All About Ozempic
Also: What an endocrinologist really thinks about the drug.
I’m switching up my newsletter this month and keeping it to a single theme: Ozempic (and similar meds). While this topic already receives tons of airtime, it seems to conjure endless interest.
I’m also working with more and more clients who use these medications and their experiences have been varied, to say the least.
Keep reading for recent coverage of the phenomenon, as well as a Q&A with my friend and colleague Dr. Nina Sundaram, a rockstar endocrinologist based in NYC, and one woman’s personal experience on these drugs.
But first, a few disclaimers.
This is a no judgement zone. You get to decide what you do with your body, always.
A friendly reminder that: You can have a ‘normal’ BMI and be unhealthy; a ‘normal’ BMI and be healthy; an ‘obese’ BMI and be healthy; and an ‘obese’ BMI and be unhealthy. These are not mutually exclusive categories.
I also want to acknowledge that I don’t personally know what it’s like to struggle with my weight. I’m naturally very petite and haven’t faced discrimination for my body size nor have I spent decades of my life trying to shrinking it. It feels important to note that.
And if you’re new here (which a lot of you are — welcome!), I promise my newsletters aren’t always this lengthy :)
The Basics
Give me 2 seconds of background info.
GLP1 receptor agonists belong to a class of drugs that was originally created for the management of diabetes. The medications mimic hormones that stimulate the production of insulin in the body.
Over the last few years, the injectables have increasingly been prescribed for weight loss, including among people without diabetes.
How do they work for weight loss again?
Drugs like Ozempic likely lead to weight loss via multiple mechanisms, including improving insulin sensitivity and slowing down gastric emptying. Not surprisingly, the longer it takes for food to leave your stomach, the less hungry you tend to feel!
These meds also seem to act on areas of the brain that are responsible for regulating appetite and cravings. That’s one reason why many people report hearing significantly less ‘food noise’ when using them. Food noise essentially refers to obsessive thoughts about food. (Here’s an article I contributed to on the topic.)
While outcomes vary, the average amount of weight lost on these medications is estimated to be around 15% of one’s bodyweight, though this is subject to change depending on the medication, dosage, duration of usage, and one’s body size.
What are the risks and how legit are they?
Medically speaking these drugs are contraindicated in people with a personal of family history of certain types of thyroid cancer. They’re also not recommended for those with pancreatitis or anyone who is pregnant or breastfeeding.
The most common side effects include GI disturbances like nausea, vomiting, constipation, diarrhea, and reflux. For many people, these side effects eventually subside. For some, they remain (or become) debilitating.
Other potential risks include dangerously low blood sugar levels, kidney and gallbladder issues, allergic reactions, and vision changes, though these aren’t common.
The drugs can also result in a loss of lean muscle mass along with fat mass. This is concerning, as less lean body mass can —> less strength, more frailty, and a sluggish metabolism over time.
There have to be some pros though, right?
For sure.
A large 2022 study reported that overweight and obese patients without diabetes who had preexisting cardiovascular disease had a 20% lower risk of death from cardiovascular causes, nonfatal heart attack, and nonfatal stroke when taking semaglutide (the active ingredient in Ozempic and Wegovy) compared to a placebo. Whether that outcome was solely due to the weight loss induced by the drug or other mechanisms is TBD. (Also, the study was funded by Novo Nordisk, the maker of Ozempic, but we’ll still take these impressive results.)
The meds have also been shown to improve blood sugar and blood pressure control in people diagnosed with diabetes. That’s no small deal given that nearly 50% of American adults have either diabetes or prediabetes.
Anecdotally, the meds also seem to help some users markedly reduce their alcohol intake. Experts believe the drugs could eventually play a role in treating addictions thanks to their powerful effects on brain chemistry.
Is that all?
I’d be remiss if I didn’t mention the psychological effects of these meds, both positive and negative.
On the one hand, these drugs can be life changing for people who have spent so much of their mental energy trying to control their food and body, oftentimes for decades. I’ve had clients tell me that the medication provided a reprieve from a lifetime of preoccupation with their next meal.
Of course, there’s a darker side to this too.
The current Ozempic craze is undeniably perpetuating thin ideals and, in some cases, fueling disordered eating or flat out eating disorders.
So you’re anti?
Actually, no. I’m not wholeheartedly against these medications — even if they’re prescribed solely for weight loss. I think there can be a time and place for their use and I don’t discount the positive effects they can have, both medically and psychologically, for many people.
And yet. It has become increasingly common for these drugs to be misused. In my opinion, Ozempic is not the answer for someone who is metabolically healthy but looking to drop 15 pounds. It just isn’t.
Ozempic-Adjacent News, Thoughts + Facts
'What happens when you’ve been on Ozempic for 20 years?’ A science reporter shares his concerns about the many unknowns.
The problem with ‘atypical anorexia.’ In case you’re unfamiliar, atypical anorexia is the diagnostic label for anyone with anorexia nervosa who is not clinically underweight. The term is downright maddening given that fewer than 6% of eating disorder patients are actually underweight. This harrowing article from 2022 doesn’t discuss weight loss meds, but it’s a poignant window into how the very same eating disorder behaviors that might admit an underweight patient to the hospital can be celebrated in eating disorder patients in larger bodies.
The next innovations for preventing muscle loss in those on Ozempic? More drugs! (Jokes aside, if you’re interested in learning more about how to eat to prevent muscle loss, don’t miss my recent feature in
’s wonderful newsletter all about the importance of protein.)Quick question: If you stopped taking a statin or an antidepressant, would you expect it to continue working? Probably not. So why are so many people expecting the effects of weight loss injectables to be any different? I assume it circles back to the fallacy that willpower is the primary determinant of bodyweight. Le sigh.
I asked an endocrinologist: What do you really think about this Ozempic era?
I chatted with my friend and colleague Dr. Nina Sundaram of Aura Endocrinology about all things Ozempic (and Wegovy and Zepbound and Mounjaro). Dr. Sundaram is also board certified in obesity medicine, so she knows a thing or two (million) about the drugs and has seen firsthand how they’ve impacted her patients.
Here are edited excerpts from our conversation:
(Anthea) I know you’ve been prescribing these medications for some time now. I’m curious how your approach to using them has shifted over the years.
(Dr. Sundaram) I’ve been prescribing these since 2017, so I feel like I’ve had time to see the nuances and pros and cons of this class of medications.
I initially thought they were going to help people become more internally resourced. Sustainable weight loss is really about eating the right foods at the right times and in the right amounts, exercising or moving every day, and managing your sleep, stress, and alcohol. I thought these medications could be a stepping stone that would help people master these things.
But that’s not what you’re seeing?
I think they can be used in positive ways but what I find troubling is when people use these meds as a treatment for body image disorders or to further promote restrictive eating patterns. Often the medication allows people to continue to restrict their food intake and they get great short term results – but they don’t last.
As we both know, restriction doesn’t work long term. So what happens eventually? After, say, six years on these meds, they’re less effective.
When you say the results don’t last, do you mean you’re seeing people gain all of the weight back or…?
Yes, either their effects start to wane or people lose considerable muscle mass from the weight loss and then there are negative consequences from that.
I’ve also seen patients stop tolerating the medications. Some people are on one of these meds for five years and then all of a sudden they start to experience severe GI side effects and have to stop using it.
Interesting. So how are you approaching prescribing meds like Ozempic with your patients now?
What I try to do now is have foundational conversations early on, making sure my patients are hitting their macros, doing regular resistance training, and minimizing alcohol.
I’m also trying to only use low doses so that the medication is the smallest tool in their toolbox. If restriction is our only tool, it’s not going to be sustainable.
And I’m highlighting the logistical issues. The cost/coverage/availability changes all the time for these meds. If someone is suddenly no longer able to get the medication, it can be extremely dysregulating. Not only does it put them in an even more anxious headspace around their weight and health, but it makes them feel like they have no ‘control’ over their body anymore.
What’s one thing you wish more people understood about meds like Ozempic?
They’re definitely not a spot treatment. People ask me if they can take one temporarily to lose 10 pounds and it just doesn’t work that way.
Also, people using them often say to me, ‘I never think about food anymore,’ or, ‘I’m never hungry,’ but we’re not trying to eradicate hunger, right? Once the effects of the medicine start to wane, some people feel very dysregulated by the return of their hunger. We need to teach people how to deal with this natural, biological signal. Feeling hungry defines being alive and being healthy and being human.
It’s like if someone feels sad and doesn’t know how to deal with the sadness. We have to teach people tools and remind them that it’s ok to feel sad. It’s ok to feel hungry! These are normal, human feelings. Now how do we work through them in ways that help our health in both the short and long term?
I love that. I often tell clients that I’m much more concerned by the absence of hunger than its presence. What are you seeing when people come off of these meds?
I could probably count on one hand how many people I’ve seen come off them with success. I now tell patients from the start, ‘I can’t guarantee that I can get you off of this.’
I imagine that’s tough for people to hear.
But if we really love and care about our bodies, we should be aware of all of these things. Weight is a tricky topic for a lot of people. So is nutrition, alcohol, exercise, and sleep. I think we’re deluding ourselves into thinking that an injectable medicine is the solution to these things.
It doesn’t mean we should never use these medications as tools. But there’s a lot of unknown.
Let’s talk positives. Independent of weight loss, are you seeing positive clinical outcomes from Ozempic, like improvements in insulin resistance or lipids?
Yes, it’s important to remember that weight loss isn’t synonymous with health. Some people are losing weight solely based on restriction but their nutrition is poor and their exercise isn’t good so their health isn’t actually improving.
I do think it helps people with consistency, especially if they feel like they aren’t getting any forward movement on their own. If they see progress with the medication, it understandably helps them feel good.
I’m not anti any of the short term outcomes. I’m more so thinking about three, four, or seven years down the line. We have to think deeper about the long term consequences of being committed to a medication with cost/coverage/availability changes and minimal long term data.
Any final comments?
The cautionary advice I have is that, shockingly, nothing is a panacea. I thought this class of medication was going to be the fix but what I’m learning is that it’s really all of the other foundational tools that are most important for our health. If you use one of these medications, it should be the cherry on top.
The cherry on top of the occasional sundae that’s enjoyed without guilt or shame, that is ;)
Straight from (one) source:
I crowdsourced on Instagram to see if anyone might be open to anonymously sharing their experience with these medications. Here’s one follower’s experience:
“I started Ozempic after calorie restriction and working out 5-6 days a week wasn't working. I’d been experiencing insulin resistance and Metformin alone wasn't doing enough to help. I also have a low thyroid and take Unithroid.
Ozempic helped me lose 25 lbs over about 4 - 5 months but the side effects were awful. I threw up all the time no matter what I ate. Sometimes just water would make me throw up. The needles would sometimes hurt and I ended up gaining 10 - 12 lbs while still on the drug within a year.
I ended up switching to Mounjaro and it was incredible!!!! The needles were pain-free…I did not have a single side effect [with Mounjaro] and I lost the weight I gained and maybe 2-3 more lbs.
I ended up getting pregnant and went off it immediately...I got pregnant on literally one try (not even one ovulation cycle, just one try)…I'm now 24 weeks pregnant and my baby is perfectly healthy and in the 75th percentile.
I still have a nutritionist and I'm quite disciplined in what I eat, tracking, and counting macros…It’s important to note that I also strength trained (130+ lbs squatting, deadlifting) the whole time [I was on the medication] to maintain muscle mass. I'm no doctor but whatever it did to help me process the food supported me way more than the reduction in appetite. This is just my personal experience.
Post-baby if my hormones don't reset and I don't lose weight naturally, I would happily go back on Mounjaro (never ever Ozempic). I just can't imagine taking it for the rest of my life.”
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