Ozempic—the injectable drug that helps treat type 2 diabetes and supports weight loss—is in high demand right now. Writer Marci Stepak explains how it works, what the side effects are, and why it’s controversial.
I’ve been fighting my weight for decades, but after a lifetime of trying to meet impossible beauty and size standards, I’ve finally, in my 50s, landed on body-neutrality—a hard-earned, much gentler and more forgiving way to live. Most days, I’m able to focus on body acceptance rather than a number on the scale. Earlier this year, however, I noticed my weight inching closer to the “uh-oh” side of the (admittedly flawed) body mass index (BMI). I had a sedentary day job and recently diagnosed hypertension (also known as high blood pressure), so I suspected that there might be additional health risks associated with my recent gain.
Still, if I’m being honest, I’d also started to be bombarded by the algorithms of my social media accounts, which somehow always seem to know when I’m feeling vulnerable about my body. On TikTok, I kept seeing startling celebrity before-and-after pics extolling the benefits of Ozempic, which they said was a weight-loss drug. I was curious, and more than a little skeptical, so I resolved to discuss it with my doctor as soon as I could.
At my appointment, I told her I felt guilty that I hadn’t been able to lose weight using the “calories in, calories out” method that’s been part of the weight-loss conversation as far back as I can remember. But my doctor gently reminded me that weight is a complex matter, impacted by your environment, your genes, your emotional health, various medical problems and even lack of sleep.
She respected my decision to seek treatment for my weight, since obesity has been linked with many chronic diseases, including type 2 diabetes, cardiovascular disease, osteoarthritis, certain types of cancer and hypertension, which I’m already experiencing. Having seen a lot of patient satisfaction with prescriptions for Ozempic, she was happy to prescribe it to me, too.
First, though, she ran a series of bloodwork to rule out any underlying conditions, and she cautioned me that this is not a miracle weight-loss drug. She stressed that Ozempic is not a quick fix, but that it could support me in my decision to lose 50 pounds.
What is Ozempic?
Ozempic is a brand name of semaglutide, an injectable drug manufactured by the Danish pharmaceutical company Novo Nordisk. It helps lower blood glucose levels to treat type 2 diabetes and has also been prescribed off-label to help people lose weight. (Note that “off-label” does not mean it’s illegal or illicit for non-diabetics—off-label can mean you’re using a medication based on medical evidence and expertise, but it hasn’t been approved by Health Canada for that specific purpose.)
Wegovy is another semaglutide brand name you may have heard about, and it’s been approved in both Canada and the U.S., but it isn’t as readily available right now. Wegovy is the same drug as Ozempic, but it comes in a higher dose and is used for weight loss, whereas Ozempic is typically used for diabetes. But due to Wegovy shortages, my doctor has prescribed me weekly Ozempic injections instead and is adjusting the dosage for me gradually.
Semaglutide—whether it’s Ozempic or Wegovy—regulates your body’s insulin and lowers blood sugar levels, imitating a hormone we produce in our intestines called GLP1 (or glucagon-like peptide-1). This “satiety hormone,” explains Ali Zentner, a Vancouver-based specialist in internal medicine, diabetes, and obesity, is one of many hormones that limits your appetite and signals your stomach to empty more slowly.
Zentner likens the drug to the kid in a game of street hockey whose job it is to yell “Car!” Ozempic, she explains, yells “Full!” to let your brain know that it’s time to stop eating. This is critical in weight loss because obesity is a state of inappropriate starvation response. “The brain no longer thinks it’s starving, so it stops hunting for food,” says Zentner.
As a result, people with obesity and accompanying health concerns have lost weight while taking Ozempic. It’s considered an effective evidence-based medication that offers a 10 to 20 percent reduction in body weight.
In my case, almost immediately after injecting my first needle into my inner thigh (it’s not a pill), all the food chatter that has been clogging my brain for decades just went—poof.
Why is Ozempic gaining in popularity?
With 63 percent of Canadians either overweight or obese according to 2018 Statistics Canada data, it’s no wonder many Canadians are excited by its possibilities—or at least they’re curious and Googling it. Obesity is a chronic condition with very few successful or sustainable treatment options. For so long, people have been given not much more than “eat less, move more” prescriptions by their healthcare providers.
Sasha High, an Ontario-based internist and obesity physician, explains that in the last decade, there have been “tremendous advances in our understanding of obesity pathophysiology and with that, better treatment targets.” With Ozempic, we now have more effective tools to address the physiology behind weight regulation, she says.
And it isn’t only about the scale—or being thin, she says. “There may be people who want Ozempic because of the societal pressure to be thinner, but for many with obesity, it’s about improving health, function and quality of life.” Yes, Ozempic causes weight loss, she says, but it also improves cardiometabolic health.
“For my patients, it’s about being able to engage fully in their lives. I have patients kayaking, skiing into their 70s, running after their grandkids.”
Who should NOT take Ozempic?
Contrary to rumour mills and what you see on TikTok, Ozempic is not just a celebrity drug or a weight-loss magic bullet. It’s also not a practical way to kickstart a crash diet. It is a prescription medication used to treat obesity—a chronic disease—under the guidance of your doctor.
High is adamant that Ozempic shouldn’t be misconstrued as a fad or shortcut. “This isn’t about vanity—this is about improving health and quality of life,” she says.
When we address obesity, she explains, we also improve the cardiometabolic conditions associated with it: diabetes, fatty liver disease, hypertension, infertility and cardiovascular disease, to name a few. Obesity is also a major risk factor for cancers like endometrial, colorectal and breast cancer.
She also warns against casual on-again, off-gain use of Ozempic. “We’ve seen this with every other weight-loss medication in the history of obesity medicine: When you stop the medication, the weight comes back on.” She says there may be rare exceptions (e.g., people who have worked very hard to change their lifestyles), but it’s a fairly typical pattern. “When people use Ozempic to lose weight, but discontinue it and inevitably regain, I worry that this is doing them a greater disservice than simply staying at the higher weight to begin with, given what we know about the negative metabolic effects of weight cycling.”
Doctors also usually do not prescribe Ozempic for those with a family history of thyroid cancer, as the medication has been proven to cause thyroid tumours and cancers in rodents during animal testing.
Are there other side effects or risks?
The most common side effects are gut-related (nausea and vomiting, reflux, constipation, diarrhea, pancreatitis). While there have been some clickbait reports of pretty horrific side effects in the media lately, the doctors I interviewed told me these side effects tend to improve as the body gets used to the medication. When the titration (starting the drug in a low dose and increasing it slowly) is done properly, the side effects should be minimal. Fewer than 4 percent of patients have significant nausea (such that they have to stop the medication) beyond three months.
Personally, I was a bit terrified before my first injection—I had read about the debilitating side effects, and I hate needles. I knew that some people on Ozempic or Wegovy took their shots on a weekend, cancelling any plans and hunkering down in their bathrooms. But my doctor reassured me that those extreme side effects were not normal, and told me that if they occurred, we could discuss other options.
I began Ozempic at the lowest dose (0.25 mg) with a plan to slowly increase that amount over several weeks (maxing out at 2.0 mg). My pharmacist gently encouraged me to load up my medicine cabinet with ginger Gravol, Tums and laxatives. But in the end, I only experienced mild discomfort around 24 hours after the injection. And as my dosage has slowly been increased, my side effects have remained minimal.
The trick, I think, is to be patient when starting Ozempic. For the most part, the debilitating side effects are not the norm, and if you are experiencing any of them, it’s time to see your doctor.
What other lifestyle changes— if any—are required once you start taking Ozempic?
High stresses that Ozempic should be taken in conjunction with learning behavioural and cognitive tools that empower a person to live the healthiest lifestyle that can be reasonably enjoyed and maintained.
She works with her patients on understanding a phenomenon she calls ‘”wanting,” a term to describe desire, cravings and the motivation for food. “For many people with obesity, their brain drives increased wanting compared to lean people and this results in overeating.” Medications like Ozempic decrease wanting along with hunger, which means people eat less and lose weight.
Zentner believes that for the most part, it’s even simpler than that. “The only thing you have to do is take your medication and go live your life. You want to exercise? Wonderful. Do it to celebrate what your body can do. Do it because exercise is good for cardiovascular health and aging and mood and health.”
What happens when you stop taking Ozempic?
As with all obesity treatments, Ozempic needs to be continued long-term, or weight regain is very likely, High says. Obesity is like any other chronic condition. If you take medication to control your blood pressure, you need to continue that medication to keep your blood pressure in the normal range. It’s the same with obesity, High explains. “If you take a medication that brings your weight down and improves metabolic health, you need to continue that medication to maintain the weight loss and metabolic improvements. The duration of treatment is one of the biggest misconceptions people have about anti-obesity medications.”
Is the reported Ozempic shortage real?
Though other countries—notably Australia and the U.S.—are experiencing shortages, Canada hasn’t been affected yet. (At least for Ozempic. It’s true that Wegovy has been harder to access here.) However, the high demand has raised the question of who should be prioritized should Canada face a shortage. Which patients deserve it more: those with diabetes or those with obesity?
Zentner and High insist it’s not reasonable to pit one chronic medical condition against another. “Both people with obesity and people with diabetes deserve effective medical treatment,” High says. “The shortages are a supply-chain issue and not a ‘people depriving people’ issue.”
“We were told we had an obesity epidemic on our hands and that a third of Canadians were carrying excess weight,” Zentner points out. “And now we have a treatment that offers 10 to 20 percent body-weight loss, an 80 percent reduction in the development of type 2 diabetes, and [we have] cardiovascular data for cardiovascular benefit in high-risk patients. It’s not surprising that there’s a rush on this stuff.”
Can I trust what I see on social media about Ozempic?
That depends. High decided to become part of the conversation, joining TikTok to promote evidence-based medical education in a sea of (mis)information and celebrity chatter. As an obesity physician, she wants to empower women who’ve been shamed and blamed for their weight to understand that it’s not their fault, and that there are effective tools to help them manage their weight beyond #CICO (calories in, calories out).
As for me, it’s been several months since I started Ozempic, and I’m finally over my squeamishness about needles (which is good, if I’ll likely be on this medication for the rest of my life).
I still struggle with feelings of guilt over not being able to lose weight with diet and exercise alone. But Zentner adamantly reminds me that no other disease has to earn its treatment like this. I did not have to explain why I deserve my hypertension meds, so why is there all this controversy and judgment for those seeking obesity treatment? As Zentner puts it, “Medicine at its purest does not care how people get sick. Medicine cares how people get well.”
Next: How the Pandemic Helped Me Embrace Weight Gain and Intuitive Eating