Ozempic: No Expert Who Is Experienced in WEight Loss And FItness Has Written Properly about It, Until Now

As semaglutide gained popularity in the past few years, a lot of people have attributed characteristics to it that are not actually uniquely due to the drug at all: changes in the face, dizziness, nausea, weight regain, etc. And as I read the various headlines, I began to realize that people would make terms like "Ozempic Face" and "Ozempic Rebound" because they had no experience in weight loss. These changes are all incredibly common in the professional fitness setting where we work with thousands and thousands of people over decades: the face changes due to weight loss; the weight rebounds due to no longer putting the pressures on the body to lose weight; some people will get dizzy as glucose is improved; some people will get nauseous. ALL people who lose weight will lose lean tissue if they don't manage protein intake and lift weights. None of this has anything to do with Ozempic per se. It's just the normal journey of weight loss. In fact, if people don't ever get any whisper of these responses, I question whether their weight loss programs are going to be successful at all. 

Where the ignorance has been particularly depressing is coming from physicians at the weight loss clinics. I would listen to their descriptions and realize that they had so little experience in settings where we see thousands of people change all the time that they were just pinning whatever happened on the drug instead of the consequences of change set in motion after responding to the drug. Every single attribute which people have pinned on semaglutide is no different than what happens in all other effective weight losses. The saddest thing about this is that genuine weight loss and fitness transformation has become so rare in the general culture that people began to believe these side effects were due to the Ozempic instead of the weight loss. When you destabilize the metabolism in order to lose body mass, all of the above and more will happen via the processes which make the body lose weight. And when you don't implement the behaviors of supporting health and fitness, it is no surprise that people begin to regain weight (except NOT the lean/healthy tissue they lost).

Like all other assists, Ozempic can be really advantageous for people. But it doesn't get anyone out of the work involved in building strength and eating enough nutrient density. No drug and no pill will ever get anyone out of the responsibility of lifting weights and eating protein. Sorry. Not sorry.

First of all, people don't even seem to know what the drug is. Semaglutide is a GLP-1 receptor agonist developed for the treatment of type 2 diabetes and obesity. It works by mimicking the action of GLP-1, which increases insulin secretion, suppresses glucagon release, and promotes satiety. Once people understand this prior line, they understand what will happen with this drug and we really need not have any more discussion about it. If you add insulin to the system, you dispose of glucose. If you inhibit glucagon, you will be left with persistently low blood sugar, requiring the body to call upon fat cells to meet energy needs. Again, this is NO different than dieting and exercising to a degree which invokes weight loss, EXCEPT that there is no strong signal to retain the lean tissue (because you didn't use it).

In a comprehensive research literature search, including but not limited to the New England Journal of Medicine, JAMA, The Lancet, and Diabetes Care, I was able to have AI tools consolidate findings on studies evaluating the effects of semaglutide on glycemic control, weight loss, and lean tissue loss.

Results:

Multiple studies have demonstrated the efficacy of semaglutide in improving glycemic control. For instance, the SUSTAIN-6 trial published in the New England Journal of Medicine reported a significant reduction in HbA1c levels with semaglutide compared to placebo in patients with type 2 diabetes. Again, there is no surprise here AT ALL once you understand the action of the drug. Improved glycemic control leads to reduced long-term complications, such as cardiovascular disease and retinopathy, resulting in significant cost savings for healthcare systems. This is the same as a person losing body mass by any other means.

Semaglutide has been shown to induce substantial weight loss in individuals with obesity. In the STEP trials published in JAMA, semaglutide led to significantly greater weight loss compared to placebo, with an average weight reduction of 15-20%. Obesity is associated with numerous comorbidities, including diabetes, hypertension, and cardiovascular disease. Weight loss achieved through semaglutide therapy can potentially mitigate these risks, leading to long-term cost savings related to the management of obesity-related complications. This is the same as a person losing body mass by any other means.
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While semaglutide is effective in reducing body weight, concerns have been raised regarding potential lean tissue loss. A study by le Roux et al., published in Diabetes Care, investigated the impact of semaglutide on body composition. The study revealed a decrease in lean tissue mass, but the magnitude of loss was minimal compared to the overall weight loss achieved. This is the same as a person losing body mass by any other means.

It is all the same as normal effective weight loss, EXCEPT that in other weight loss programming we would insist that the person learn long-term behaviors and implement strategies to stave off lean tissue loss. All in all, semaglutide, like any other weight loss drug, could be incredibly helpful. The major downside is that people don't seem to understand that it isn't magic, it isn't really doing anything novel at all, and that it does not ever show promise if the person doesn't implement some degree of self-discipline and healthy behaviors as part of a lifelong strategy. Possibly worst of all is that it inhibits hunger, which is UNLIKE any other effective weight loss effort. This helps its short-term effectiveness; but it also deprives the patients this critical tool for long-term healthiness. People SHOULD get hungry. Hunger is the sign of fat loss. Hunger is good. Hunger is the indicator that what you're doing is working. And without ever learning that, I do question how effective the loss from such a scenario will be.

1. Marso SP, Bain SC, Consoli A, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375(19):1834-1844.
2. Ryan DH, Yockey SR. Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. Curr Obes Rep. 2017;6(2):187-194.
3. le Roux CW, Astrup A, Fujioka K, et al. 3 Years of Liraglutide Versus Placebo for Type 2 Diabetes Risk Reduction and Weight Management in Individuals with Prediabetes: A Randomised, Double-blind Trial. Lancet. 2017;389(10077):1399-1409.
4. Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults with Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425.
5. Blüher M, Jensen CB, Karpf DB, et al. Effects of Treatment with Once-Weekly Semaglutide on Appetite, Energy Intake, Control of Eating, Food Preference and Body Weight in Subjects with Obesity. Diabetes Obes Metab. 2017;19(9):1242-1251.