The Skinny on Ozempic
By Bonny Osterhage
Artwork by Alejandro Abeledo
It's a small world and getting smaller by the day, judging by the growing number of shrinking celebrities admittedly jumping aboard the Ozempic train. They aren’t the only ones going full steam ahead. Millions of people have turned to Ozempic, Mounjaro, Wegovy, or one of the other glucagonlike peptide-1 (GLP-1) medications to shed unwanted pounds. Designed for managing blood sugar in type 2 diabetics, these medications quickly surged in popularity for their appetite-suppressant qualities. Prescriptions have risen among pre- and even non-diabetics looking for a way to manage their weight.
However, as with anything that promises an easy solution to weight loss, nothing is as simple as it seems. There are several considerations when it comes to taking GLP-1 drugs, especially without an underlying condition, a significant amount of weight to lose, or doctor supervision. Side effects and high costs can outweigh the benefits for some people, while others might be willing to endure a few inconveniences for a shot at a slimmer way of life.
How It Works
According to Sarah Evans, a nurse practitioner in charge of the weight loss management program at Nova Aesthetics, GLP-1 medications influence hunger hormones to decrease hunger pangs and increase feelings of fullness. In other words, patients on the drugs eat less and still feel satisfied.
“GLP-1 medications make it easier for individuals to adhere to healthier eating habits without feeling deprived or overly hungry,” she explained, adding that the drugs also work to slow the digestive process. “This slower digestion helps keep blood sugar levels stable, preventing the rapid spikes and crashes that often lead to cravings or overeating,”
According to Evans, patients can expect to steadily and gradually lose approximately 5%–10% of their body weight over six months, with potentially more significant losses occurring after one year. For people like wardrobe stylist Jules Aldaz, who has struggled with her weight for years, it's easy to see why these drugs might look like the long-awaited answer to their prayers.
Aldaz has had a lifelong battle with her weight, fluctuating up and down before topping out at 200 pounds on her 5'1" frame. Pre-diabetic and with high blood pressure, the 55-year-old mother of two decided to try Mounjaro at the suggestion of her physician, Tamyra Rogers, MD. "It worked great. I lost seven pounds in the first month," she said.
Now, two years later, Aldaz is 80 pounds lighter. But more than just weight, she has lost her pre-diabetic status and is completely off of her blood pressure medication. Those losses equate to a big win overall.
Weighing the Side Effects
While Aldaz has been happy with her results, there were challenges along the way – some she still lives with. Much has been shared about the potential side effects of GLP-1 medications, specifically moderate to severe gastrointestinal issues. These issues can disrupt a patient's lifestyle or even affect the quality of it.
“The most common side effects of GLP-1 drugs include nausea, vomiting, diarrhea, and constipation, especially at the start of treatment,” said Evans. “Those side effects can often be minimized by gradually increasing the dosage and staying at the lowest effective dosage.” Of course, individuals should always consult a doctor or qualified health professional before beginning any new medication or changing dosing or treatments.
For Aldaz, however, the symptoms did not subside. “It’s not for the weak,” she said. Admitting that although some of the side effects subsided after a day or two, she experienced constant nausea and indigestion while on Mounjaro. "I took it once a week and was nauseous for two days after, with day two being the worst," she recalled.
There is also the risk of hypoglycemia, especially in diabetic patients who are on additional drugs to help lower glucose levels. A local diabetic woman who asked to be identified as L.Z. said that she often felt like her blood pressure was bottoming out while on Ozempic. "I felt dehydrated and dizzy," she described. Coupled with the fact that she didn't experience a significant reduction of appetite, only lost five pounds, and eventually had to have surgery for a ruptured gallbladder, L.Z. elected to discontinue the drug and switched to Mounjaro.
Dr. Monica Anz-Cavazos and Dr. Frank Kuwamura explain GLP-1 agonist drugs help decrease appetite and lower gastric emptying time, which helps patients eat less.
But they also laid out some serious caveats.
Always consult with a qualified healthcare professional before starting, stopping, or altering any medication.
Prescription drugs should only be taken as directed by a licensed physician or healthcare provider.
Regular lab work will help make sure GLP-1 therapy is safe and effective for you.
Get your labs checked periodically to monitor metabolic markers like calcitonin (a marker for cancer), pancreatic enzymes, and renal function to detect early signs of drug-induced kidney stress.
Weigh the risks.
These drugs may cause unwanted or serious side effects, like pancreatitis or medullary thyroid cancer, especially in patients with a family history of certain diseases. Nausea associated with GLP-1 therapy can lead to dehydration.
Diet and lifestyle changes are necessary.
Proper protein intake, exercise, and activity are necessary to maintain muscle mass. A loss of muscle mass can result in a lowered resting metabolic rate, making it harder to lose weight down the road.
GLP-1 medications are not appropriately indicated for patients with more severe obesity.
Bariatric surgery is typically the standard care option for weight management In patients with a 40+ BMI (or even 35+ BMI combined with metabolic or chronic conditions like diabetes or hypertension).
“I am feeling much better and have been able to change my eating habits since switching,” she said. “Personally, I would not recommend Ozempic.”
Interestingly, one of the most talked-about side effects of GLP-1 drugs – loss of muscle mass – may not be directly related to their use.
“Muscle loss itself isn’t directly caused by GLP-1 medications,” explained Evans. “Rather, it can result from losing weight too quickly, which can happen with any aggressive weight-loss program.”
To combat that issue, Evans recommends that patients incorporate strength training and focus on adding adequate protein to their diet, using the lowest effective dose of the medication to keep the weight coming off consistently, rather than at an excessive rate.
It is imperative that patients communicate with their physicians to ensure the medication and dosage are correct for their particular body type and needs. As L.Z. discovered, everyone's experience is different, and the medication that works for one person may not work as well for another. That's why Evans recommends compounded formulas.
“Compounding allows for customization to meet individual needs, such as adjusting dosage or combining ingredients,” she explained.
Plus, as insurance companies begin cracking down on coverage on GLP-1 drugs for patients who do not have diabetes, compounded formulas can be more cost-effective. That was the case for Aldaz, who had to switch to the compounded tirzepatide. “My insurance stopped covering Mounjaro because Iwas no longer considered pre-diabetic,” she said.
There’s No Magic Bullet
There is no denying that GLP-1 drugs are beneficial for helping stabilize blood sugar in people with diabetes. It is also a fact that weight loss can improve blood pressure and cardiovascular health. However, these drugs are not magic bullets and should not be considered substitutes for healthy lifestyle changes.
“They are most effective when used as part of a comprehensive lifestyle plan that includes a balanced diet and exercise,” said Evans. "They are not intended as a quick fix, as they support sustainable weight loss rather than rapid, short-term results.”
Dr. Monica Anz-Cavazos, Clinical Director of Sage Bariatric Institute in San Antonio, agreed. “These drugs are just one element of many that are needed to lose weight in a healthy way,” she said. “They help you eat less, but without dietary education and changes, they can do more harm than good.” Especially in terms of pre-diabetics, GLP-1 drugs shouldn't always be the first line of defense, as the same outcomes may be achieved by lifestyle intervention or different medications.
Dr. Anz-Cavazos underscored the importance of eating well in the face of eating less. “Our bodies cannot function healthfully without proper nutrition — we end up with vitamin and mineral deficiencies, chronic inflammation, and disease. When you are eating smaller amounts, it’s all the more important to be eating highly nutritious foods such as vegetables and lean proteins.”
Aldaz said that she recognizes that her medication is something to use in conjunction with—not instead of—a healthy lifestyle. "It is not a miracle worker," she advised. "You have to put in the effort and be very disciplined."
Without putting in the work to establish healthy habits, there is the very real possibility that the weight will return if and when a patient discontinues the use of the GLP-1 medication.
“Some patients may experience a return of appetite, which could lead to weight regain if not managed,” cautioned Evans.
One Size Does Not Fit All
For someone like Aldaz, who had tried for years to manage her weight through diet and exercise to no avail, GLP-1 medications have been life-changing and, in her opinion, worth the side effects. To those who suggest that the medication is a crutch, she is quick to point out that she exercised and followed a strict, physician-monitored diet and still couldn't get the scale to move. "I needed the shots because nothing else I'd done was working," she said. "I wanted to be healthy for my daughters.”
According to Evans, GLP-1 medications are typically only prescribed to patients with a body mass index (BMI) of 30 or greater, or a BMI of 27 or higher with an associated medical condition like hypertension, type 2 diabetes, or sleep apnea. It may not be the best option for those who want to use it simply to knock off five or ten pesky pounds.
"These medications are generally reserved for those with more significant weight management needs due to the potential side effects and cost," she explained.
They are also generally reserved for adults. Although childhood obesity and early-onset diabetes among adolescents are on the rise, Evans says that prescribing GLP-1 medications to minors, though approved by the FDA for a select group of younger patients, needs to be carefully regulated.
"There should be a thorough evaluation and collaboration between a child's pediatrician and endocrinologist to ensure that the benefits outweigh any risks, as children's developmental needs differ from those of adults," she said. "Ultimately, it should rely on the outcomes of rigorous studies, FDA review, and doctors' input to set appropriate guidelines.”
The future of GLP-1 drugs for children remains to be seen. Still, for adults like Aldaz, these medications can provide either a short-term jump start or a long-term solution, depending on the patient’s needs.
"I will probably be on it for the rest of my life, just at a lower dose and a longer period between injections," she said. "Everyone's journey is different, but if I had it to do over, I'd do it again in a minute. For me, it has been 100 percent worth it." ■
Disclaimer: This article is for informational and educational purposes only and should not be considered medical or health advice.
Consult with a qualified healthcare professional before starting any new medication or treatment. The authors and publishers of this
article do not assume any liability for the use or misuse of the information contained herein.
