot weight you’re really prone to lose – trace: it’s not as a lot as you may assume), what the identified negative effects are, and why you have to be cautious about the place you’re accessing these meds from.

What’s GLP-1?

These weight reduction medicines fall into a category of medicines referred to 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 larger doses of semaglutide. 

As soon as Wegovy grew to become FDA-approved for weight reduction, it rapidly 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 rapidly adopted go well with.

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 probably the most and may have severe well being ramifications for these with diabetes.

Semaglutide continues to be in scarcity as of scripting this weblog put up in December 2023.

How do GLP-1 agonists assist these with diabetes?

In people with diabetes, incretin’s results are lowered (by about 30%), which ends up in larger 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 medicines will help decrease A1c ranges by 1 – 2.4 proportion factors and may cut back the danger of cardiac occasions, no matter weight modifications.

5 issues it is best to learn about Ozempic and Wegovy (and different GLP-1 agonists)

1. You might or could not shed pounds with Ozempic and when you cease taking it, you’ll seemingly achieve the burden proper again.

Not everybody loses weight taking these medicines, which is necessary to notice, in any other case individuals who don’t shed 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 trying solely on the STEP trials, outcomes present that 80% of individuals taking these medicines lose some quantity of weight. So about 20% of parents who take these meds received’t lose any weight. For individuals who do shed pounds, on the very least, they’re dropping about 5% of their physique weight (that’s about 10 lbs for somebody who weighs 200 lbs).

Roughly half of the parents 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 parents 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 in fact what’s driving all of the hype and media protection on these medicines.

However let’s take into account that these trials weren’t solely funded by the maker of the medicines but additionally had plenty of exclusion standards. Individuals couldn’t be 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 and not using a extremely efficient contraception technique, simply to say a number of.

If you take a look at different trials on semaglutide, with out the pharma funding and intensive exclusion standards, the outcomes are much less spectacular. Solely 40% of parents are dropping at the least 5% of physique weight. Taking a look at a meta-analysis (evaluate) of RCTs, most weight reduction totals hovered round a median of 8-10 lbs, with a number of research displaying extra vital weight reduction, round 25-40 lbs.

In case your objective is to lose about 5-10% of your physique weight then these medicines may provide help to get there however if you’re in search of extra dramatic weight reduction, these meds in all probability received’t provide help to meet your objectives. 

It’s additionally necessary to acknowledge what occurs if you cease taking the medicines. As a result of possibly your insurance coverage will cease masking it, or you possibly can not afford it, or there’s a scarcity, and many others.

Research have checked out what occurs if you take somebody off semaglutide and change it with a placebo and located that weight regain occurs in a short time. Inside a 12 months, folks regain nearly all of their weight misplaced, even whereas nonetheless doing behavioral interventions like vitamin, train, and cooking lessons.

Sounds similar to all of the analysis on what occurs to your weight when you cease doing a weight-reduction plan (you achieve it again).

Graphic with quote: "Studies have looked at what happens when you take someone off Ozempic (semaglutide) and replace it with a placebo and found that weight regain happens very quickly. Within a year, people regain almost all of their weight lost, even while still doing behavioral interventions like nutrition, exercise, and cooking classes."

2. Ozempic comes with very disagreeable negative effects.

Research present {that a} vary of 60% as much as 93% of individuals taking these medicines will expertise some negative effects – the commonest being gastrointestinal misery. These negative effects could embody nausea, vomiting, diarrhea, constipation, GERD, and belly ache. For most individuals, extreme GI signs ought to resolve inside a number of days and extra gentle GI negative effects often resolve inside 8-12 weeks.

These medicines additionally include a black field warning that they’ll improve the danger of thyroid tumors. That is primarily based purely on research performed 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 medicines are contraindicated for these with a household historical past of thyroid tumors. 

There are different very uncommon negative effects like pancreatitis, gallbladder illness, kidney harm, and suicidal ideation. The FDA additionally lately added ileus to the listing of negative effects on the label, which is when your bowel stops functioning and you’ll’t take away waste – it could solely be handled with surgical procedure and may be deadly.

After which there’s the aesthetic reported facet impact persons are speaking about, “Ozempic face”. Because of fast weight reduction (for some) and certain not getting satisfactory vitamin, folks report having free pores and skin on their face and a hollowing underneath the eyes and close to the temples. This look can also 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 accredited or regulated.

When a drug goes on the FDA drug scarcity listing, 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’ll produce it till 2032 so compounding pharmacies don’t have entry to this energetic ingredient. 

So these pharmacies are promoting treatment and calling it semaglutide however it’s actually one thing else. It is likely to be a watered down model of it or it is likely to be one thing referred to as semaglutide sodium or acetate, the salt types of semaglutide, which haven’t been proven to be secure or efficient in people, or it is likely to be one thing else all collectively.

If you wish to take a weight reduction treatment, get a prescription out of your physician and safe it from a licensed pharmacy. Keep far-off from wellness facilities, spas, or telehealth suppliers touting these medicines at a low value.

4. There’s no long-term information on Ozempic.

Let’s not neglect that now we have NO long run information on these medication. Semaglutide was accredited by the FDA for diabetes remedy in 2017 and the longest examine I discovered was follow-up with a bit over two years. We simply don’t know if there are any long-term negative effects. We additionally don’t know if you happen to preserve your weight reduction if 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 information and had been finally taken off the market due to irreversible severe adversarial negative effects like deadly hypertension, coronary heart valve issues, coronary heart assault, stroke, and dying.

It’s necessary to weigh this when deciding to take the treatment – you merely can’t know what the security 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 may be harmful for these with a historical past of an consuming dysfunction or disordered consuming.

This treatment finally 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 gasoline already restrictive consuming patterns, and result in potential nutrient deficiencies.

Graphic with quote: "Ozempic ultimately puts you out of touch with your body's natural hunger and fullness cues, which is counterproductive to eating disorder recovery and the intuitive eating framework. It causes you to eat less, which can exacerbate and fuel already restrictive eating patterns, and lead to potential nutrient deficiencies."

For these with binge consuming dysfunction or who wrestle with episodes of binging, coming off the treatment may end up in vital upswings in starvation, which can make you extra vulnerable to binges.

After which there’s the influence of weight modifications in your psychological well being. In case you don’t shed pounds taking the treatment, chances are you’ll go to extremes to limit your meals consumption. Or reducing weight could set off you to wish to lose much more, fueling extra restriction. Or if you happen to lose vital weight after which achieve all of it again when you come off the treatment, that change in physique look could trigger emotional misery and result in disordered consuming.

In the identical means I wouldn’t advocate a weight-reduction plan or intentional weight reduction to people with an energetic consuming dysfunction, a historical past of an consuming dysfunction, or disordered consuming, I wouldn’t advocate these weight reduction medicines both. It reinforces the concept skinny is greatest and leads to insufficient nourishment and vitamin.

If you’re struggling to get satisfactory vitamin whereas taking one in all these medicines or are debating on taking one in all these medicines and would love extra individualized vitamin help, our crew would love that will help you. Ebook a vitamin evaluation immediately.

References:

https://www.fda.gov/medication/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss

https://pubmed.ncbi.nlm.nih.gov/32441473/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840940/#:~:textual content=Semaglutidepercent202.4percent20mgpercent20ispercent20to,greaterpercent2Cpercent20receivedpercent20FDApercent20approvalpercent20in

https://pubmed.ncbi.nlm.nih.gov/33567185/

https://maintenancephase.buzzsprout.com/1411126/13747346-ozempic

Consuming Problems & Diabetes: A Give attention to Diabetes Drugs Webinar by Erin Phillips, MPH, RD, CDCES; hosted by EDRD Professional

For extra weblog posts like this try:

The way to Set Sustainable Well being Objectives For the New 12 months that Are Really Sustainable

Am I Consuming Sufficient? 8 Indicators You’re Undereating 

Is Intuitive Fasting Actually Intuitive or Is It Simply One other Food plan?

What Is Orthorexia? When Wholesome Consuming Turns into Obsessive

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