How effective is Ozempic?
Ozempic and the other “GLP-1 Agonists” medications for weight loss have received nearly unprecedented popularity in just the last two years since their introduction. These medications routinely result in an average of 12 to 15% loss of bodyweight in overweight and obese patients. The GLP-1 medications include Ozempic (prescribed to diabetics who may also be overweight or obese), and Wegovy (the exact same medication prescribed for patients specifically for obesity). Other medications in the GLP-1 class include Mounjaro and Saxenda. Ozempic is also available as “compounded generic semaglutide” at a lower cost for patients who do not have insurance coverage for these medications. (In this blog I will refer to these medications, for the sake of simplicity, collectively as “Ozempic”.)
Ozempic is effective, but …
GLP-1 medications are without question effective in achieving weight loss. However, there are a couple questions that individuals contemplating going on these medications should ask themselves before starting treatment:
“Do I want to be on this medication for the rest of my life?”
“How do avoid becoming “addicted” to this medication, so I can eventually come off it?”
These are great questions, because the risk of becoming “drug dependent” to sustain weight loss is real. Why? Because in all the clinical studies on these medications patients have “significant weight regain” when stopping the medications. How much? The generally accepted percentage is that about two-thirds, or 66% of the weight lost will be regained. But there are exceptions (see below) . . . and sustainable weight loss without ongoing medication dependence is achievable.
What is the best approach to using Ozempic for weight loss?
As a clinician I feel it is very important that before I begin any patient on a GLP-1 medication we talk about their goals, and in most cases, their plan for eventually “getting off the medication”. This plan must include a number of techniques. Those techniques include the following:
“Begin with the end in mind.”
The first technique is that both the patient and I agree on the weight loss goal, and that the plan is to stop the medicine at some point. This may sound obvious, but in many cases, patients are prescribed medication without talking about the ultimate goal and plan.
Implement a comprehensive weight loss approach. That is, agree that the medication is only one component of the program.
Take an approach in which both doctor and patient agree that taking a shot once a week is not the only program component. Both are committed to the fact that other program components including diet and exercise plans are critical.
Avoid maximal medication dosages.
Ozempic and similar medications are taken as a once weekly injection. Because of the possible side effects (mostly nausea) these medications are “titrated” in escalating dosages monthly. For example, the first four-week dose is .25mg, the second month dosing is .5 mg weekly, the third month dosing is 1.0 mg weekly. Dosages as high as nearly 2.5 mg are common.
However, I have found that maximal dosing is usually not necessary. Often a top dose of 1.5 weekly will do the trick. Avoiding higher dosages facilitates eventual medication discontinuation.
Implement sustainable lifestyle change early on, with a plan to maintain them for a lifetime.
As alluded to above, I believe the best way to use these medications are as a “bridge” while sustainable lifestyle changes leading to long term health are put in place. At Metabolic MD we have been guiding patients in making these changes for over half a decade. (Well before the GLP-1 medications became popular.) Because the reason most patients are overweight has to do with their blood sugar metabolism (insulin resistance) I believe the best approach to sustainable weight loss during medication use and after medication discontinuation include:
A low carb diet guided by a continuous glucose monitor. (I believe in this approach so much I wrote a book about it: “The Continuous Glucose Monitor Revolution for Nondiabetics).
An intermittent fasting plan
An exercise program including strength training (because strength training reduces insulin resistance).
To avoid “Ozempic Addiction”, work with a medical provider who has your best interests in mind.
For nearly every patient, that best interest includes a plan to eventually discontinue the use of this medication. For that to happen, a comprehensive program for weight loss and optimal health should be put in place while on the medication. Without a plan, patients become committed to a lifetime of treatment . . . or significant weight gain when the medication is stopped. Ozempic provides an opportunity for a “reset” with regard to weight. This can be an effective medication, but only as part of a comprehensive program if permanent dependency is to be avoided.
Metabolic MD offers such a comprehensive and effective program utilizing both continuous glucose monitors and compounded semaglutide for patients who do not have insurance coverage for the brand name medications.