Whether from news media, social media, or word-of-mouth media, chances are you’ve heard something about Ozempic.

Perhaps you knew someone who was taking it for diabetes but then you heard celebrities were using it for weight loss. So, is it a diabetes drug? A weight-loss drug? Does it treat other health concerns, too?

These are important questions to ask. Before we dive into some of the common questions asked about Ozempic, let’s look at what Ozempic is and how Ozempic works.

Ozempic is the brand name for semaglutide, a drug approved by the FDA in 2017 for managing type 2 diabetes. Semaglutide mimics a hormone produced by the body called glucagon-like peptide-1 (GLP-1). It does this by binding to the same receptors on cells where GLP-1 connects, stimulating the same actions as GLP-1. For this reason, semaglutide and similar drugs are in a class of drugs called GLP-1 agonists.

Normally, in a healthy individual, GLP-1 is released in the gut when food is consumed. It tells the pancreas to secrete insulin, a hormone necessary for lowering the amount of sugar in the blood following a meal. It also tells the pancreas not to secrete glucagon, a hormone that has the opposite effect of insulin by raising blood sugar if it gets too low. In addition, GLP-1 increases satiety – the feeling of fullness – triggering the brain to signal that it’s time to stop eating.

As food enters the stomach, acids, enzymes, and smooth muscle contractions work to break down food into proteins, fats, and carbohydrates (sugars). Of the three macronutrients, carbohydrates break down the fastest and can move into the small intestine rapidly. This means the body must regulate both how quickly sugars enter the small intestine and the release of hormones, like insulin and glucagon, that regulate sugar in the blood.

Enter GLP-1.

GLP-1 slows down the speed at which the stomach empties its contents into the small intestine, allowing for proper digestion, absorption of nutrients, and blood sugar regulation. In addition, keeping more food in the stomach for longer maintains satiety and inhibits overeating.

For hormonal regulation of blood sugar, GLP-1 triggers insulin production, which regulates blood sugar by telling the cells of the body to bring sugar inside them where it can be used to create energy needed to fuel the body’s processes. And, as described above, GLP-1 also causes a decrease in glucagon, preventing the liver from making and releasing more sugar into the blood between meals.

Ozempic was created mainly for this reason – to help manage blood sugar in individuals with type 2 diabetes, a condition in which there is often too little insulin, cells become resistant to the action of insulin, and too much glucagon is produced. However, while using Ozempic for blood sugar management, an interesting side effect frequently occurred – patients reported weight loss, often when it had been a struggle for them to lose weight in the past – and without extreme effort.

What followed is as you might have expected. In 2021, a second, higher-dose version of semaglutide, called Wegovy, was approved by the FDA for long-term weight management. Ozempic remains FDA-approved only for type 2 diabetes, but doctors can prescribe it “off-label” for weight management. In 2022, due to a national shortage of Wegovy, some doctors began prescribing Ozempic for weight loss more frequently. In the spring of 2023, social media posts about personal experiences with Ozempic became popular and Ozempic’s notoriety soared.

Ozempic, Wegovy, and their cousin Mounjaro (tirzepatide) are important, life-saving drugs for the individuals who need them. However, as with any prescription drug, they are not without risk and should only be used with medical supervision.

Now that we’ve explored some of the science and history behind Ozempic and its colleagues in the GLP-1 agonist drug class, let’s dive into several of the top questions surrounding Ozempic’s use.

1.  What should I expect if my doctor prescribes Ozempic?

If your doctor prescribes Ozempic, you can expect to give yourself an injection of the drug once a week into your stomach, thigh, or arm. It is manufactured as an injector-pen, a device with a tiny needle that is calibrated to deliver an exact amount of medication a limited number of times. Ozempic injector-pens range from 0.25 mg to 2 mg per dose and include 4-6 doses per pen.

Individuals prescribed Ozempic will start at the lowest dose (0.25 mg weekly) for four weeks before increasing to a maintenance dose of 0.5 mg weekly for at least four weeks. For individuals who need additional blood sugar management, doses can be increased gradually to 1 or 2 mg once per week.

During the first four weeks of Ozempic use, you might not notice much change. The 0.25 mg dose is necessary to help the body get used to the medication, but it provides little therapeutic effect. In the weeks after moving up to 0.5 mg weekly, Ozempic users can expect to begin experiencing more feelings of fullness after eating and fewer food cravings due to increased satiety. Over time, blood sugar regulation, as measured by the hemoglobin A1c blood test, generally improves.

Weight loss as a side effect of Ozempic generally comes later. Each dosing increment of Ozempic must be maintained for at least four weeks before moving up to the next step up, and Wegovy, the version approved for weight loss, reaches maximum dosing at 2.4 mg, 0.4 mg higher than Ozempic.

Ozempic is best used in conjunction with lifestyle changes such as optimal nutrition, adequate exercise, proper sleep, and stress management. Some individuals might also benefit from treatment for food addiction, an often-undiagnosed medical condition.

2. Is Ozempic safe? What are Ozempic’s most common side effects?

Ozempic is generally considered safe when it is used as it was approved by the FDA – in doses up to 2 mg per week in individuals with type 2 diabetes. For individuals without type 2 diabetes, particularly those who do not have obesity, less is known about the safety of Ozempic. Therefore, it’s best to work closely with your doctor to determine if Ozempic is right for you.

The most common side effects of Ozempic (and Wegovy) are gastrointestinal-related and include nausea, vomiting, diarrhea, stomach pain, and constipation. In studies, nausea occurred most often when first starting the medication, was generally mild, and tended to go away over time. Side effects also tended to be more frequent with higher doses: those taking Wegovy for weight loss reported nausea and diarrhea more frequently than those taking Ozempic for type 2 diabetes.

Fatigue, hair loss, vivid dreams, and changes in the face have also been reported with Ozempic use. The term “Ozempic face” has been used colloquially to describe the loss of facial fullness that often accompanies semaglutide-related weight loss.

Some individuals have reported experiencing a potential downside from the slower gastric emptying and increased feelings of satiety with Ozempic – namely, a loss of pleasure and interest in food. While for some this might be a benefit, for others it might not be.  

Serious side effects of Ozempic are rare, but can include pancreatitis, gallbladder problems, low blood sugar, kidney problems, changes in vision, and serious allergic reactions. Few individuals will experience severe side effects when taking Ozempic, but they can occur.

Ozempic also can have mood-related side effects – feeling irritated, agitated, or experiencing other strong emotions, such as feeling nervous, angry, restless, violent, or scared. In the most severe instances, Ozempic can increase depression and cause suicidal thoughts or ideations. Be sure to follow up with your doctor if any new or worsening symptoms occur.

3. Does Ozempic have benefits beyond weight loss?

As mentioned previously, Ozempic is predominantly used to manage type 2 diabetes, and better blood sugar regulation is the major benefit for individuals with this disease. Because type 2 diabetes affects the entire body, Ozempic has other cardiometabolic benefits as well, including lowering the risk of heart attack, stroke, and death.

Many individuals report an absence of “food noise” – constant or recurring thoughts of food – while using Ozempic. Although hunger is a physical sensation that indicates the body’s need for fuel, food noise is the brain craving food even when the body is not hungry. Food noise can potentially trigger overeating, might be related to disordered eating patterns, and can decrease quality of life. So, for some individuals, the absence of food noise can be life changing.

It’s important to note there are also non-pharmaceutical options for learning to manage food noise.

Although weight loss is a benefit for many who take Ozempic, the body doesn’t only lose fat when it sheds pounds. Lean body mass – muscle tissue – is also lost during periods of weight loss. Bone-mineral density can decrease as well. Implementing appropriate physical activity and proper nutrition while taking Ozempic helps preserve lean body tissues. Although implementing healthy lifestyle activities is not a direct benefit of the drug, it is a benefit nonetheless.

4. What happens when you stop taking Ozempic?

You might have already guessed what happens when you stop taking Ozempic – generally the opposite of what happened when you started taking it.

Within the first few weeks, appetite returns, gastric emptying speeds up, and any related GI side effects go away. For individuals with type 2 diabetes, blood sugar may rebound and return to a similar, elevated level as before starting Ozempic.

A study of 2,000 individuals who took a 2.4-mg dose of semaglutide – the amount in the highest dose of Wegovy – showed that most participants regained two-thirds of the weight previously lost within one year of stopping semaglutide.1 Whether the weight gain was due to stopping the medication alone or a return to less healthy lifestyle choices is unclear.

Additionally, improvements to cardiometabolic health can also reverse when Ozempic is stopped. So, while you might have heard of individuals achieving weight loss with Ozempic while continuing to eat mainly unhealthy foods, consider these stories a cautionary tale. Results with Ozempic are not guaranteed, but working to develop positive lifestyle habits while taking the medication can go a long way toward helping you achieve your health goals and maintaining them long term.

5. Is there a natural alternative to Ozempic?

Despite the claims of popular social media posts, there is no natural alternative to Ozempic. Botanical extracts are being studied for their potential GLP-1-like activity, but dosing, effectiveness, and safety for their use in this way has not been fully determined. And while some nutritional supplements support balanced blood sugar, there is no 1-to-1 alternative to achieve the effects provided by Ozempic.

In general, nutritional supplementation is helpful for bridging gaps in the diet, supporting exercise programs, and helping the body adapt to stress. So, you might find nutritional supplements to be a beneficial part of your daily routine. Be sure to check with your doctor about any supplements you are thinking about taking while using Ozempic. 

If you’re interested in exploring options for weight loss, blood sugar management, or health testing, then check out Thorne’s Find a Health Professional Directory to locate a health-care practitioner near you. The following Thorne resources can also help you on your weight-loss and overall health and wellness journey:

References

  1. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab 2022;24(8):1553-1564. doi:10.1111/dom.14725