Quick Guide: Wegovy/Ozempic for Weight Loss

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I received the following request from  reader Anisha:

I like the in-depth reviews you have of the studies for Wegovy, but I’m talking to a lot of friends and family about this and it would help to have something that’s easier to read. If you are open to writing it you would have my thanks!

You got it Anisha! This is a quick guide to Wegovy/Ozempic for weight loss. I’ll provide links for those who want to dive deeper into this.

I want to point out that Tirzepatide, a similar drug from a different manufacturer, has recently been approved for weight loss as well. I wrote about that here and have a deeper-dive into the research around that in process,

Ozempic and Wegovy are the same drug

Ozempic and Wegovy are brand names for the same drug – Semaglutide a GLP-1 receptor agonist which is owned by Novo Nordisk. It was originally marketed as a drug for Type 2 Diabetes under the brand name Ozempic. The brand name for the weight loss application of the drug is Wegovy. Which leads us to:

Wegovy is not a weight loss drug

Wegovy is not truly a weight loss drug, it is a megadose of a type 2 diabetes drug (Ozempic) that has a side effect of weight loss. When Novo Nordisk realized that their Type 2 Diabetes drug had a side effect of weight loss, they went about trying to find a titration and dosage of the drug that would create the side effect at the highest level possible and getting it FDA approved. The required dose of Wegovy (based on FDA-approved prescribing instructions) which is 2.4mg is more than the the maximum dose of Ozempic which is 2mg (and, prior to just March 28 of 2022, was only 1mg.) That’s because the goal of Ozempic is to provide blood sugar management while minimizing side effects, while the goal of Wegovy is maximizing a side effect.

Wegovy has serious side effects

This drug has side effects that can range from very unpleasant to fatal, and you can’t really increase the rate of one side effect (weight loss) without increasing the rates of the other side effects. (I dig into side effects and rates here). There are currently inquiries into the concerns around self-harm and suicide brought about by the drug. Healthcare practitioners and weight loss drug pill mills that blow off the side effects instead of having (ethically required) informed consent conversations with their patients are also a huge problem. The drug carries a boxed warning, the FDA’s strongest warning.

If you go off the drug, you will regain the weight that you lost

Novo’s own study shows that those who go off the drug regain the weight they lost and lose cardiometabolic benefits quickly. Some people are reporting gaining back more, including twice as much, as they lost. This tracks with a century of research on intentional weight loss.

If you stay on the drug, you may regain the weight that you lost

Novo Nordisk’s (massively profitable) “solution” to this is to claim that people need to stay on these drugs for life (using the ludicrous claim that being higher-weight is like having asthma or type 2 diabetes.) There are only two years of data on this drug. At the end of two years, weights were trending up. (There is a deep dive into this here.) People also experienced weight cycling on the drug which is strongly linked to harm. Novo Nordisk, and the weight loss industry as a whole, is attempting to rebrand weight cycling as relapsing-remitting ob*sity and claiming that it’s part of their treatment. This too is scientifically ludicrous.

Many people can’t stay on the drug

Whether it’s cost, access, inability to tolerate the common side effects, or severe side effects that cause discontinuation, many people will not be able to stay on this drug for life.

Novo Nordisk has a history (and present) as a bad actor

Novo Nordisk was instrumental in the massive increase in the price of insulin,(a medication whose original patent was sold for $1 because its inventors wanted to be certain that the drug would always be affordable to those who needed it.) This includes the practice of “shadow pricing.” In that situation they had customers using a drug that they needed to take for life, and they systematically increased the price along with their competitors (which is why I don’t buy the argument that the exorbitant prices of $1300+ per month will come down as competitors enter the market.) They’ve been forced to reduce the price of insulin and so they are looking to Wegovy as their new gold mine.

They were ordered to pay $58.65M to the federal government for intentionally misleading physicians about the dangers of a similar GLP-1 agonist) drug. (You can read Mikey Mercedes excellent write-up about this here.)

The Association of the British Pharmaceutical Industry (ABPI) a trade association that works in England, Scotland, Wales, and Northern Ireland in partnership with the government and the NHS on behalf of their members, recently reprimanded and suspended Novo Nordisk for being in breach of the ABPI code of practice.

Novo Nordisk is the subject of a multi-part investigative journalism series at The Observer by Shanti Das and Jon Ungoes-Thomas around their deceptive trade practices.

They show no sign of stopping since just a few months ago they turned a recent study about Wegovy into a deeply deceptive publicity stunt.

Overall

These drugs are very expensive (and are not typically covered by insurance – usually based on the insurance company’s calculations that any benefit the drugs may provide isn’t worth the price.) They have serious side effects and only two years of data which does not suggest that weight loss will be maintained, even if someone is able to stay on the drug for the rest of their life which, for many reasons, they may not be able to do. Any actual health benefits of the drug are based on questionable research and it’s likely that they could be achieved through weight-neutral interventions with far less expense and risk.

I also very highly recommend the GLP-1 Agonist informed consent project from Medical Students for Size Inclusivity. They do all kinds of incredible work and this is no exception providing a great framework for providers who might be asked about not just semaglutide but the entire class of GLP-1 agonists. Check it out here! https://sizeinclusivemedicine.org/glp1/

I am also speaking on a Center for Body Trust online panel on Friday the 12th from 9:30-11:30am Pacific about weight loss injectables with Sirius Bonner, Lisa Dubreuil, and Marianne McCormick. Registration is sliding scale and you can get details and register here.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.