Beyond the Prescription: The Global Ozempic Dilemma

We first wrote about Ozempic and its use for weight loss in December 2023. When discussing the glucagon-like peptide (GLP-1) drug, we found that although it was originally developed as a diabetes treatment, Ozempic (otherwise known as Semaglutide) has gained widespread attention for its weight loss effects, though with emerging limitations (1–3). The mechanism of action includes the increased stimulation of insulin production, which helps balance blood glucose concentrations and reduce appetite. This reduction in appetite results in reduced calorie consumption and eventually weight loss (4,5). In recent months, Ozempic has been the subject of significant media coverage, presenting several noteworthy developments that warrant further examination and discussion.

Previously, we discussed various scientific studies that showed the drug was effective in achieving weight loss, but once taken off the drug, a large number of participants gained back all the weight lost (1,3). According to a 2024 study published in The Lancet Diabetes & Endocrinology, weight regained after stopping Semaglutide was common. The study included 180 participants, half of which received Semaglutide while the other half received a placebo as well as lifestyle changes, for 52 weeks (6). Once again, the study showed positive weight loss results in the Semaglutide versus the placebo group (13.9% body fat reduction vs 2.7%, respectively). However, once taken off the drug, weight loss was regained (6). Consequently, putting patients back at their starting point, at their doctor’s office requesting additional prescriptions, creating a reliance on the drug. 

The increasing use of Ozempic has resulted in a drug shortage all over the world (8), which has no clear resolution. This shortage means no weight loss drug for overweight patients, but also none for diabetic patients. It’s important to remember that the original purpose of Ozempic was to manage diabetes, a potentially fatal lifestyle disease with long-term symptoms such as blindness, amputation, and heart failure (9). This shortage creates a difficult question: should a drug intended for diabetes management be redirected for weight loss, especially when it's not FDA-approved for this purpose?

A side effect of the drug shortage is the illegal purchase of the drug on the black market (7). A recent position statement from the South African Health Products Regulatory Authority (SAPHRA) warned that Ozempic is not cleared as a weight loss treatment in South Africa, and rather only for the use of diabetes (9). They also mention that no generic options are available and that people should be cautious about buying the drug from anyone other than their registered practitioner. Despite these warnings, reports have surfaced of people buying the drug online, at beauty salons and fitness centers. This can lead to dangerous side effects as the ingredients of the drugs on the black market may contain toxic ingredients (11). Buying medications online or from illegitimate sources places people on chronic medication at an additional risk, due to the likelihood of medications responding negatively to one another. People should practice extreme caution when buying any sort of prescription drug “over the counter” from unreliable sources.  

Initially, only mild side effects were reported when using the drug, such as nausea or constipation. Recently, however, more severe side effects have surfaced, such as pancreatitis, stomach paralysis, digestive issues, and bowel obstructions. A recent study published in the journal The American Medical Association investigated the effects of Semaglutide on the digestive system. In addition to controlling blood glucose, the drug works by delaying gastric emptying, subsequently leading to severe constipation and digestive blockage when used for extended periods (7). Severe, long-term obstructions can lead to hospitalization or, in worst-case scenarios, be fatal. 

Despite the side effects, worldwide shortage, and the high prices (mentioned in our previous article, at R1200 – R1500 a syringe), it remains popular in the public eye. When searching for the latest news, celebrities such as Oprah, Christina Aguilera, Kylie Jenner, and many others have publicly discussed using Ozempic (10). Oprah in particular hosted an ABC special discussing the use of Ozempic with doctors and specialists. The episode highlighted the importance of finding effective treatments for obesity, which Ozempic is proving to be. Although the FDA has not cleared the drug for weight loss, doctors are eligible to decide whether to prescribe it for weight loss, or not. Despite its efficacy, increasing reports highlight its lack of long-term sustainability. Articles indicate that patients struggle to maintain their weight loss, often facing heightened hunger and regaining weight after discontinuing the drug, which aligns with the findings in the scientific literature (1,3). Given the high prices and ongoing shortage, an increasing number of patients are being forced to discontinue the drug. This raises an important question: wouldn't it be more beneficial to explore sustainable weight loss treatments that can be maintained long-term?

If you’re considering Ozempic, it's crucial to weigh the long-term implications. The benefits cease when the medication does—so ask yourself, is this a commitment you’re willing to sustain indefinitely? While Ozempic has its place, countless sustainable strategies for weight management exist and don’t come with the same dependency. Building a balanced routine that includes daily movement, a diet rich in protein, fiber, and vegetables, regular strength training, adequate hydration, and quality sleep can be both affordable and transformative. At the end of the day, the healthiest journey is often the one we can maintain for life.

References:

1. Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug 1;24(8):1553–64.
2. Smits MM, Van Raalte DH. Safety of Semaglutide. Vol. 12, Frontiers in Endocrinology. Frontiers Media S.A.; 2021.
3. Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults with Overweight or Obesity. JAMA. 2021 Apr 13;325(14):1414.
4. Jones C. Rolling Stone. 2023. Weight Watchers Is Pivoting to Ozempic. Influencers Aren’t Following.
5. Kunene Z. News24. 2023. Ozempic: A hashtag and a helpful effect collide, draining global stocks of a diabetes drug.
6. McGowan, B. M., Bruun, J. M., Capehorn, M., Pedersen, S. D., Pietiläinen, K. H., Muniraju, H. A. K., Quiroga, M., Varbo, A., & Lau, D. C. W. (2024). Efficacy and safety of once-weekly semaglutide 2·4 mg versus placebo in people with obesity and prediabetes (STEP 10): a randomised, double-blind, placebo-controlled, multicentre phase 3 trial. The Lancet Diabetes & Endocrinology, 12(9), 631–642. https://doi.org/10.1016/S2213-8587(24)00182-7.
7. Sodhi, M., Rezaeianzadeh, R., Kezouh, A., & Etminan, M. (2023). Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA, 330(18), 1795. https://doi.org/10.1001/jama.2023.19574
8. Aoife WPRai. BBC News. 2023. Weight loss injection hype fuels online black market.
9. Diabetes Australia. Diabetes - long-term effects. 2013.
10. Oprah Hosts ABC Special on Impact of Ozempic, WeGovy, Mounjaro Weight Loss Medications. 2023.
11. Public Urged To Use Registered Ozempic Products. 2023.