Ozempic is an injectable medication containing "semaglutide" as an active ingredient. The medication is primarily used to treat type 2 diabetes, but it has also been shown to promote weight loss in people who are overweight or have obesity. The question is, HOW?

Well, apart from helping the pancreas to produce insulin and preventing the liver from making and releasing too much sugar to manage type 2 diabetes, semaglutide also works by slowing down stomach emptying, which suppresses appetite and induces satiety (a feeling of being full) which is a primary factor of weight loss.

Hence, Ozempic (semaglutide) can help you lose weight in two ways: Appetite suppression and slower gastric emptying.

Appetite Suppression

When semaglutide acts on the GLP-1 receptors in the brain, it imitates the effect of eating, giving you a feeling of satiety (less appetite). A suppressed appetite means a reduced food intake and higher chances of sticking to a calorie-restricted diet. This chain of events will ultimately significantly reduce your body weight over time.

Slower Gastric Emptying

Another mechanism through which Ozempic (semaglutide) produces the feeling of fullness and appetite loss is by slowing down the rate at which food moves through and out of your stomach into the small intestine. This process typically makes you feel fuller for longer periods and reduces your overall food intake, resulting in weight loss.

The Impact of Ozempic on Blood Sugar Control

Ozempic (semaglutide) mimics the effect of GLP-1 (glucagon-like peptide-1) in the body. GLP-1 is a naturally-occurring hormone in the gut that triggers insulin production and reduces glucagon production to regulate blood sugar levels.

In other words, As a GLP-1 receptor agonist, Ozempic binds to the GLP-1 receptors on pancreatic beta cells and activates them to stimulate insulin release and inhibit glucagon release, thereby reducing glucose production in the liver.

By increasing insulin production and inhibiting glucagon release, Ozempic can help to lower blood sugar levels in people with type 2 diabetes. It can also slow down stomach emptying, reducing postprandial (after-meal) blood sugar spikes.

What is Ozempic?

Ozempic is a prescription medication for type 2 diabetes treatment. It is a product of a Danish pharmaceutical company, Novo Nordisk: the developer of the popular insulins Novolog and Fiasp.

Ozempic is an excellent alternative when first-line treatments like Metformin and lifestyle changes fail to control high blood sugar. It contains semaglutide as an active ingredient and is injected subcutaneously once weekly due to its long duration of action.

People with type 2 diabetes are typically either insulin resistant or don't produce enough insulin, leading to high blood glucose levels. Ozempic works by activating the GLP-1 receptors in the body to increase insulin production, reduce glucose production in the liver, and slow down glucose absorption in the small intestines. This chain of actions helps to lower blood sugar levels and improve glycemic control in people with type 2 diabetes.

But that's not all! Because apart from helping diabetic patients achieve blood sugar control, Ozempic is also an off-label drug for weight management, and clinical research has proven its effectiveness in that regard!

Moreover, type 2 diabetes patients with higher risks of cardiovascular (CV) events such as stroke, high blood pressure, and heart attacks can take Ozempic (semaglutide). Research has shown that the medication significantly reduced the risk of life-threatening CV events.

Who Can Take Ozempic for Weight Loss?

Although not an approved weight loss drug, many healthcare professionals prescribe Ozempic off-label for chronic weight management. This is after several clinical trials have yielded positive results regarding the effectiveness of semaglutide as a weight loss medication.

However, Ozempic is not for everyone, especially those with a personal or family history of medullary thyroid carcinoma (a type of thyroid cancer) or patients with multiple endocrine neoplasia syndrome type-2. Clinical research on rodents has shown a connection between Ozempic and certain thyroid cancers. However, the risks are yet to be ascertained in humans. But safety demands complete avoidance of the medication if you or your relative have a history of the disease.

You shouldn't take Ozempic if you are pregnant or trying to be. Those allergic to semaglutide are also not eligible for this drug class.

However, you are a good candidate for Ozempic (semaglutide) if you fall into any of the categories below:

  • You are an adult with Type 2 diabetes.
  • You have cardiovascular disease or are at a high risk of developing cardiovascular disease.
  • Your A1C level is uncontrolled with other medications.
  • You are struggling to lose weight and have type 2 diabetes.

Requirements for Ozempic Use in Weight Loss

The Food and Drug Administration (FDA) approves Ozempic for type 2 diabetes treatment and risk reduction for specific cardiovascular events in people with type 2 diabetes.

However, Ozempic may be prescribed off-label for weight management by some doctors if,

  • You are an adult with a body mass index (BMI) of 30 kg/m² or greater.
  • You are an adult with a BMI of 27 kg/m² or greater with at least one weight-related comorbidity like hypertension, type 2 diabetes mellitus, or dyslipidemia.

Notably, Ozempic is not intended for use as a stand-alone weight loss medication. It is typically used as part of a comprehensive weight loss plan. Hence, you must continue your lifestyle modifications (including a healthy diet and exercise) to achieve and maintain weight loss while on Ozempic.

Contraindications and Precautions

Ozempic (semaglutide) is contraindicated in patients with the following:

  • A personal or family history of medullary thyroid carcinoma (MTC).
  • Multiple Endocrine Neoplasia syndrome type-2 (MEN 2).
  • Known hypersensitivity to semaglutide or any of the product components.

Is Ozempic Safe?

Since Ozempic is an FDA-approved medication, it is considered safe and effective when used as indicated.

But "safe" doesn't imply the total elimination of risks!

For instance, Ozempic comes with a boxed warning about thyroid C-cell tumors occurring in rodents, although the risks are yet to be ascertained in humans. Hence, it shouldn't be used if you or your family have a history of certain thyroid cancers.

Common Side Effects of Ozempic

Like any medication, Ozempic potentially has a few common side effects:

  • Nausea
  • Diarrhea or constipation
  • Vomiting
  • Burping
  • Reflux
  • Indigestion
  • Constipation
  • Stomach pain
  • Abdominal distension
  • Gas 
  • Flatulence
  • Gastritis

Ozempic may also pose severe side effects that warrant urgent medical attention. A few examples include,

  • Life-threatening allergic reactions,
  • Worsening of existing diabetic retinopathy
  • Kidney disease or injury
  • Chronic renal failure exacerbation
  • Inflammation of the pancreas (pancreatitis)
  • Inflammation of the gallbladder
  • Gallstones
  • Fainting
  • Signs of a thyroid tumor (swelling or a lump in your neck, trouble swallowing, a hoarse voice, shortness of breath, etc.).

Many side effects are not captured on this list. So before you start taking Ozempic, talk to your doctor about the possible side effects and how the benefits outweigh the risks.

NOTE: The most common side effects of Ozempic can be managed at home, and the most serious ones are not very common.

Importance of Medical Supervision and Follow-Ups

It's crucial to work closely with a healthcare professional, whether you are taking Ozempic for weight loss, type 2 diabetes, or any related complications.

Your doctor is best positioned to monitor you for potential side effects, including evaluating your thyroid and renal functions. This close surveillance will inform your doctor when to adjust your dosage or change your prescription entirely if necessary.

Alternatives to Ozempic

While Ozempic has a high success rate and wide acceptability in treating type 2 diabetes and related issues, it may not work for some people.

Some patients are at higher risk of serious side effects. Others can't cope with the mildest adverse effects like nausea and vomiting. Another reason some resort to Ozempic alternatives is insurance coverage issues or a general supply shortage.

Whatever reason you can't take Ozempic, your doctor may prescribe any of the following alternatively:

Wegovy

The FDA approved using semaglutide for weight loss in 2021 under the brand name: Wegovy. Since Ozempic contains the same active ingredient (semaglutide) but is only approved for type 2 diabetes (and used off-label for weight loss), Wegovy is not just an excellent alternative but the ideal once-weekly injection as far as weight loss is concerned.

While both medicines work similarly, the only notable difference is their dosages. Ozempic can be taken at 2 mg once a week, whereas Wegovy can go as high as 2.4 mg weekly. The higher doses of semaglutide available in Wegovy result in greater weight loss for patients using the medicine.

In the population studied for Wegovy, users lost 35 pounds on average after 68 weeks. But the population studied for Ozempic only lost about 9 pounds with the 0.5 mg dose and about 12 pounds with the 1 mg dose.

Your doctor will typically prescribe Wegovy if you have a BMI of 30 kg/m2 or greater (obesity) or a BMI of 27 kg/m2 or greater (overweight) with at least one weight-related comorbidity like hypertension (high blood pressure), Type 2 diabetes, or dyslipidemia.

Rybelsus

Rybelsus (semaglutide) was approved in 2019 as the first oral GLP-1 receptor agonist for type 2 diabetes. Hence, this is not just an alternative to Ozempic but also a vital oral antidiabetic drug for patients who can't use injections!

Unlike the once-weekly Ozempic and Wegovy injections, Rybelsus is taken once daily, usually with a starting dose of 3mg for 30 days. This is then increased to 7mg daily for 30 days and then to 14mg daily, depending on how the user responds to treatment.

Although this drug is not currently approved for weight loss, healthcare professionals may prescribe it off-label for weight management since it has proven quite effective in recent studies.

Trulicity

The primary difference between Trulicity and Ozempic is their active ingredients. While Ozempic contains semaglutide, Trulicity has dulaglutide. However, both drugs are GLP-1 receptor agonists injected once weekly to lower blood sugar levels in people with Type 2 diabetes.

Like Ozempic, Trulicity is not yet approved for weight loss, although clinical research has proven its effectiveness. For instance, in a 36-week study, an average weight loss of 6.6 pounds occurred in patients taking the 1.5 mg dose. Also, a weight loss of 8.4 pounds happened among those on the 3 mg dose. And a weight loss of about 10 pounds was noted among those on the 4.5 mg dose.

However, it's crucial to consider the statement from the Trulicity manufacturer: "On average, patients experienced weight loss; however, some patients did not lose weight."

While Ozempic has evidently caused more weight loss than Trulicity, studies have shown that either medication can help people with Type 2 diabetes lose weight.

Metformin

Metformin is another common antidiabetic medication taken orally by people with Type 2 diabetes to help lower blood sugar. However, it neither has the same active ingredient nor the exact working mechanism as Ozempic and Rybelsus.

But some type 2 diabetes patients have lost weight while taking Metformin, according to various clinical trials, meaning that some others failed to lose weight.

Another separate study that investigated Metformin's weight loss effectiveness in nondiabetic patients with obesity found that Metformin can be effective in reducing extra weight in a naturalistic outpatient setting in insulin-sensitive and insulin-resistant overweight and obese patients. Specifically, the average weight loss in the Metformin-treated group after six months was 5.8 kg (about 12.8 pounds). 

Metformin, however, is not approved as a weight-loss medication and is sometimes prescribed off-label for overweight or obese people. So it can be another option other than Ozempic for weight loss.

Frequently Asked Questions

Can Ozempic help you lose weight?

Clinical studies have shown that treatment with Ozempic can lead to significant weight loss in people with obesity or overweight. In one study, people taking Ozempic lost an average of 10-15% of their body weight after 68 weeks of treatment combined with lifestyle changes like reduced-calorie diets and increased physical activities.

When will I start seeing results with Ozempic?

The timeframe for seeing results with Ozempic for weight loss can vary from person to person. But results from clinical studies have shown that most people taking Ozempic can notice a significant weight loss after 12 weeks of treatment; others can see results after a few weeks.

Several factors can determine the amount of weight loss and the timeframe for seeing results. For instance, a person's age, gender, baseline weight, medical history, and lifestyle habits can affect their weight loss timeframe and results. People who follow a healthy diet, exercise regularly, and take Ozempic as prescribed by their healthcare provider are also more likely to achieve weight loss.

What happens when you quit Ozempic?

Stopping the Ozempic medication will likely have a rebound effect on your initially lost weight. This is partly because your metabolic health will return to what it used to be; your stomach emptying will get quicker; you will get hungrier, and your cravings may come back, making you eat more and gain weight.

A 2022 study found that people who discontinued semaglutide gained back two‐thirds of their prior weight loss within one year.

Conclusion

Ozempic is one of the many antidiabetic medications that can help with effective weight management through appetite suppression, slower gastric emptying, and lowering blood sugar levels.

For better weight loss results, taking the medication along with healthy diet and lifestyle changes is crucial. But since Ozempic is only approved for type 2 diabetes treatment, obese people taking the medication off-label for weight loss should only do so as prescribed by a doctor.

Sources

To ensure that we give you correct, accurate, and relevant information, all articles on Diabetic & Me are backed by verified information from academic research papers, well-known organizations, research institutions, and medical associations.

  1. National Library of Medicine Glucagon-like peptide 1 and appetite
  2. National Library of Medicine Recent advances in understanding the role of glucagon-like peptide 1
  3. National Library of Medicine Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity
  4. National Library of Medicine Effects of semaglutide on risk of cardiovascular events across a continuum of cardiovascular risk
  5. Novo Med Link After 2 years, Ozempic® significantly reduced the risk of potentially life-altering CV events (MACE)
  6. National Library of Medicine Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity
  7. Ozempic Considering Ozempic
  8. Trulicity Trulicity and weigthloss
  9. National Library of Medicine Weight regain and cardiometabolic effects after withdrawal of semaglutide

About the Author

Ely Fornoville

Hi, I'm Ely Fornoville, and I am the founder of Diabetic Me. Being a type 1 diabetic since 1996, I developed a passion to help people learn more about diabetes. I write about diabetes and share stories from other diabetics around the world. I currently use a Medtronic Guardian 4 CGM and a MiniMed 780G insulin pump with Humalog insulin.

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