Ozempic for Weight Loss: Everything You Need to Know

Many factors influence a person's weight, including what you eat and how much you move, of course, but also things that aren't under your control, such as your environment, genetics and ethnicity, according to the National Institutes of Health (NIH). If lifestyle changes aren't helping you move toward your weight-loss goals, you may be tempted to try another tool: medications like the much-discussed Ozempic.

We talked to experts about what to expect if you take Ozempic for weight loss (such as GI-related discomfort in the early days) as well as who is a good fit for this medication and more.

Ozempic, which is injected once a week, is a diabetes medication. It helps improve blood sugar for people with type 2 diabetes, per the Ozempic website.

Ozempic is in a class of medications known as incretin mimetics, which help the pancreas release appropriate levels of insulin when blood sugar levels are high, according to the National Library of Medicine (NLM).

The medication can also can lead to weight loss — up to 14 pounds, per the Ozempic website.

"Ozempic mimics one of the hormones created in the body," says Mir Ali, MD, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California.

That hormone is known as glucagon-like peptide-1 (GLP-1), which slows down digestion and reduces the amount of nutrients absorbed in the GI tract. Ozempic contains semaglutide, which mimics this hormone.

Using Ozempic for weight loss is common, but also considered an "off label" use, at least for now, because the medication is not approved for weight loss by the FDA. "Ozempic is not a weight-loss drug," per the drug's website.

That said, another medication, Wegovy, which contains a higher amount of the same active ingredient (semaglutide) and is made by the same company, was approved for weight loss in June 2021 by the FDA.

Semaglutide, the active ingredient in Ozempic, is effective for people with type 2 diabetes because it helps lower blood sugar. But two additional effects of Ozempic explain why it can be helpful when it comes to weight loss:

1. ‌Food stays in your stomach longer.‌ Semaglutide causes a slow-down in the emptying of your stomach, Dr. Ali says.
2. ‌It also affects your brain.‌ Ozempic "acts centrally in the brain to kind of suppress your appetite," Dr. Ali says.

When you take Ozempic, you don't feel as hungry because you don't get hunger cues from your brain — and you'll also feel full longer due to the slow-down in your digestion.

"It's multifactorial," says Mitchell Roslin, MD, the chief of bariatric surgery at Lenox Hill Hospital in New York — that is, Ozempic works on several parts of the body in different ways.

And when it comes to weight, semaglutide makes a difference. "It has been shown to be more effective than a lot of the other medications that are available for weight loss," Dr. Ali says.

One study looked at the effects of taking semaglutide weekly for adults with overweight or obesity. Study participants received injections of 1.7 or 2.4 milligrams; the maximum recommended dose of Ozempic (the lower-dose semaglutide medication) is 2 milligrams per week, according to Novo Nordisk, which makes both Wegovy and Ozempic. At three months, study participants had lost 5.9 percent of their body weight, and at six months, they'd lost 10.9 percent, per the September 2022 results in ‌JAMA Network Open‌.

In a double-blind trial funded by Novo Nordisk of nearly 2,000 adults with obesity, some participants received a placebo medication, while others took a once-a-week injection of 2.4 milligrams of semaglutide for a period of 68 weeks (nearly a year and half). Both received lifestyle interventions as well, but the people taking the medication lost 14.9 percent of their body weight, while those taking the placebo lost only 2.4 percent of their weight, per the March 2021 results in ‌The New England Journal of Medicine‌‌.‌

When people first begin taking Ozempic, they often experience a range of unpleasant gastrointestinal symptoms. That includes nausea, vomiting, cramping, diarrhea or, sometimes, the opposite effect of constipation, Dr. Ali says.

These symptoms tend to "fade with time," Dr. Ali says. Typically, to reduce symptoms, doctors start people with a low dose and let them "acclimate to the symptoms," he says, slowly upping the dosage over a period of a few months.

It's important to note here that just about any medication comes with the possibility of side effects. "Only in science fiction can things be fairly effective and people don't feel [side effects]," Dr. Roslin says. The question is usually whether the results of taking the drug outweigh these unwanted effects.

Ozempic was first approved by the FDA as a diabetes medication in 2017, so it's been prescribed for several years.

"It's relatively new for weight loss, but it has been around for some years for diabetes," Dr. Alis says, noting that it doesn't appear to make blood sugar levels drop too low. He says he's unaware of any serious complications due to the medication. "But of course, everybody responds differently to medication," he notes.

Certain people should avoid taking the medication, according to Novo Nordisk — this includes anyone with:

• A family history of medullary thyroid carcinoma
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• Pancreatitis or a history of it

The medication should not be used during pregnancy, or for a few months prior to conceiving.

There's also a risk you may lose muscle instead of just fat, which is why it's important to work with a professional to make sure you're losing weight in a healthy way.

There may be other, less common risks — such as diabetic retinopathy complications — per Novo Nordisk. Plus, in animal studies, Ozempic caused thyroid tumors (including cancerous ones). And while this can't be extended to humans, other research — published February 2023 in ‌Diabetes Care‌ — has found that similar drugs (liraglutide, exenatide and dulaglutide) increase the risk of thyroid cancer in people. Semaglutide (Ozempic) wasn't included in the study.

As the buzz around Ozempic has gotten louder, media outlets have begun covering an anecdotal side effect of the drug dubbed "Ozempic face." According to ‌The New York Times‌, this is the term for the gaunt, exhausted look people might have after rapid weight loss, because they've lost facial fat.

This "facial aging" is not a side effect you'll find on the medication's label, but you will find plenty of fodder about it on TikTok.

As a reminder, Ozempic is currently only FDA-approved as a treatment for diabetes. It's not approved as a weight-loss treatment — but Wegovy, a medication with a higher dosage of semaglutide, is.

In the bariatric community, semaglutide medications are considered for people with a body mass index (BMI) higher than 30, which is considered obesity, Dr. Ali says, or a BMI greater than 27 with at least one weight-related disease (such as diabetes or high blood pressure). "I do have patients with BMI lower than that coming in, and I have to tell them that it's considered an off-label use of the medication," he says.

Wegovy is also approved for people with overweight and a weight-related health condition (think: high cholesterol or high blood pressure), according to the FDA.

If you're taking a semaglutide medication with the goal of losing weight, keep in mind that once you stop taking the medication, you may find yourself gaining back weight. "If you stop these drugs, you're going to see recidivism," Dr. Roslin says.

One study looked at what happened after people stopped taking 2.4 milligrams of semaglutide a week for 68 weeks, as well as removing structured lifestyle interventions. After a year, "participants regained two-thirds of their prior weight loss," per the August 2022 study in ‌Diabetes, Obesity and Metabolism‌.

That may seem discouraging. But consider this: While they did regain weight, it was less than those who'd initially been given a placebo. People who'd been in the placebo arm of the study — getting a placebo medication as well as structured lifestyle interventions — basically reverted to their initial weight after a year without either the placebo or lifestyle interventions. But those who'd taken the medication wound up below their starting weight by 5.6 percent.

Insurance companies will not cover the cost of an off-label use of Ozempic, which means you may have to pay out of pocket to use the medication for weight loss.

A 90-day supply of Ozempic (without insurance) is on average $2,663, per GoodRx, which compares the costs of prescription medications at various pharmacies.

Studies point to semaglutide as being effective for weight loss. But medications have limits. "This is obviously going to help you eat less food [but] it's not going to tell you what to eat," Dr. Ali points out. "The goal is to get those patients on a healthy path and the medication is helping them get to that path."

In other words, you'll need to make lifestyle changes too if you want to keep from regaining the weight you lose while taking the drug.