A Doctor’s Perspective: When Ozempic Makes Sense for Weight Loss

Obesity is a chronic medical condition that affects millions of individuals worldwide, and it is associated with numerous health complications such as type 2 diabetes, cardiovascular disease, and certain cancers. As a physician, I understand the challenges and frustrations that patients face when trying to lose weight and maintain a healthy lifestyle. In recent years, medications like Ozempic (semaglutide) have emerged as promising tools in the management of obesity and its related conditions. In this article, I will discuss the role of Ozempic in weight loss from a doctor's perspective, focusing on when it makes sense to consider this medication as part of a comprehensive treatment plan.

Understanding Obesity and Its Impact on Health

Before delving into the specifics of Ozempic, it is crucial to understand the nature of obesity and its impact on overall health. Obesity is defined as a body mass index (BMI) of 30 kg/m² or higher, and it results from a complex interplay of genetic, environmental, and behavioral factors (1). The prevalence of obesity has been steadily increasing over the past few decades, and it is now considered a global epidemic (2).

The health consequences of obesity are well-documented and far-reaching. Individuals with obesity are at an increased risk of developing type 2 diabetes, hypertension, dyslipidemia, coronary artery disease, stroke, sleep apnea, osteoarthritis, and certain types of cancer (3). Moreover, obesity can significantly impact mental health, leading to depression, anxiety, and reduced quality of life (4).

The Role of Lifestyle Modifications in Weight Management

As a physician, my first line of treatment for obesity is always lifestyle modification. This includes a combination of dietary changes, increased physical activity, and behavioral therapy. Numerous studies have demonstrated the effectiveness of lifestyle interventions in promoting weight loss and improving overall health (5, 6). However, despite their best efforts, many patients struggle to achieve and maintain significant weight loss through lifestyle modifications alone.

I understand that making lasting changes to one's diet and exercise habits can be incredibly challenging. Patients often face barriers such as lack of time, limited access to healthy food options, and difficulty in maintaining motivation. Additionally, genetic and hormonal factors can make it more difficult for some individuals to lose weight, even with diligent adherence to lifestyle recommendations (7).

When to Consider Pharmacotherapy for Weight Loss

When patients are unable to achieve their weight loss goals through lifestyle modifications alone, it may be appropriate to consider pharmacotherapy as an adjunct to their treatment plan. The American College of Cardiology, the American Heart Association, and The Obesity Society recommend considering anti-obesity medications for patients with a BMI of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related comorbidity (8).

Ozempic, a glucagon-like peptide-1 (GLP-1) receptor agonist, has emerged as a promising option for weight management. Initially approved for the treatment of type 2 diabetes, Ozempic has been shown to promote significant weight loss in patients with and without diabetes (9, 10).

The Mechanism of Action of Ozempic

Ozempic works by mimicking the effects of the naturally occurring hormone GLP-1. This hormone plays a crucial role in regulating appetite, food intake, and glucose metabolism. By activating GLP-1 receptors in the brain, Ozempic helps to reduce hunger and increase feelings of satiety, leading to a decrease in caloric intake (11).

In addition to its effects on appetite, Ozempic also slows gastric emptying, which can contribute to weight loss by promoting a feeling of fullness and reducing the desire to eat (12). Furthermore, Ozempic has been shown to improve insulin sensitivity and glucose control, which can be beneficial for patients with type 2 diabetes or prediabetes (13).

Clinical Evidence Supporting the Use of Ozempic for Weight Loss

The efficacy of Ozempic for weight loss has been demonstrated in several large-scale clinical trials. The STEP (Semaglutide Treatment Effect in People with Obesity) program, a series of randomized controlled trials, investigated the effects of once-weekly semaglutide 2.4 mg (the dose used for weight management) in patients with obesity or overweight (14).

In the STEP 1 trial, patients treated with semaglutide 2.4 mg experienced an average weight loss of 14.9% of their initial body weight over 68 weeks, compared to 2.4% in the placebo group (15). Similar results were observed in the STEP 2 trial, which included patients with type 2 diabetes, with an average weight loss of 9.6% in the semaglutide group compared to 3.4% in the placebo group (16).

These findings were further supported by the STEP 3 trial, which demonstrated an average weight loss of 16.0% with semaglutide 2.4 mg in patients without diabetes, compared to 5.7% with placebo (17). The STEP 4 trial showed that semaglutide 2.4 mg was effective in maintaining weight loss over a 20-week period following an initial 20-week weight loss phase (18).

Identifying Suitable Candidates for Ozempic

As a physician, I carefully consider each patient's unique circumstances when determining whether Ozempic is an appropriate treatment option. Based on the available evidence and clinical guidelines, I generally recommend Ozempic for patients who meet the following criteria:

  1. BMI ≥ 30 kg/m² or BMI ≥ 27 kg/m² with at least one weight-related comorbidity: Patients who fall into these categories are at an increased risk of obesity-related health complications and may benefit from pharmacotherapy to support their weight loss efforts.

  2. Inadequate response to lifestyle modifications: Patients who have made sincere efforts to lose weight through diet, exercise, and behavioral changes but have not achieved their desired goals may be suitable candidates for Ozempic.

  3. Absence of contraindications: Ozempic is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. It should also be used with caution in patients with a history of pancreatitis, severe gastrointestinal disease, or diabetic retinopathy (19).

  4. Commitment to ongoing lifestyle changes: While Ozempic can be an effective tool for weight loss, it is not a standalone solution. Patients must be willing to continue making healthy lifestyle choices, including adhering to a balanced diet and engaging in regular physical activity, to maximize the benefits of the medication.

Discussing the Benefits and Risks of Ozempic with Patients

When discussing Ozempic with my patients, I take the time to thoroughly explain the potential benefits and risks associated with the medication. I emphasize that Ozempic is not a quick fix or a magic pill, but rather a tool that can help support their weight loss journey when used in conjunction with lifestyle modifications.

The most common side effects of Ozempic include nausea, vomiting, diarrhea, and constipation, which are typically mild to moderate in severity and tend to improve over time (20). More serious side effects, such as pancreatitis and gallbladder disease, are rare but can occur (21). I carefully review these risks with my patients and ensure that they understand the importance of promptly reporting any concerning symptoms.

I also discuss the potential for weight regain after discontinuing Ozempic. Studies have shown that patients may experience some weight regain following the cessation of the medication, underscoring the importance of long-term lifestyle changes to maintain weight loss (22). I work closely with my patients to develop a comprehensive plan that includes strategies for sustaining their weight loss even if they decide to stop taking Ozempic in the future.

Monitoring and Support During Ozempic Treatment

Once a patient begins treatment with Ozempic, I closely monitor their progress and provide ongoing support. Regular follow-up appointments allow me to assess their weight loss, monitor for any side effects, and make adjustments to their treatment plan as needed.

In addition to tracking changes in body weight, I also monitor other important health parameters, such as blood pressure, lipid levels, and glycemic control. Many patients experience improvements in these markers as they lose weight, which can reduce their risk of obesity-related complications (23).

I encourage my patients to maintain open communication throughout their treatment with Ozempic. If they experience any side effects or have concerns about their progress, I am always available to address their questions and provide guidance. I also work closely with dietitians, exercise specialists, and behavioral therapists to ensure that my patients have access to the comprehensive support they need to achieve their weight loss goals.

Conclusion

As a physician, I understand the complex nature of obesity and the challenges that patients face in their weight loss journey. Ozempic can be a valuable tool in the management of obesity, particularly for patients who have not achieved their desired results through lifestyle modifications alone.

When considering Ozempic for weight loss, I carefully assess each patient's individual circumstances, including their BMI, weight-related comorbidities, response to lifestyle changes, and absence of contraindications. I engage in open and honest discussions with my patients about the potential benefits and risks of the medication, emphasizing the importance of ongoing lifestyle modifications to support their weight loss efforts.

By providing close monitoring and comprehensive support throughout the treatment process, I aim to help my patients achieve sustainable weight loss and improve their overall health and well-being. If you are struggling with obesity and have not found success with lifestyle changes alone, I encourage you to discuss the potential role of Ozempic with your healthcare provider. Together, we can develop a personalized treatment plan that addresses your unique needs and helps you reach your weight loss goals.

References

  1. World Health Organization. Obesity and overweight. [Internet]. 2021 [cited 2023 Apr 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

  2. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288-298. doi:10.1038/s41574-019-0176-8

  3. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021;143(21):e984-e1010. doi:10.1161/CIR.0000000000000973

  4. Luppino FS, de Wit LM, Bouvy PF, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220-229. doi:10.1001/archgenpsychiatry.2010.2

  5. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102-S138. doi:10.1161/01.cir.0000437739.71477.ee

  6. Look AHEAD Research Group, Wing RR, Bolin P, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154. doi:10.1056/NEJMoa1212914

  7. Loos RJF, Yeo GSH. The genetics of obesity: from discovery to biology. Nat Rev Genet. 2022;23(2):120-133. doi:10.1038/s41576-021-00414-z

  8. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract. 2016;22(Suppl 3):1-203. doi:10.4158/EP161365.GL

  9. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183

  10. 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. doi:10.1001/jama.2021.3224

  11. Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab. 2018;27(4):740-756. doi:10.1016/j.cmet.2018.03.001

  12. Nauck MA, Kemmeries G, Holst JJ, Meier JJ. Rapid tachyphylaxis of the glucagon-like peptide 1-induced deceleration of gastric emptying in humans. Diabetes. 2011;60(5):1561-1565. doi:10.2337/db10-0474

  13. Nauck MA, Quast DR, Wefers J, Meier JJ. GLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art. Mol Metab. 2021;46:101102. doi:10.1016/j.molmet.2020.101102

  14. Kushner RF, Calanna S, Davies M, et al. Semaglutide 2.4 mg for the Treatment of Obesity: Key Elements of the STEP Trials 1 to 5. Obesity (Silver Spring). 2020;28(6):1050-1061. doi:10.1002/oby.22794

  15. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183

  16. Davies M, Færch L, Jeppesen OK, et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021;397(10278):971-984. doi:10.1016/S0140-6736(21)00213-0

  17. Wadden TA, Bailey TS, Billings LK, et al. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial. JAMA. 2021;325(14):1403-1413. doi:10.1001/jama.2021.1831

  18. 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. doi:10.1001/jama.2021.3224

  19. Ozempic (semaglutide) injection [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; 2022.

  20. Blundell J, Finlayson G, Axelsen M, et al. Effects of 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. doi:10.1111/dom.12938

  21. Monami M, Nreu B, Scatena A, et al. Safety issues with glucagon-like peptide-1 receptor agonists (pancreatitis, pancreatic cancer and cholelithiasis): Data from randomized controlled trials. Diabetes Obes Metab. 2017;19(9):1233-1241. doi:10.1111/dom.12923

  22. 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. doi:10.1001/jama.2021.3224

  23. Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183