How Did Ozempic, A Drug For Diabetics, Become A Weight Loss Sensation?

Unless you have been living under a rock, you have likely heard of or are maybe even using the “wonder’ weight loss drug Ozempic.

Ozempic (Semaglutide), a glucagon-like peptide receptor agonist, was originally used to treat Type 2 Diabetes. In March 2021, the New England Journal of Medicine published results of the STEP 1 study entitled “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” This was a double-blind, placebo-controlled study of non-diabetic patients with a BMI over 30 who were divided into two groups: placebo and weekly 2.4 mg injection of Ozempic. Both groups received lifestyle intervention instruction over the course of the study.

The results?

Participants who received Semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline than those who received placebo.

The mean change in body weight from baseline to week 68 was −14.9% in the Semaglutide group as compared with −2.4% with placebo. The change in body weight from baseline to week 68 was a loss of 34 lbs in the semaglutide group as compared with a loss of 5 lbs in the placebo group.

Participants who received Semaglutide were more likely to lose 5% or more, 10% or more, 15% or more, and 20% or more of baseline body weight at week 68 than those who received placebo.

The results pretty much speak for themselves. 86% of the study participants achieved meaningful weight loss. I would say this is kind of miraculous.

So Why All The Hype and Virtue Signaling In The Media Against Using It For Weight Loss?

Understandably, a once a week medication with a miraculous success rate for weight loss had many people interested. This interest led to reduced supplies of the drug in pharmacies. The media took the opportunity to shame those who were using the medication for a weight loss indication as “stealing” the medication from patients using it for diabetes.

But let’s take a closer look at really what’s going on here…

Many Medications Are Used “Off-Label” From Their Originally FDA Approved Indication

Not to mention, there are MANY options available for treating diabetes successfully. In fact, there are several OTHER GLP-1 receptor agonists available for the treatment of diabetes. A short list includes Mounjaro, Rybelsus, Byetta, Bydureon,Tanzeum, Trulicity, Victoza, and Adlixin to name a few. There is no reason that a diabetic patient couldn’t be prescribed another same class drug to treat diabetes should there be a shortage of one particular GLP-1 agonist.

Obesity happens to be a chronic disease and significant public health issue. It can lead to insulin resistance, hypertension, lipid disorders, cardiovascular disease, non-alcoholic fatty liver and reduced life expectancy. This is a disease that should be treated. Let us not forget the link of increased mortality from C0VID in those who were overweight.

Although lifestyle interventions are a cornerstone of weight management, past drug interventions to maintain weight loss have been minimally effective.

What About Celebrities and People Using It Who Are Not Obese, But Just Want To Shed That Extra 10 Pounds?

This is a murkier scenario. Arguably the risks of untreated diabetes are not the same as the risks of not fitting into a Size 4 pant. It might be a health care emergency in Roslyn, NY. But in reality, we are not living in an Either / Or  situation. Every individual has the right to make health care choices that are right for them. Someone looking to optimize their health should not be shamed for choosing to take advantage of an intervention that is objectively helpful. Additionally, other similar drug options are readily available if a shortage were to occur.

Enough About The Ozempic Equity Debate – Does It Lead To Excessive Lean Muscle Mass Loss?

Recently there has been a lot of hullabaloo and hoopla, as well as hoo-haa and ballyhoo about the loss of LEAN muscle mass associated with GLP-1 receptor agonists. Though a certain amount of lean muscle mass occurs during weight loss (ideally less than 25% of the total weight loss), the goal is to maintain and build lean muscle mass.

Why is this important?  Glad you asked!

Body composition is an important marker of health and longevity. Absolute weight or BMI does not give you the full picture with regard to a healthy body composition. The term “skinny fat” refers to thin-appearing people who have higher than ideal visceral fat, which is the fat that surrounds the internal organs. When visceral fat is high even in thin appearing people it is associated with higher rates of heart disease and mortality rates.

Speaking of which, I think I’m skinny fat. This can be measured. Perhaps one day I will measure this as I have a machine in my office. The bliss of being in the dark……Hellooooo Mint Chocolate Cookie Ben & Jerry’s!!

The weight loss data in clinical trials is impressive, but how does it impact your lean muscle mass? This is tricky to figure out since most weight loss trials don’t measure body composition as a study endpoint. In the study we discussed above about 140 of the nearly 2000 patients underwent DEXA scan analysis to measure body composition. Lean muscle mass loss accounted for about 39% of total weight loss. Another study of 178 patients in the SUSTAIN 8 trial studying the effect of Semaglutide in diabetics revealed a 40% loss of lean muscle mass.

So overall, in an obese population, there is a higher than ideal loss of lean muscle as part of the overall weight loss.

Is The Loss Of Lean Muscle An Even Bigger Concern For Non-Obese Patients Using Ozempic For Minor Weight Loss Benefit?

The answer is…we don’t know. The studies have not been done in this particular population. So in the absence of official research data, what is the safest option?

If You Are Using Ozempic For A 15 lb. or Less Weight Reduction, What Should You Do?

• First off, have you really tried to lose weight on your own?
• Have you optimized your nutrition and exercise protocol?
• Do you prioritize protein in your diet?
• Do you prioritize strength training as part of your exercise regimen?
• Have you addressed you sleep, stress levels and inflammation in your body?

If this has NOT been accomplished, I advise AGAINST using Ozempic for weight loss.

What If You Have Done “All The Things” and You Still Can’t Shed The Weight?

I think it is reasonable to us Ozempic as a weight loss tool if used appropriately and with these safety factors in place.

1. ESTABLISH HEALTHIER NUTRITION HABITS: Ozempic creates a loss of appetite and early feeling of fullness. It’s a great idea to use this effect to help you stick to and create healthier eating habits and to help you stay on course with a better eating style
2. CHECK YOUR BASELINE BODY COMPOSITION: Make sure you are losing more FAT than MUSCLE. What is your starting point for visceral fat, body fat and lean muscle? Check this periodically to make sure that your weight loss is not mostly muscle loss.
3. PRIORITIZE PROTEIN: Eat at least 75 grams of protein daily and more if your exercise routine demands more. It’s not easy to do on Ozempic since your taste for protein, and food in general goes down.
4. PRIORITIZE BUILDING MUSCLE: Strength training and muscle building activity is a MUST. If you are not participating in a strength training exercise, Ozempic will definitely deplete your lean muscle mass. Again, monitoring your lean muscle using a body composition device is very helpful.
5. UNLOAD THE TOXINS RELEASED FROM FAT: Make sure you are detoxing monthly. As you mobilize fat, you release stored toxins. Forced release without the proper safety net in place will lead to a whole host of symptoms like headache, aches, pains, brain fog, fatigue, gut issues and even skin rashes.
6. UP YOUR B VITAMINS: Ozempic depletes your B vitamins. Support these religiously with either B vitamin packed monthly shots or daily oral support. Check your levels to make sure you have enough on board while using Ozempic.

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For more information about my wellness programs and my practice, check out my website drsadaty.com. Hey Look!  You are already here…

Ready for the legal disclaimer? Information offered here is for educational purposes only and does not constitute medical advice. As with any health recommendations, please contact your doctor to be sure any changes you wish to consider are safe for you!