Should you take Ozempic? It’s a question my friends ask me and it’s also a hot topic among my scientific colleagues. The answer is complicated.
Ozempic has been touted as a new miracle weight loss solution that can help those who have struggled to lose weight for years successfully lose weight with a single weekly injection.
The vaccine contains a drug called semaglutide, originally developed to help control type 2 diabetes, by helping the body produce more of the hormone insulin and thus keeping blood sugar levels under control. Then it was noted that there was a side effect: weight loss. The rest, as they say, is history. Demand for the drug has been such that shortages have been reported around the world.
Weight loss occurs when semaglutide mimics the effect of the satiety hormone GLP-1 that is produced naturally in the gut when you eat, signaling to the brain that you are full.
The appeal of this synthetic version of GLP-1 is that it is longer lasting and more potent because it does not break down quickly in the body, so it can be administered as a weekly injection. Not only will it reduce your appetite but it will also slow down the movement of food through the intestine, meaning you will feel fuller for longer.
Other GLP-1 agonists that function like semaglutide have been suggested to significantly alter the gut microbiome, reducing microbial diversity.
For most people, this leads to significant weight loss, and here is my first “but”, since even this “miracle” solution will not work for everyone.
What’s more, it’s worth noting that your success still depends on eating fewer calories than you need; Without this, it won’t work.
In one trial, published in 2022 in the journal Nature, 152 participants with a BMI of 27 (which is overweight; 30 or more is obese) or more took semaglutide for two years (along with a low-calorie diet and monthly support of a dietician, in addition to being encouraged to do at least 150 minutes of exercise a week) and lost on average 15 percent of their body weight, compared with a 3 percent loss in a placebo group.
Impressive numbers, yes, but while the study showed that 77 percent of participants lost at least 5 percent of their original weight (which is believed to lead to benefits such as better blood sugar levels, lower blood pressure blood pressure and less stress on the heart), 23 percent did not achieve this crucial 5 percent weight loss.
And to put it in context, losing 5 percent of your body weight is about the amount achieved by counting calories or eating a more traditional diet over a two-year period, according to a 2008 study published in the New England Journal of Medicine. .
Then there are the side effects, which commonly include nausea, vomiting, diarrhea, and constipation (since semaglutide slows the passage of food through the intestine). For some, these can be bad enough to make it difficult to live a normal life, including leaving the house. I get asked a lot if the drug could harm the gut microbiome (the community of microbes that live in the gut and play a role in many different elements of health).
We know that many medications interact with the gut microbiome. For example, a 2018 study published in Nature found that about a quarter of more than 1,000 commonly used medications (and that’s not including antibiotics) can affect gut bacteria, although not all of them negatively. (Some may even reduce levels of harmful bacteria.)
As for semaglutide, there is still much to discover. Several studies on other GLP-1 agonists that work like semaglutide have suggested that they can significantly alter the gut microbiome, reducing microbial diversity (and diversity is beneficial to our health).
Dr Emily Leeming says: “Semaglutide is a serious drug, which is far from the easy option it seems to be.” It is not for thin people looking to lose a few kilos.
Ozempic has been touted as a new miracle weight loss solution that can help those who have struggled to lose weight for years successfully lose weight with a single weekly injection.
Specifically about semaglutide, earlier this year a study in mice published in the journal Biochemical and Biophysical Research Communications suggested the opposite: that the drug increased levels of certain “good” gut bacteria and supported the health of the intestinal barrier lining. . However, I must emphasize that findings obtained in mice do not always translate to humans, and to date, almost no research has looked at this.
While the future of semaglutide seems hopeful, it has only been on the market since 2017 and not enough time has passed to know for sure what it does in the long term, although it seems safe for now.
There have been weight-loss drugs before, although many, such as the amphetamine-based fen-phen and Meridia (hyped as the next miracle but withdrawn for having dangerous side effects) have fallen at the last hurdle, when problems arose over time. term.
But what I mean is that semaglutide has side effects, some of which we know about and some of which we may yet discover. We should reserve this medication for those who really need it, those who are in the obese category with BMI, 30 or more. For some of them, the medication could potentially save their lives.
In the UK, national guidelines recommend that it can be prescribed to people who have a BMI of 35 or higher and at least one weight-related health problem, such as high cholesterol or type 2 diabetes (or a BMI of 32.5 for people of South Asian, Chinese, other Asian, Middle Eastern, black African or Afro-Caribbean origin (who are often at higher risk of weight-related health problems) as part of a specialist weight management service, along with a low-calorie diet and exercise.
It can also be prescribed to people with a BMI between 30 and 34.9 if they meet specific criteria.
I welcome this as an alternative option for those whose weight problems are endangering their health. We have to recognize that, for most people, losing weight is difficult.
It’s not just about moving more and eating less; There are complex genetic and environmental reasons why someone may be larger than another person. Even your gut microbiome may play a role, as some people’s bacteria may be more efficient at harvesting energy from food than others.
Some people have health problems or take medications that mean they are also more likely to gain weight. The human body is programmed not to lose weight, probably a necessity to survive in our caveman days during periods of famine.
If you have been prescribed semaglutide and are experiencing side effects, it may be helpful to try eating smaller meals more frequently and follow the usual advice for nausea, drinking peppermint or ginger tea, and staying hydrated if you experience vomiting or diarrhea.
In the longer term, it is important to remember that once you stop taking it (and currently prescriptions can only be prescribed for two years), hunger signals return to normal, so weight can accumulate again within a matter of months, which is why retraining your eating habits, in addition to taking the medication, are essential.
Semaglutide is a serious drug, far from being the easy option it seems. It is not for thin people looking to lose a few kilos.