Ozempic® may be one of the most talked-about medications in recent history. Celebrities are touting it. Doctors are hailing it as a research-backed breakthrough. And that commercial jingle is probably one of the most frustratingly catchy tunes since “Baby Shark.”
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Its popularity has led to shortages, as people and their providers scramble to get their hands on a drug that has been shown to be incredibly effective for treating both diabetes and obesity. It’s a major medical advancement that could make a big difference.
The U.S. Centers for Disease Control and Prevention (CDC) estimates 42% of Americans are living with obesity (defined as a body mass index, BMI, of 30 or higher). For them, Ozempic and anti-obesity medications are being hailed as a major triumph. And for good reason.
For people with a BMI lower than 30, the old standbys of diet and exercise are the best route to maintaining a healthy body weight. But for people with obesity, lifestyle changes won’t likely do the trick. But new medications can reverse dysfunctional pathways that cause obesity and lead to a host of chronic diseases, like heart disease, kidney disease, sleep apnea and more.
So, how does Ozempic work, and who should take it (and who shouldn’t)? Obesity medicine specialist W. Scott Butsch, MD, MSC, helps explain why Ozempic has become so popular for weight loss and why new anti-obesity medications are a major victory for people with obesity.
What is Ozempic?
Ozempic (also known by the generic name semaglutide) was approved for use as a diabetes medication in 2017. The makers of Ozempic call weight loss a “side effect,” but it’s been shown in numerous research studies to be an effective option for treating the disease of obesity.
Dr. Butsch explains that Ozempic is the same medication as Wegovy®, which was approved by the U.S. Food and Drug Administration (FDA) in 2021 as an anti-obesity medication. Ozempic is just a slightly lower dose of the same drug.
Providers can (and do) prescribe Ozempic “off-label” for people who are living with obesity. Using a medication off-label means it’s prescribed for a use other than its stated purpose. And it’s really common across the medical field. For example, you could be prescribed certain heart drugs called beta-blockers for situational anxiety or your provider may prescribe anti-seizure medication to treat migraines. In the case of Ozempic, it makes total sense to use it to treat obesity, considering its sister drug, Wegovy, is approved for that use.
The FDA says that after it approves a medication, it’s able to be used in other situations when medically appropriate. In other words, there’s nothing dangerous or “wrong” about medicines like Ozempic being used off-label to treat obesity. That is, if you have obesity and your provider determines that it’s the best course of action for you.
How does Ozempic work for people with obesity?
Ozempic is a drug you inject once a week in your thigh, abdomen or upper arm. It’s in a class of medications called “GLP-1 receptor agonists” or “GLP-1 drugs” for short. These medications mimic a hormone released from the digestive tract called glucagon-like peptide (GLP-1), which helps lower blood sugar and promotes a feeling of fullness.
“We’ve seen GLP-1 agonists used for 15+ years to manage diabetes and obesity,” Dr. Butsch notes.
And in the past few years, those medications have become more effective and easier to use. In the past, these medicines required injections daily or even twice a day. Today, they need to be injected only once a week. And the dosage has increased.
More than an appetite suppressor
When you take Ozempic or other GLP-1 agonists, your body makes more GLP-1. That lowers your appetite and, therefore, you eat less. But Ozempic isn’t simply a tool that suppresses appetite, Dr. Butsch says. Ozempic, like anti-obesity drugs, actually changes how your body responds to weight loss.
“Obesity isn’t a behavioral problem. It’s not managed by just eating less or exercising more,” Dr. Butsch says. “Obesity is a complex, metabolic disease. It’s a dysfunction of the normal pathways that regulate our body weight or, more specifically, our body fat. Taking anti-obesity medications or other GLP-1s, like Ozempic, may change your body’s reaction to food intake and weight loss.”
In other words, Ozempic and anti-obesity medications work not simply because they’re correcting a “bad” behavior by lowering your appetite and causing you to eat less. They change how your body responds to food.
“These medications allow your body to seek a lower weight range, and that may not be solely related to reducing your food intake,” Dr. Butsch says. “At the same time, GLP-1s also may lower your risk for a host of obesity-related diseases.”
Think of this common scenario: Even when we “diet” and increase our exercise, we tend to hit a weight-loss plateau, where our bodies actively fight against continued weight loss. It’s totally normal and expected. It’s part of what’s called your weight set point.
Your weight set point is the weight your body wants to live at. It’s the weight your body thinks is good for you, even if your BMI says otherwise. The defense of body weight (or body fat) in humans has evolved to fend off starvation. When we lose weight, our body fears we’re starving. So, it mounts a defense to keep weight on. It sends in “hunger hormones” and lowers “fullness hormones.” In short, your body will battle tooth-and-nail against weight loss.
So, rather than simply making you want to eat less, anti-obesity medications and Ozempic — like metabolic and bariatric surgery (“weight loss surgery”) — change the very functioning of your body in order to help you lose weight and keep it off. It’s that metabolic change that makes these medications appropriate for treating the disease of obesity, rather than a quick-fix weight loss for people who want to slim down for bikini season.
Is Ozempic effective for treating obesity?
Research has proven that higher doses of Ozempic — 2.4 milligrams of semaglutide — are very effective for reducing weight in people with obesity. In one landmark study, people with obesity who used the drug in combination with lifestyle interventions lost about 15% percent of their body weight in 68 weeks. They lost about 34 pounds on average. Research participants who didn’t take the medication lost about six pounds on average.
Who could benefit from anti-obesity medication?
Dr. Butsch says that all signs point to the use of an anti-obesity medication as a safe and effective treatment for people living with obesity, yet it’s not being used as often as you’d expect.
“42% of people in the United States have the disease of obesity, but only 2% of them are being treated with anti-obesity medications,” he adds.
Compare that with people living with diabetes — researchers say 88% of people who have diabetes use medication to treat their condition.
What’s the difference?
Though anti-obesity medications have been proven effective, there are several reasons people haven’t been able to access them readily.
- It’s expensive, and usually not covered by insurance. Wegovy, for example, can cost more than $1,000 per dose.
- Outdated thinking and stigmas about obesity abound. “Some providers haven’t yet come to understand that obesity is a disease that can (and often should) be treated medically,” Dr. Butsch states. “And many people living with obesity have internalized a stigma that makes them believe their obesity is somehow their fault. So, they aren’t asking for medication as a route to treatment.”
These tides are turning, though (and quickly!), leading to a shortage of both Wegovy and Ozempic. More on that in a bit.
Who shouldn’t use Ozempic?
Ozempic should be used only when prescribed by a medical professional. With the growing popularity of the medication and coupons widely available that initially bring down the cost, virtual clinics are popping up online to dole out Rx’s.
But Dr. Butsch cautions against obtaining a prescription online from a so-called “diet doctor.”
“Proper counseling about anti-obesity medication and other GLP-1s and their use is really important,” he stresses. “Understanding how the medication works and how it treats obesity can make a difference in how effective it will be for you.
“Additionally, anti-obesity medications are, for most people, medications you stay on for long periods of time, so if you can’t afford the medication when the coupon runs out, it’s not going to be effective long-term. These are the conversations you should be having with a medical professional who understands obesity.”
Like any other anti-obesity medication, Ozempic shouldn’t be used for short-term weight loss.
“Obesity is a chronic disease. Medications prescribed to treat obesity are used in the same way we treat diseases like high blood pressure or high cholesterol,” Dr. Butsch explains.
“Medications are used in combination with lifestyle modification to increase long-term effectiveness. One of the most common misconceptions is that people believe they could take a medication for a few months, then stop and maintain weight. However, you’re likely to regain the lost weight once the medication is stopped.”
In other words: Think of anti-obesity medication as a long-term commitment, not a quick fix for dropping a couple of pounds. You wouldn’t take insulin if you don’t have diabetes, and shouldn’t take anti-obesity medication if you don’t have the disease of obesity.
Why is there a shortage of Ozempic?
Demand for Ozempic has spiked big time in the past year or so, thanks in part to celebrity endorsements, provider willingness to prescribe and coupon programs that (at least initially) bring down the cost of the medication.
“Everyone’s hearing about this drug these days,” Dr. Butsch says. “People are excited. We finally have medications that are highly effective in treating obesity for the long term, and it’s a game-changer.”
As drug companies race to keep up with demand, one thing is for sure: New options for treating obesity have been shown to be effective when used properly. If you’re living with obesity, talk with a provider about whether you’re a candidate.