The Truth About Ozempic | A Registered Dietitian’s Perspective

Medically reviewed by Abbey Sharp, Registered Dietitian (RD), BASc.

Today we will be discussing the notorious TikTok-endorsed weight loss drug, Ozempic, and its lesser-known cousins, Mounjaro, and Wegovy. We dive into the research about these medications and discuss potential risks and benefits.

It’s finally time I talk about Ozempic. It’s been called the not-so-secret miracle weight loss drug of the Hollywood elite. It’s been rumored to be linked to the Kardashians’ recent body transformations and celebrities like Mindy Kaling.

But some media reports haven’t been so kind. The Guardian, for example, coined it “an eating disorder in an injection”, or the “clockwork orange for junk food”.  On the other hand, body positive activists like Aubrey Gordon see it as society’s last-ditch effort to “get rid of fat people” for good.

Regardless of the backlash, its quickly become one of the hottest hashtags on TikTok. Aside from Botox and maybe Viagra, it seems like Ozempic is quickly becoming one of the most recognizable pharma brand names of our generation. Honestly, most of us are more attuned to Ozempic than local politics, worldwide disasters, a global pandemic, or the weather in our own backyard.

Not surprisingly, the social media buzz alone is now believed to be the lead cause of the shortage in the United States. And this shortage has people fired the fuck up.  It feels scary to even be talking about this as a straight sized anti diet culture dietitian, but I’m ready to finally clear the air.

Folks, let’s talk about Ozempic.

Also a huge thank you to Eric Williamson, who is a dietitian and PhD who specializes in sports and weight management. If you’re not already following him, check out his Instagram here and get in touch for one on one support that I can personally endorse. 

What Is Ozempic?

So let’s start with some cold hard facts. First of all, as many of you may know, Ozempic is not even a medication for weight loss, it’s currently only approved for diabetes. But the active ingredient in ozempic, semaglutide, is also found in a drug that IS approved for obesity called Wegovy. And when Wegovy demand outdid supply earlier on in the year, doctors started to prescribe Ozempic off-label for weight loss because the active ingredient was the same.

But then like the great toilet paper gate of March 2020, news reports claimed that Ozempic also became hard to get- not only for folks now using it for obesity but also for those with diabetes who had been taking the drug for years.

The final player is Mounjaro, which is another close cousin of Ozempic. The active drug here is something called tirzepatide which has slightly different properties that I’ll discuss in a moment. But like Ozempic, at this time, it’s also only approved for diabetes though is also being prescribed off-label for obesity. So why the sudden spike in demand in these new age weight loss drugs? Well, probably partially celebrities, partially TikTok testimonials, partially lingering Covid pounds, and mostly the fact that they honestly really do work.

Effectiveness of Weight Loss Medications

Before we had semaglutide or tirzepatide, we had a bunch of other weight loss drugs with less than stellar track records. Most resulted in about 5-8% weight loss on average, but came with a laundry list of not-so sexy side effects like loss of voice, difficulty breathing, anxiety, insomnia, or the dreaded orlistat anal leakage.

Previous Medications	% weight loss
Orlistat	6%
Lorcaserin	6%
Phentermine-topiramate	8%
Naltrexone-bupropion	5%

On the flip side, most studies on semaglutide suggest it results in about 15% loss of body weight when paired with healthy lifestyle interventions like diet and exercise, which is a pretty dramatic leap.

Tirzepatide ,which is the active ingredient in Mounjaro, is potentially even more promising, and while it hasn’t been directly compared to the dose of semaglutide typically provided for weight loss, preliminary evidence suggests it may result in up to 20% to 25% body weight loss. Possibly even more for some folks. 

How These Weight Loss Drugs Works

Wegovy, Ozempic and Mounjaro are all GLP-1 agonists aka glucagon-like peptide 1 agonists. The word agonist means it acts similarly to our bodies natural hormone GLP-1. This hormone has a multitude of benefits, but in short, it helps slow down food absorption in the stomach so you feel fuller longer, it regulates insulin and blood sugars, and most importantly, it helps tell your brain that you are full.

Mounjaro is not only a GLP-1 agonist, but its ALSO a GIP agonist aka glucose dependant insulinotropic polypeptide as well. The combo of the 2 very long words seems to have synergistic effects, making Mounjaro more powerful than a GLP-1 agonist alone. And this is why it seem to be more effective and is sited to overtake the Ozempic and Wegovy craze, though research is still in its infancy.

But back to why Ozempic and its cousins are causing rapid weight loss in so many folks. Ultimately, these drugs significantly suppress hunger, and this tends to make achieving a calorie deficit a lot easier. In fact, its been shown to reduce calorie intake by 35% without changing people’s perceived hunger levels in the day. In other words, you can eat less, and not feel hungry. 

And this unique mechanism is arguably the essential key to long term weight loss success. This drug is essentially suppressing the body’s natural compensatory mechanisms that kick into high gear whenever we’re in a calorie deficit. Normally, when on a diet, our body fights to maintain body weight homeostasis by increasing hunger hormones, and decreaming satiety hormones in a desperate effort to make us eat more. And as I discussed in my video on weight loss right here, this is one of the main reasons why long-term weight maintenance is really hard. Without a medication like Ozempic, the body is programmed to ramp up your appetite with every extra pound of body weight you lose. Some research even suggests that these hunger adaptations persist for years after the diet ends.

Aside from physical hunger, Ozempic, Wegovy and Mounjaro also reduce cravings and help people feel more in control of their food intake. Again, this is revolutionary in the weight loss world because typically people who have lost weight experience more cravings and less satisfaction after eating, which in turn can derail long term efforts. So bottom line – these weight loss drugs are not magic, they still require a calorie deficit to work. But because of the impact on physical satiety and psychological satisfaction, they make obtaining that deficit much much easier. 

So those are the facts. But we haven’t even touched on the juicy controversies surrounding this drug and the great shortage of 2023.

Ozempic Controversy

Let’s start with the million-dollar question that rocked people’s worlds- who is worthy of obtaining this drug? Should we prioritize folks who have a disease like diabetes, when people in larger bodies should just be “putting the work” in at the gym?

You’ve all seen the horror stories on TikTok and other news outlets from folks prescribed Ozempic for diabetes needing to cross state lines to find a single dose of their life-saving meds. When you imagine the stress and anxiety of being unable to fulfill a prescription because it’s going to an unofficial demographic, I can empathize with the anger, frustration, and fear.

On the flip side, it’s worth pointing out that obesity, not unlike diabetes, is also officially recognized as a chronic disease worthy of medical support by authorities like Obesity Canada, the Canadian Medical Association, the American Medical Association, and the World Health Organization. So I know this is in stark opposition to the teachings of HAES, but you guys know I don’t personally identify with all aspects of that movement. I think for some folks, weight loss may help support their physical health and their psychological well-being. I also try to follow science as objectively as possible. And science tells us that like someone with diabetes needing pharmaceutical support for blood sugar management, many folks with obesity may need medical intervention to override some of the genetic factors responsible for differences in reward response, hunger and fulness cues and propensity to gain weight in todays environment.  

Which brings me to the importance of genetics and why some folks may not be able to dramatically shift their set point weight without some medical intervention. Weight gain and weight loss capabilities are genetically determined. Some people will naturally experience higher appetite, greater dopamine spikes from food, lower reward stimulation from exercise, greater relief from stress from overconsumption, a stronger drive to eat when experiencing negative emotions, or a lower sense of fullness from calorie consumption alone. Research on twins separated and raised by two different families has found that obesity is 70% genetically determined, and only 30% environment.  Hence the adage, genetics loads the gun and the environment pulls the trigger. 

Likewise, some people are going to experience more negative health outcomes when living with obesity than others. This is not a homogenous group so we need to look at the individual to determine if adding in medication to complement a healthy lifestyle is right for them.

And its worth emphasizing that even with medication, the recommendations do still focus on a nutrition, exercise and lifestyle intervention as first line of defense, both before, during and of course after medical obesity treatment.  So no one here is suggesting that taking a weight loss drug like Ozempic is a free ride.

Side Effects of Ozempic

Speaking of free ride, these medications are not without side effects. The most common side effect is nausea, followed by the other usual GI suspects. Thankfully, most report the nausea declines pretty steadily over time. But for a lot of folks, it’s completely debilitating with a lot of users describing being suddenly repulsed by even seeing their favourite foods. Some even reported being turned off or filled up too quickly by water, which can potentially put one at risk for dehydration as well. There are more potential side effects like thyroid cancer seen in animal research, plus pancreatitis or gallstones. 

But not unlike a birth control pill, antidepressant, or even an antibiotic, medicine is all about risk and benefit. It’s all about weighing the potential discomforts or risks with the potential benefits, both immediate and long-term. Different people are also going to react differently, and for some those risks or discomforts won’t outweigh the benefits of the drug. This is why it’s important to work with your healthcare team to determine if an intervention like this is right for you.

Ozempic for Life?

But lets move along to talk about the elephant in the room – if you started taking ozempic to lose some weight, do you now need to stay on it for life?

If you want to keep the weight off for life, probably yes. Research suggests that one year after coming off Ozempic or Wegovy, participants gained an average of ⅔ of the weight right back.  And this really isn’t a surprise because as we established earlier on, the main reason why we see such success with this medication beyond just lifestyle habits is because it helps counteract the increased appetite associated with weight loss. But if we go off the drug, at a now lower body weight, our appetite drastically rages – not only to its normal pre-drug levels, but even higher as our body fights to get us back to its preferred set point weight. There may be some patients who can slowly wean while maintaining a pretty strict diet and exercise regimen, but I would expect it will feel like a real struggle after having this pharmaceutical boost.

First of all, I believe in body autonomy. I say it all the time. And I don’t think one chronic disease cohort is more “worthy” than another of access to a potentially life saving or life changing drug. It’s a shame that we need to triage patients or turn getting a prescription into a modern hunger games. Especially because there’s already so much stigma and shame for folks in larger bodies trying to access supportive care. If a medication can help them regain their mobility, metabolic health, happiness, confidence, whatever- I am all for it.

Fears on Ozempic

For one, I am worried that social media and Hollywood culture are being positioned as an easy solution for fast weight loss. That they’re something you can just take to into a certain gala dress for a night or bikini vacation, and then go off again when you want to have a cheat day with your girls. 

I also worry that due to shortages and desperation, people will seek out unregulated compounded cocktails underground. For completely bogus reasons, generic semaglutide is exempt from normal FDA approval, so a lot of pharmacies, and medi-spas are offering their own “weight loss” cocktails that they compound themselves, often for much cheaper than brand name. But experts are warning that because it’s unregulated and untested, these compounded prescriptions could be ineffective at best, and dangerous at worst, so it’s really not worth the risk.

I also fear that people will see this as a REPLACEMENT for physical activity and a balanced nutrient-dense diet. The research suggests that a large proportion of weight loss while taking these medications is lean muscle mass – around 39% of the weight loss according to one study. So if we are not supporting the pharmaceutical regimen with a protein-rich diet, and resistance exercise, we run potentially make ourselves more metabolically healthy in one way at the expense of another.

I’ve also been focusing on health here, but not surprisingly, the internet has been focusing on the Ozempic aesthetic, most notoriously the now stigmatized Ozempic face. This is a whole other topic worth unpacking related to agism, classism and access. But from a nutritional perspective, its a good reminder that nutrition really does matter. Ozempic users do need to focus on high quality diet to maintain muscle mass with rapid weight loss. 

Finally, this is a massive topic that needs a whole other video to unpack. But I’m honestly terrified about the long term implications on general body dysmorphia and what is considered a normal healthy weight. I wouldn’t have concerns if these drugs were only being used as intended- for folks with chronic obesity or diabetes. But when every already slim celebrity and influencer is now another 20 lbs smaller, how are we as a society going to feel about “healthy” sized women like me. Will this be the new obese of 2025? Of course on an extreme end I’m concerned about these drugs being abused in ED communities as a not so secret  weight loss “hack”. But even without a history of dieting or disordered eating, when we start to only see Ozempic bodies represented in the media, the goal post for an acceptable body gets further and further away.

Obviously, this is me going down the doomsday rabbit hole, and I’m hoping that none of these things occur. But we all live in a social media echo chamber, where the small snippet of the world that we see is typically what we perceive to be fact and true. So I just hope that celebrity Ozempic bodies don’t become the unofficial “true” look of wellness.

Final Thoughts on Ozempic

So in conclusion, I think there is absolutely an important role for medications like Ozempic, specifically for folks with obesity whose weight puts them at health risks, and for whom lifestyle changes alone have not been successful. But this is not to help people drop the last bit of baby weight. This is not to help you fit into your wedding dress. This is nutrition medical therapy for a chronic disease intended to be utilized for life. And even if you do fit the target criteria and demographic, taking Ozempic is not a quick fix invitation to never exercise or eat a vegetable again. Lifestyle support is critical for long term success and muscle preservation, so I strongly suggest working with a registered dietitian on your journey. 

If you’re seeking one on one support yourself, whether it’s for weight loss with or without pharmaceutical support, I strongly recommend Eric Williamson for one on one coaching. You can check him out at here and follow him on Instagram and TikTok (@UnlockedFitnessAndNutrition). I expect the research and recommendations around drugs like Ozempic will quickly grow. Diabetes drugs will be approved for obesity, new competing drugs will be developed, and the price of everything will inevitably fall, making these medications more accessible to the layperson. So I’ll be keeping my finger on the pulse for an updated post.

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What are your thoughts on Ozempic and similar medications? Leave me a comment below!