Semaglutide (Ozempic) is currently one of the most talked-about medicines on TikTok. It’s often portrayed as a miracle drug for weight loss, garnering attention not only from individuals struggling with obesity but also from those with a normal BMI, including some celebrities.
Semaglutide, a glucagon-like peptide-1 (GLP-1) agonist, was originally developed as a medication to control blood sugar in diabetes and showed an unexpected side effect during studies. Some diabetic patients experienced significant weight loss, seemingly unrelated to blood sugar control. This discovery prompted further research into the potential therapeutic benefits of semaglutide for obesity.
Numerous randomized clinical trials conducted in recent years have consistently shown that semaglutide does lead to weight loss in participants. This effect is primarily attributed to a reduction in appetite, improving control over eating habits and reducing overall energy intake.
The STEP 1 trial investigated the impact of Ozempic among individuals with a BMI of 30 or greater or a BMI of 27 or greater with weight-related coexisting conditions (such as hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease). The results revealed that the Ozempic group lost 14.9% of their weight by the end of the study, significantly higher than the placebo group, which only experienced a 2.4% weight loss. Additionally, 50.5% of the Ozempic group achieved a weight loss of 15% or more. Similar benefits were observed in adolescents with obesity (12-18 years of age) in the STEP TEENS trial.
Despite the significant benefits of Ozempic for individuals with obesity, it has some drawbacks. Firstly, weight rebound is common. The STEP 4 trial investigated whether participants continued to lose weight after discontinuing Ozempic. During the 20-week treatment period, participants lost about 10.6% of their weight. Subsequently, some participants continued Ozempic for another 48 weeks, while others stopped. As expected, those who continued Ozempic lost an additional 7.9% of weight by the end of the study. However, participants who switched to a placebo (without Ozempic) didn’t lose weight; instead, they gained 6.9%. Essentially, continuous use of Ozempic is necessary to sustain the benefits of weight loss.
Secondly, all clinical trials were conducted among individuals with obesity or overweight. It remains uncertain whether individuals with a normal BMI will experience the same benefits. Anecdotal case reports on TikTok suggest that Ozempic is effective for those with a normal BMI. However, the larger question is whether this is beneficial for overall health. This brings us to the third caveat – side effects.
According to data from clinical trials, gastrointestinal (GI) side effects, such as nausea, vomiting, and diarrhea, are prevalent, ranging from 20% to 40% in the Ozempic group. When compared to a placebo, Ozempic has a 2-5 times higher likelihood of causing these GI side effects. In addition, a recent cohort study raised concerns that glucagon-like peptide-1 (GLP-1) agonists, including Ozempic, may increase the risks of pancreatitis, bowel obstruction, and gastroparesis. More definitive data may emerge as more people begin using GLP-1 agonists.
In summary, for obese or overweight individuals, Ozempic proves to be a beneficial medication for weight control and potentially improving overall health, as long as they can tolerate the side effects and use Ozempic continuously. For individuals with a normal BMI, the benefits remain unclear. While TikTokers may attest to its efficacy, the perceived benefits may not outweigh the associated risks, especially considering the unclear long-term side effects.
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