The Food and Drug Administration (FDA) approved the medication Ozempic in 2017 to control blood sugar (glucose) for people with type 2 diabetes. But it made headlines this year because celebrities and social media influencers were using it for weight loss, causing a shortage of the medicine for those who really needed it.
Andrea Coviello, MD, medical director of the UNC Health Medical Weight Program, answers five common questions about this drug that has skyrocketed in popularity for casual weight loss.
1. What is Ozempic?
Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist drug known generically as semaglutide. It is a weekly injectable medication for people with type 2 diabetes that lowers blood sugar levels by helping the pancreas make more insulin.
“GLP-1 stimulates the pancreas to produce insulin to help use sugar to fuel your body,” Dr. Coviello says.
These medicines also regulate appetite by mimicking the hormones produced in the intestine and the colon that are produced in response to eating.
“GLP-1 alters how fast you digest your food from the stomach through the gut—slowing that a little bit—and it increases satiety after you’ve eaten to make sure that you feel full and stop eating at the end of a meal,” Dr. Coviello says.
When using Ozempic to treat diabetes, most people experience weight loss.
2. Should I use Ozempic for weight loss if I don’t have diabetes?
Ozempic was approved for use in people with type 2 diabetes. In 2021, however, the FDA approved the same drug semaglutide with a slightly higher maximum dose of the active ingredient in Ozempic to treat obesity under the brand name Wegovy.
“Ozempic and Wegovy are the same compound, semaglutide, which is Ozempic-approved for diabetes and Wegovy-approved for weight loss,” Dr. Coviello says. “Semaglutide is a synthetic version of the natural gut hormone GLP-1, and they have the same physiologic effects, which are both good for sugar metabolism and good for weight loss because of satiety.”
Ozempic and Wegovy are made by the same company. The two medicines were approved under two names because the FDA required separate applications. If you use these medications, it’s important to continue to make lifestyle changes to help your weight loss, such as eating a healthy diet and exercising.
Also, your body may get used to these medications after you take them for a while. This can cause your weight to plateau.
“If you stop taking them, you probably will gain back some or even all of the weight you lost,” Dr. Coviello says.
3. What are alternatives to Ozempic?
In 2022, the FDA approved the medicine Mounjaro (generic name tirzepatide), another injectable medication to treat type 2 diabetes. Just as Wegovy followed Ozempic, the FDA approved Zepbound in November 2023, a new drug for weight management by the maker of Mounjaro that also contains the compound tirzepatide.
In addition to GLP-1, tirzepatide targets glucose-dependent insulinotropic polypeptide (GIP), a hormone that stimulates the release of insulin.
“You make GIP naturally as well. Like GLP-1, GIP is a gut hormone produced in the intestines after you eat,” Dr. Coviello says. “So tirzepatide has the activity of both of those gut hormones, and it’s more effective for weight loss.”
According to a study in the New England Journal of Medicine, people with obesity who used tirzepatide in a clinical trial lost more than 20 percent of their weight.
“With the foundation of lifestyle management, these drugs can be very successful,” Dr. Coviello says.
Be careful when taking other medications that claim to be off-brand versions of semaglutide or tirzepatide, which have been found at compounding pharmacies across the United States.
“We have seen some very negative side effects from taking off-brand drugs from compounding pharmacies with allergic-type reactions. Since neither drug is available generically, it is not clear what is in the compounded versions. They could put you at risk and may or may not have any beneficial effect in terms of blood sugar control or weight loss,” Dr. Coviello says. “At present, the safety of obtaining these types of medications from compounding pharmacies is not clear as it is not clear what they actually contain. It’s not recommended at this time due to safety concerns.”
4. What are the side effects of Ozempic?
The most common side effects of Ozempic and similar medications are nausea and diarrhea, and sometimes vomiting and constipation.
“Some of the side effects we see are related to the fact that you have gone from this hormone that naturally breaks down and is gone an hour after you eat to something that lasts all week,” Dr. Coviello says. “It slows gut motility [movement], not just for that time frame after you ate and you’re digesting, but all week long. Some of the satiety or bloating effects you get are because that’s how the natural hormone works, but you now have a version of that natural hormone that hangs around a lot longer.”
In other words, because digestion is slowed, you have more food sitting in your stomach for a longer time.
“That’s why some people feel mild nausea and more commonly have constipation,” Dr. Coviello says. “It tends to go away as you adjust to the medicine and go slowly up on the dose over time (months).”
5. What are other treatments for obesity?
Obesity is a chronic medical disease, and the goal of treatment is not about achieving a certain size. It’s about health. There is no magic pill that will cure obesity, but even modest weight loss can improve or prevent the health problems associated with obesity. A healthier diet, increased physical activity and modified behavior can help you lose weight.
If you need to lose more than 10 percent of body fat, lifestyle changes alone might not be enough. Prescription weight-loss drugs with compounds such as semaglutide and tirzepatide may help you feel less hungry or full longer and decrease your appetite.
While promising, these anti-obesity medications can be expensive without insurance, and if you do not meet the FDA’s criteria to take them, you may have trouble getting your insurance to cover the cost.
If you have a body mass index (BMI) of 35 to 39.9 and a history of obesity-related conditions such as high blood pressure, type 2 diabetes, infertility, high cholesterol or sleep apnea, or a BMI of at least 40 regardless of any obesity-related diseases, you might be a candidate for weight-loss surgery, according to guidelines set by the National Institutes of Health.
If you’re concerned about your weight, talk to your doctor or contact the UNC Health Medical Weight Program. Need a doctor? Find one near you.