Humankind has been on a quest to find the Fountain of Youth for thousands of years, but for many, the quick fix for weight loss is even more appealing, even for those who just want to lose a few pounds. Beyond juice cleanses or weight loss surgery, there has been a bevy of prescription options in recent decades—often with side effects that range from detrimental to downright embarrassing.
Consider fen-phen (fenfluramine-phentermine). It was the go-to weight-loss medication in the ’80s and ’90s. . . until it was pulled from the market for causing heart valve damage. Orlistat, known by the brand names Xenical and Alli, has been approved by the U.S. Food and Drug Administration (FDA) for more than 20 years—and available over the counter for about a decade—and can trigger urgent and uncontrollable oily bowel movements. But a new treatment option now has providers and patients alike feeling optimistic that science has brought us a safer solution for losing weight, whether you’re considered obese or are just hoping to lose a few pounds: semaglutide.
Semaglutide, rumored to be the secret behind the sudden dwindling frames of some celebrities, was approved by the FDA in December 2017 under the brand name Ozempic, for the treatment of type 2 diabetes. A member of a class of drugs called GLP-1 receptor agonists, semaglutide is a once-weekly subcutaneous injection (read: injected into squishy fat) that stimulates the pancreas to produce more insulin, helping to control glucose levels. However, “one of the happy side effects that we found with the medication was that it allowed people to lose weight,” says Dr. Steven Batash, a board-certified gastroenterologist in Rego Park, New York. After several years of it being prescribed off label for weight loss, the FDA granted approval to use the same medication from the same manufacturer for weight loss under a new name, Wegovy. (Note: A medication approved in the summer of 2022, known as Mounjaro, or tirzepatide, works similarly but is more potent than semaglutide. It is FDA approved solely for diabetes, but Dr. Batash expects that its manufacturer will follow in Ozempic’s footsteps and receive FDA approval for weight loss. Tirzepatide is not nearly as readily available as semaglutide.)
How Wegovy and Ozempic for weight loss work
Semaglutide works for weight loss via two channels. The first is appetite suppression, which is accomplished by reducing the rate of gastric emptying, or how fast food moves through your stomach. Instead of sitting in your stomach for up to an hour, food stays there for about six or seven hours when you take semaglutide. The other is improved satiety, or sense of fullness—a process which is controlled by the brain. “Many people say that when they start eating a meal, they reach a point when they know that their belly is full, but they’re still hungry,” says Dr. Batash. “The stomach is desperately trying to send a message of fullness or satiety to the brain, but this feedback mechanism is either delayed or broken—and unfortunately, it’s the brain that gets to decide when you’re hungry and when you’re not.”
This makes semaglutide an effective weight-loss option for almost anyone, whether they’re prediabetic, are diabetic, or have polycystic ovarian syndrome (which causes insulin resistance and, often, weight gain) as well as those who are obese, overweight, or even at a normal BMI and just hoping to lose a few pounds. Though the medication offers more significant results when supported by a healthy diet (more on this shortly) and when taken by patients who are overweight, studies show that in four months, semaglutide can cause weight loss of about 10% and up to 20%. “My patients tell me they’re not hungry or focused on food all the time,” says Dr. Jessie Cheung, a board-certified dermatologist in Chicago who specializes in aesthetics, regenerative medicine, and hormone replacement therapy. “They get full after three or four bites, don’t crave their junk foods, and don’t find satisfaction in eating them. It’s almost magical.”
Houston-based registered dietitian nutritionist and content creator Dana Omari, aka @igfamousbydana, has been documenting her experience with semaglutide on her platform. Though she’s always maintained a healthy lifestyle, she struggled a bit during the pandemic (as so many of us did), gaining 30 pounds in two years. “As a dietitian, I know the old-fashioned way of losing weight is very slow—about two or three pounds a month,” she says. Her primary care provider suggested semaglutide as a possible option, and after a few months of working on her weight, Omari decided to give it a try and filled her Wegovy prescription.
The first day, she was horribly nauseous and couldn’t eat. “I had dinner before my shot, and I ended up throwing that up,” she recalls. “After that, I didn’t really have nausea unless I ate too fast.” Omari experienced a few other common side effects, including constipation at the start of her treatment. But many other side effects of this medication can be caused by patients not eating enough during their treatment. “You’ll feel the effects of low blood sugar or being really hungry without feeling hungry,” she explains. “Headache, dizziness, fatigue—things that would happen if you felt like you were starving—but without that tummy rumbling.”
Before starting treatment with semaglutide, Omari was already changing her habits and working on losing weight; the medication has acted as a booster for her efforts. “I gained weight because I stopped eating and exercising the way that I normally do,” she says. [Otherwise,] I have always been able to maintain my weight because I eat really healthily.” For those who have never had ideal eating habits, it’s best to work with a nutritionist to understand how to eat healthily and control portion sizes. Not only will this help you lose more weight, but it’ll decrease your likelihood of feeling ill from the medication. “If you overeat on semaglutide, you are going to be miserable for at least three or four days because the food is just going to sit in your stomach,” warns Dr. Batash.
You’ll also want to make sure you’re getting all the nutrients you need, which you might not be if you’re eating much smaller meals than you once did. “I went on an easily digestible multivitamin, I’m on a once-a-month vitamin D—50,000 IU—and a good fish oil, and I stay hydrated with a lot of water and electrolytes,” says Omari, pointing out that dehydration slows weight loss. “Your body requires water to help break down fat into the energy you need. Electrolytes balance your hydration in and out of your cells.” To support this process, she incorporates Liquid I.V. products into her routine every few days.
As of early October, about two months into her semaglutide journey, Omari has lost nearly 20 pounds, a rate of weight loss that most people couldn’t accomplish safely in the same amount of time. (Dr. Cheung notes that this is common amongst the patients in her practice, depending on how much weight her patients have to lose.) She’s also seen plenty of additional benefits: “Every single day, I needed a piece of chocolate or wanted a cookie—if I saw it, I wanted it,” Omari says. “I’ve had my favorite cookie dough in the refrigerator the whole time [I’ve been on semaglutide], and I’ve only made myself two cookies.” Her pants fit better, and she has seen her stomach flatten. Though rapid weight loss can often cause issues, she’s seen no negative effects to her skin or hair and, aside from some occasional nausea, has noticed only that she’s more tired in the evenings than she used to be.
Ozempic risks and side effects
This isn’t to say there aren’t any risks that come from taking this medication, which could be heightened in thinner or healthier patients. “I find that my patients who have a prediabetic risk don’t seem to notice as many side effects,” says Dr. Cheung, a sentiment that Dr. Batash echoes. Pancreatitis, though rare, is a potential side effect that would immediately disqualify you from continuing your course of treatment. You’ll know right away if you have it—you’ll not only “look” sick but feel severe abdominal pain after eating, have a fever, and vomit. Dr. Batash also notes that it should be used with caution in patients with gallstones, which can trigger pancreatitis.
Studies also show a connection between this medication and the development of thyroid cancer. Dr. Batash was quick to point out that this occurred only in lab testing on mice. “What I usually tell our patients is that if the patient or their family has a history of medullary thyroid cancer, we would advise against taking this medication,” he says. Currently, it is unknown whether taking semaglutide can lead to the formation of thyroid tumors in humans. A recent clinical study of the use of GLP-1 receptor agonists (including semaglutide) and their effect on thyroid health shows that the drugs neither increased nor decreased the risk of thyroid-related conditions, but more studies are needed to make a thorough conclusion.
What should I eat while taking Ozempic?
Because you won’t be able to eat as much as you once could, pay close attention to your diet. “I recommend healthy fats, protein, and lots of vegetables,” says Dr. Cheung, as well as plenty of fiber. Eating clean and drinking lots of water will not only support the results of taking Ozempic, but make you feel good on the drug. “Since you are eating less, you won’t be pooping as often and you may experience constipation,” she says. Fiber will help that, as will staying hydrated. “When you’re not hungry, you may not feel thirsty, and you need water to help avoid constipation,” she adds.
Broccoli and leafy greens like cabbage, kale, and spinach are rich in B vitamins, which can help with the nausea you might experience while taking semaglutide in addition to boosting depleted energy levels. Dr. Cheung also recommends getting enough vitamin D. “Vitamin D helps with fat metabolism, and many patients are deficient in it anyway,” she says. Fish like salmon, tuna, and sardines, plus fortified dairy and plant milks, will help you add more vitamin D into your diet. Dr. Cheung recommends incorporating glutathione, too, which you can get through eating avocado, cruciferous veggies, and alliums like garlic and onions. This antioxidant helps your liver’s ability to detoxify your body. “Fat stores toxins, and as fat breaks down, toxins are released, and need to go through the liver and kidneys for proper excretion,” explains Dr. Cheung. “You don’t want to stall or gain all the weight back if your body can’t push the toxins out.”
You can also bolster your levels of these vitamins and other nutrients with supplements. It’s best to work with your provider to get bloodwork—your lab results can help them analyze deficiencies and create a custom plan for you to enhance your weight loss and maintain your weight once you taper off Ozempic.
Foods to avoid while taking Ozempic
If you’re already on Ozempic, you likely already know which foods make your body unhappy. “Your body will punish you for having a carb-heavy, junky meal, as that can lead to loose stools and indigestion,” says Dr. Cheung. Similarly, overly sugary, fatty, greasy, and fried foods will have the same effect, making you physically uncomfortable while making it harder to achieve your weight loss goals. You may also want to avoid eating spicy foods, as they can lead to heartburn. If you enjoy a cocktail or two, know that booze can absolutely cause heartburn too, but many people find that they lose the desire to drink alcohol on Ozempic, as the medication reduces cravings.
The size and timing of your meals is also important. Though you won’t have the same desire or ability to eat a large meal, doing so may lead to nausea and indigestion. Instead, focus on eating more frequent meals that are closer in size to a snack. Adds Dr. Cheung, “semaglutide will help you with intermittent fasting, as one meal in the late afternoon is enough for most patients.” Regardless, be sure to eat your last meal several hours before going to bed. Because Ozempic causes your GI tract to slow down, eating late at night could result in heartburn or acid reflux.
How much does Ozempic cost?
Risk aside, it’s hard to deny the benefits of this medication; in addition to the obvious goal of weight loss, semaglutide can help improve patients’ cholesterol levels, says Omari. But for many, there is one major downside: the price. Some can get Ozempic or Wegovy covered by insurance (which, really, is possible only if you have a health condition like diabetes or PCOS). Omari was not one of those patients. “Little did I know it would be almost $2,000 [a month] out of pocket,” she says. “I went back to my doctor and told her, ‘That’s insane, I can’t do that.’”
That’s when Omari learned about compounded semaglutide. This means that instead of using the brand-name medications, which are dispensed in auto-inject pens, pharmacists will blend their own solutions for patients. “They take the semaglutide molecule and compound it with something else—commonly, it’s vitamin B12,” says Dr. Batash. Though not all providers prescribe compounded semaglutide—out of an abundance of caution, Dr. Batash prefers sticking with the branded product—you’ll find that going this route cuts the price of the treatment significantly. Omari pays $129.
In addition to not potentially depriving diabetes patients of necessary medication—there is currently a shortage of Ozempic and Wegovy, due to increased demand and manufacturing issues that are believed to last through the end of 2022—compounded semaglutide comes with the added benefit of customized dosage. “It is very hard to change the dose with the auto-inject pen,” the dosage of which starts at 0.5 milligrams, says Dr. Cheung. “If you start at half a milligram, you’re just miserable—we start at about a quarter of that dose.” She then increases patients’ dosage every week until they’ve reached the max of what they can tolerate.
How long do you have to use Ozempic to see results?
Regardless of whether your doctor titrates your dose of semaglutide weekly or monthly, that increase is critical to seeing success on the scale. “You have to increase the dosage until you reach the maximum dosage or the maximum tolerable dosage,” says Dr. Batash. “Just taking the smallest dose and then deciding whether the medication works is not a real attempt.”
The big question: Does this real attempt have to last forever? That depends. When semaglutide is not prescribed in conjunction with another weight-loss measure, such as endoscopic sleeve gastroplasty, Dr. Batash believes so. “In most patients, the weight that was lost will be regained, whereas the combination of the procedure with taking the medication for 6 to 12 months allows the brain/stomach connection to be reset.”
However, as both a provider and patient of treatment with semaglutide (and someone who has had gestational diabetes and a family history of diabetes), Dr. Cheung disagrees. “At my practice, we give you two months to start with; I would say 75% are pretty happy after that,” she says. Patients who desire more weight loss are prescribed more treatment on a month-to-month basis. However, some of her patients do want to stay on it long term—whether that’s to fight cravings and lose weight or just feel better on the medication. “I take a low dose every so often,” adds Dr. Cheung. “My blood tests have come back so much better—my hemoglobin A1C, my cholesterol, other things we look at to see the levels of inflammation in the body.”
Is using Ozempic for weight loss safe?
Though every patient is different, all of our experts agree that this is a safe medication, especially when prescribed by a provider who will monitor your progress. Semaglutide can also change lives. “I’ve seen over a hundred pounds of weight loss in a single person,” says Dr. Cheung, recalling a patient who has gone from qualifying for gastric bypass surgery to approaching a normal BMI. That weight includes not just squishy subcutaneous fat but the dangerous and harder-to-lose visceral fat around the organs. “Fat is inflammatory and so bad for many disease processes,” she says. Plus “it’s not crash dieting—you’re still eating, you just naturally limit yourself.”
Dr. Cheung points out that patients who are already quite thin should not be prescribed this medication. Otherwise, whether you’re within just a few pounds of or still have a ways to go before you reach your desired weight, semaglutide may be worthy of consideration. If you’re looking into how to get Ozempic for weight loss, the first step is setting up a consultation with a trusted provider—whether that’s a GP or a plastic surgeon—to determine if it’s right for you. They can evaluate your medical history and assess whether semaglutide can help you achieve your goals—safely and effectively.
