Ozempic, who is it for and how will affect your health?

with a contribution from Kim Restall Head of Weight management Institute - Saint James Hospital

BSc (Hons) Nutrition & Dietetics

In 2022, 2.5 billion adults were overweight, of which over 890 million were living with obesity. That is, about 16% of all adults worldwide were obese in 2022 - more than double the prevalence in 1990. In Europe nearly 60% of adults and 1/3 of children are classified as overweight or obese. Obesity is a complex chronic disease with increased risk of cardiovascular disease, diabetes, cancers, chronic respiratory diseases and is a leading cause of death. To date nothing has slowed the growth of obesity in any nation - diets, calorie-counting, exercise programs, surgery, lifestyle coaching, behaviour modification or group therapy efforts have done little to curb the problem. In 2021 semaglutide, under the brand name Wegovy, was approved specifically to treat obesity.

Semaglutide belongs to a class of relatively new medications known as GLP-1 receptor agonists. Originally these drugs were prescribed to treat type 2 diabetes as they improve blood sugar control however over time it was noticed that they also promote weight loss. They work by reducing sugar in the blood, slowing stomach emptying and increasing feelings of fullness. There are currently three such medications approved for weight loss: liraglutide (Saxenda), semaglutide (Wegovy; Ozempic when prescribed for diabetes) and tirzepatide (Zepound; Mounjaro when prescribed for diabetes). 

The popularity of these drugs has boomed in the past few years due to the rapid weight loss results. However it is important to understand that they are just one part of a treatment plan when treating insulin resistance and obesity. The weight loss results seen in clinical trials occur in combination with a significant lifestyle change - a change in diet and increase in exercise. 

Like all drugs these medications also carry the risk of side effects. These include gastrointestinal upset, headaches and fatigue. When prescribed for weight loss there are some very important considerations which must be made and discussed with your doctor.

Not all weight loss is healthy, even in obese individuals. Body weight does not take into account body composition - the proportion of fat, bone and muscle in your body. These drugs cause a rapid loss in body weight, a significant portion of which is lean mass (bone and muscle). So whereas shedding excess fat (especially visceral fat) has many health benefits, losing lean mass is associated with several health risks.

Low muscle mass and strength are associated with a higher risk of disease and muscle is also an extremely important metabolic organ. In order for these medications to be beneficial they must have an overall positive effect on body composition. So, for example, individuals who are obese but have low muscle mass (sarcopenia) may not be the ideal candidate for this weight loss strategy, and resistance training (weights) will form an important part of the treatment strategy. 

As these drugs slow down digestion certain foods may become more challenging to tolerate, for example high fat and greasy foods, which may trigger heartburn and other gastrointestinal discomfort. Also, as you start to feel fuller quicker, portion sizes and frequency of meals will decrease, making it crucial to prioritise foods which are nutritious and support health and weight loss. Certain food groups like fibre, protein and healthy fats must be prioritised. There is no one size fits all diet for patients on this drug and therefore nutritional needs should be closely supervised by registered dieticians.

Kim Restall BSc (Hons) Nutrition & Dietetics - Head of Weight management Institute, Saint James Hospital.

It is important that dietary invention is also followed in conjunction with taking Ozempic. Firstly, due to the fact that the medication slows own digestion and therefore may make some foods more challenging to tolerate. For example, high-fat and greasy foods, that are therefore remaining in the stomach for a longer period may trigger heartburn and even constipation.

Secondly, due to the decrease in portion size and frequency of meals being eaten while on such medications, it is crucial to prioritise the foods eaten for a balanced nutrition for both overall health and increased weight loss. Therefore, it is important to ensure that the diet does not restrict or eliminate food groups and includes foods high in fibre, protein, and healthy fats. Nevertheless, there isn’t a one-size-fits-all diet for all patients taking Ozempic, and therefore patients’ nutritional needs should be closely supervised by registered dietitians.

Physical activity and exercise remains a crucial part of your overall well being too. Getting regular aerobic exercise along with sufficient resistance training every week are key to obtaining and maintaining successful results with these drugs. 

As a general rule GLP-1 agonists are the appropriate weight management solution for obese patients who have sufficient lean mass. When prescribed these drugs efforts must always be made to minimise lean mass loss. There are two crucial ways in which this is done:

1. Consume sufficient amounts of protein (about 2g of protein per kg of body mass) - ensuring you eat enough protein throughout the day by consuming high amounts of protein with every meal and, if necessary, supplementing with protein shakes to help preserve muscle mass. 

2. Regular resistance training (at least 2 sessions per week)  - in the form of bodyweight exercises and/or weight training, is critical in helping slow any loss in muscle mass as well as maintain bone density.

Clearly these drugs have a potent effect on blood sugar control and weight loss when prescribed correctly. Other benefits - which seem to be a result of the drastic weight loss - are the lowered risk of heart disease, heart failure, stroke, kidney disease as well as improved blood pressure and cholesterol levels. Careful monitoring and guidance whilst on these drugs is essential. As these drugs are relatively new to the market, their long-term effects are not yet fully understood. ‘Ozempic face’ is one undesirable effect currently being reported due to rapid weight loss. These are potent drugs and should only be taken when prescribed under the guidance of your doctor in conjunction with other specialists such as dieticians and must be combined with lifestyle changes.

If you would like to test your personal risk factors for developing chronic diseases of ageing, and find out if weight loss drugs are indicated for you, find out more about the Longevity Annual health check and download the longevity doctor guide to healthy living.