Since anti-obesity drugs such as semaglutide (branded as Ozempic or Wegovy) have been approved, they have gone from being niche medicines prescribed by doctors to treat people with type 2 diabetes, to being used widely as weight-loss tools. In the United States, a survey of adults found that 12% had taken Ozempic or a similar type of medicine – they are known as GLP-1 agonists – and 6% (about 15 million people) were on it regularly. This was in spite of the monthly cost of the medicine, which is almost $1,000 for those without insurance.
In the UK, Ozempic-like drugs have been prescribed on the NHS (free of cost) to people with type 2 diabetes, or when the drug has been deemed medically necessary. Yet just like in the US, the sales of British online retailers including pharmacies and beauty companies have boomed, as they have offered the weekly injection solution to those wanting to shed excess weight, at prices as low as about £72 ($92) a month. The consequence is that too many people (including those whose weight doesn’t present any health risks) are taking the drug who don’t need it. In many cases they don’t understand how it works in the body, or its side effects. An A&E doctor recently warned that young women are presenting with potentially deadly complications from using the drug to achieve weight loss.
Here’s how Ozempic (and similar types of medicines) work. The active ingredient semaglutide suppresses appetite by mimicking the role of a natural hormone called GLP-1, which is produced by the body when we eat. This hormone tells the brain we’ve eaten and makes us feel full. Semaglutide also helps the pancreas produce insulin, which is why it was approved to help manage type 2 diabetes.
But Ozempic-type drugs come with potential side effects such as nausea and stomach pain, and may be implicated in gallbladder issues, kidney damage, pancreatitis and thyroid cancer, although research is ongoing. They can also cause unwanted aesthetic effects, such as “Ozempic face” where the skin sags and wrinkles. And ultimately we don’t know the long-term health consequences because the drugs have been in widespread use for less than a decade.
Another downside is that the drugs need to be taken continuously, otherwise the weight lost through the suppression of appetite may be regained. For example, one study found that once individuals stopped taking semaglutide, they regained two-thirds of their weight within a year. Users are signing up for a weekly injection for the rest of their lives.
The “Ozempic” debate has been heated, between those who see this as a miracle breakthrough at a population level to reduce obesity, and those who caution that anti-obesity drugs make it easier for governments to ignore the deeper issues, such as the ubiquity of unhealthy processed food. My take is slightly different, as a public health professor and as someone who has trained as a personal trainer and seen up close that weight loss is harder for some people than for others.
When someone comes to me asking to lose weight, I shift the conversation towards improving overall health goals, which include being pain-free and happy in their body. I don’t believe that putting the spotlight on weight and weight loss alone is the best way to attain good health and avoid chronic disease and pain. It ignores the key role of exercise and diet in wellbeing.
Exercise and staying active is good for our minds and bodies, not because we lose weight but because exercise improves our health and lung function; it improves our muscle to fat ratio, which helps us stay active and independent in daily tasks as we get older; and it also helps us avoid back pain and other chronic ailments linked to sedentary behaviour. Moving our bodies releases “hope molecules” into our brain that make us feel happier overall too.
Similarly, what we eat is arguably more important than how much we eat. Diet is about the quality of the nutrients, minerals and energy sources fuelling us, and how they maintain our organs, bones and blood system – rather than whether we’re losing or gaining weight through calories. Again, having higher quality nutrition is usually good for weight loss, but it’s almost a side-effect.
In short, Ozempic and other anti-obesity injections for weight loss are useful in certain cases, and can be a valuable tool for those who are severely obese and need support to lose weight. But using it as a quick fix to drop 15 pounds puts the focus on body size instead of improved health. Exercise and better diet are two of the best ways to improve your health and feel better, with the side-effect for most people of moving into a healthy weight range. Taking a drug to suppress appetite doesn’t bring those overall benefits and comes with real risks. It’s a shame that this message has been lost in the focus on getting a beach body (what does that term even mean?) and reaching a certain size.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
