Semaglutide, Wegovy and Ozempic: The Truth About 'Skinny Jab' Taking Over Hollywood
When Elon Musk was asked on Twitter what ‘made the biggest difference’ in his recent 30kg weight loss, the billionaire was unusually forthright – at least compared to your average celebrity. There was no raw vegan juice cleanse or obscure macronutrient balance. He didn’t exercise twice a day, six days per week, or chew each bite of food 40 times before swallowing. ‘Fasting, Ozempic/Wegovy, and no tasty food near me,’ was his response. Twitter exploded.
Given that the world’s second wealthiest man has publicly cited Ozempic and Wegovy – brand names for the breakthrough drug semaglutide, approved for the treatment of type 2 diabetes and obesity respectively – as his weight loss weapon of choice, it’s not entirely libellous to assume that at least some of his A-list peers have the same prescription to thank for their increasingly svelte physiques.
Fasting + Ozempic/Wegovy + no tasty food near me
— Elon Musk (@elonmusk) November 16, 2022
An appetite-suppressant in injectable form, semaglutide turns conventional weight loss dogma – which demands ‘discipline’ and ‘sacrifice’ – on its head, seemingly offering a physiological cheat code to those adverse to the old adage ‘eat less and move more’. While that might be true of the Hollywood roster pursuing prescriptions behind closed doors, for those living with obesity – the people Wegovy is intended for – semaglutide provides life-changing metabolic equity.
Just as antidepressants improve symptoms by bringing a person’s serotonin levels back to baseline, semaglutide injections recalibrate the brain and body signals behind hormone-driven weight gain. Understanding these mechanisms has powerful societal implications. When we trivialise the root cause of obesity as little more than a lack of willpower, we overlook crucial factors that place those living with the disease at a striking biological disadvantage.
Today, depression is widely accepted as a complex chemical imbalance, interwoven with myriad multi-layered individual and environmental factors – and clinicians are hopeful the Hollywood hype surrounding semaglutide could open up a cultural conversation about obesity in the same way. Here’s what you need to know about semaglutide, Ozempic and Wegovy, from the experts.
What is semaglutide?
Semaglutide injections belong to a class of drugs called GLP-1 receptor agonists, which have existed since the early 2000s. They work by mimicking the effects of a hormone called GLP-1, which is released in the gut after eating. ‘The issue with GLP-1 is that it needs to be very responsive, so it’s got a very short half life,’ explains molecular geneticist and obesity researcher Dr Giles Yeo MBE. ‘When you eat, it pulses then goes away. [It has a] two-minute half life and then gets destroyed in the blood. So people began to weaponise it. Put simply, they extended the half life of GLP-1 by tinkering with its molecular structure – putting some decorations on it.’
Semaglutide injections are the latest advancement in GLP-1 biotechnology. But there’s one crucial difference between this drug and its predecessors. ‘The reason it's broken the internet – and Elon Musk is running around taking it – is because it's gone from a once-daily injection to a once-weekly injection, which is obviously a game changer,’ says Dr Yeo. ‘Because they're so long lasting, they kick around the blood. They help with your type two diabetes if you have it, and with a slightly different dosing regime, they make you feel fuller. You feel fuller, you eat less. You eat less, you lose weight.’
We’re not talking about a few pounds either. In the trial STEP 1, people who took semaglutide lost an average of 15% to 17% of their body weight over 68 weeks, compared to 2.4% for those who took a placebo. For people living with obesity, this is a life-saving amount of weight to shed. ‘We have 20 gut hormones,’ Dr Yeo says. ‘GLP-1 is one of them. You’re just tweaking the concentration of one gut hormone in your body and suddenly you don’t feel as hungry.’
What Are Wegovy and Ozempic?
Wegovy and Ozempic are brand names for injectable prescription medications that contain semaglutide, and they’re targeted towards different conditions. ‘Ozempic is used to treat type two diabetes, whereas Wegovy has a licence to treat obesity and support weight management,’ explains Dr Babak Ashrafi of Asda Online Doctor. ‘Both of these medications require you to up the dosage as you progress through your treatment, but those prescribed with Wegovy are eventually given a higher dose. Both Ozempic and Wegovy users are generally started on a dosage of 0.25mg, with Wegovy users eventually given a dosage of 2.4mg per week.’
Their efficacy varies from person to person, with dietary habits, physical activity and other medical conditions all playing a part, says superintendent pharmacist Carolina Goncalves from Pharmica. Ozempic users can expect to see results in ‘a minimum of around eight weeks, but typically at least several months,’ she says. ‘Some patients with type 2 diabetes reported losing up to 7% of their body weight after 56 weeks of treatment.’ For Wegovy, ‘weight loss results can be seen as early as four to 16 weeks after the initial treatment,’ Goncalves continues.
How Does Semaglutide Work?
Semaglutide works by acting on the internal communication systems that connect your body and brain. Various body parts, such as your intestines, pancreas and stomach, send signals to your brain’s control centre, the hypothalamus, which dictate how much food to eat and how much fat to store. One signal is the hormone leptin, which is released by fat cells and activates one of two primary pathways in the brain that are responsible for weight regulation.
The first pathway sees leptin bind to a certain receptor in the brain that activates a neuron called POMC. ‘When we fire down this pathway, we stimulate the production of BDNF,’ explains Dr Fatima Cody Stanford, obesity medicine physician in Massachusetts and associate professor at Harvard Medical School. ‘When you have high levels of BDNF, you receive a signal which tells you not only to eat less, but also to store less of what you eat.’
However, in the brains of people living with obesity, ‘leptin binds to a different receptor and stimulates a different neuron called the AGRP,’ she explains. ‘These patients receive a signal which tells them not only to eat more, but also to store more of what they eat.’ When semaglutide binds to the brain’s GLP-1 receptors, it blocks the AGRP pathway and stimulates the POMC pathway. And that’s not all the drug does to modify your appetite.
‘Semaglutide also slows the rate at which food progresses from the stomach to the small intestine, increasing the duration it spends in the stomach,’ Goncalves says – keeping you satiated for longer. Plus, it improves insulin sensitivity, which lowers blood sugar levels and reduces glucose production in the liver. ‘The result of this is that there is a reduction in fat storage in the body, as stored fat is metabolised and used up,’ says Golcalves.
How Do Semaglutide Injections Make You Lose Weight?
From an experiential point of view, semaglutide injections simply make you feel fuller faster and for longer. They don’t change the taste of food or eliminate the pleasure of eating. ‘There are obviously going to be exceptions, but for most people, [semaglutide] doesn’t remove the enjoyment of life,’ explains Dr Yeo. ‘It’s not like they’re sitting there miserable because they can’t enjoy food any more. They just don’t have to eat as much of it. That’s how the drug works.’
Of course, just like any medication, it doesn’t necessarily work for everyone – ‘this may not be the pathway that needs to be regulated,’ Dr Stanford explains – but among those who do respond, semaglutide injections quieten down the part of the brain that is preoccupied with food.
‘Some people wake up and they’re automatically thinking about not only breakfast, lunch, and dinner, but tomorrow’s meals [too],’ says Dr Stanford. ‘They have other pathways that are really enhanced. Their brain is just not signalled to signal satiety and they have a high appetite stimulus. They’re not trying to feel that way, their body just isn’t regulating the sense of fullness.’
While patients may notice their appetite starting to reduce within a few days of their first injection, advises Dr Ashrafi, the average period to notice considerable weight loss is around six months, he says, with the most significant results seen in patients who ‘implement diet control, reduce their calorie intake,’ and exercise consistently.
People don’t develop obesity overnight, as Dr Stanford points out. ‘Some people can have it very early – at age two,’ she says. ‘But for a lot of us, it takes time to accumulate adipose tissue, and we don’t expect to solve it overnight. Safe prescribing – working with a clinician that understands the person, the disease – is really key.’
Who Are Semaglutide Injections Suitable For?
Semaglutide injections like Wegovy are suitable for adults with weight issues or obesity. Clinically speaking, ‘obesity’ is measured as a body mass index (BMI) of 30 or above, and ‘overweight’ is registered between 25 and 29. The terms are defined as ‘abnormal or excessive fat accumulation that presents a risk to health’, according to the World Health Organisation (WHO).
Since obesity is a major risk factor for heart disease, type two diabetes and certain cancers, semaglutide injections help to reduce those associated risks. But how much fat is too much?
When your body fat increases or decreases, ‘people think you gain fat cells and lose fat cells, and that’s not true,’ explains Dr Yeo. But it’s more accurate to think of fat cells as balloons that expand or shrink. ‘When your fat cells become full – for lack of a better term – the fat ends up in your liver, your muscles, your pancreas, and it begins to cause metabolic havoc,’ he says.
Our fat cells have unique storage capacities, so ‘there are going to be thin people with type two diabetes, and larger people who are perfectly metabolically healthy,’ Dr Yeo continues. ‘A large part of this is down to how much their fat balloons can expand before becoming full.’ Semaglutide is designed to reduce excess fat levels to the point where they improve metabolic health – not to make people underweight.
Despite this, in the age of self-love, many view the drug as a backwards step. ‘The body positivity movement is interesting in that clearly, they don’t want weight stigma,’ says Dr Yeo. ‘They want people to be proud of themselves. All this is good, I agree with them. But one of their messages is "health at every size", and that is just not possible.
‘There can be health at many sizes,’ he continues. ‘But the moment you independently surpass your own individual safe fat carrying capacity, you will become ill. There are going to be a lot of people at the edge of their safe fat-carrying capacity in spite of what they look like. And I think that is where semaglutide and other classes of drugs like this will help – now and in the future.’
What Are the Side Effects of Semaglutide?
Some people don’t experience any side effects from semaglutide. Among those who do, the majority are associated with digestive distress in some form – with nausea, vomiting, indigestion, diarrhoea and constipation among the most common. ‘These side effects can be minimised by making subtle changes to your diet, or even using over the counter remedies,’ explains Sam-Yorke. ‘For example – if you’re experiencing indigestion, you could look to decreasing your portion sizes, eating a little less but at regular intervals, and avoiding spicy foods.’ Over-the-counter remedies such as Gaviscon or Windeze may also help, he adds.
As with any substantial weight loss, you’ll also lose muscle as well as fat when taking semaglutide. ‘It’s just how our bodies work,’ explains Dr Stanford. ‘You can’t be like, "I want to eat and exercise in such a way that I only lose fat." It just doesn’t do that.’ Interestingly, there is currently a weight loss drug – bimagrumab – which going through trials for retention of muscle mass. ‘It won't have the same degree of weight loss from what we can see in the early trials,’ she advises, ‘but it will help retain lean muscle mass, which we inevitably lose over our lifetime.’
Given that semaglutide is a lifelong drug, the long-term data on GLP-1 agonists is reassuringly positive. ‘This class of medicines has been around since the early 2000s – it’s just only in the more recent time has it been utilised for weight regulation,’ says Dr Stanford. ‘We see a decreased risk of both fatal and non-fatal heart attacks, fatal and non-fatal strokes. We see a reduction in all cause mortality. We see decreased likelihood of being admitted for heart failure. So we have a lot of positive things that we see on average, long term.’
How to Get Hold of Semaglutide in the UK
Both Ozempic and Wegovy has been approved by the National Institute for Health and Care Excellence (NICE) for use in the NHS, with the latter set to hit UK high-street pharmacies from spring 2023. ‘There are separate requirements for Ozempic and Wegovy, as they are targeted towards different conditions,’ advises Dr Ashrafi.
You may be eligible for Wegovy if you meet the following conditions:
A BMI of between 27 kg/m² and 30 kg/m² and a health problem that can affect your weight, such as diabetes, high blood pressure or high cholesterol.
A BMI of 30 kg/m² or more, even if you do not have a weight related medical condition.
If you have kidney problems, diabetes, inflammation of the pancreas, low blood sugar levels (hypoglycaemia) or diabetic eye disease (retinopathy), Wegovy may not be suitable for you, Dr Ashrafi advises. ‘Furthermore, you should not take Wegovy if you are allergic to any of the ingredients in the medication, or if you are pregnant or breastfeeding,’ he says.
For Ozempic, you may be eligible for the treatment if you have the following conditions:
Type two diabetes
An HbA1C level that is uncontrollable with other interventions
An increased risk of cardiovascular disease
An increased risk of kidney disease or heart failure
If you have a condition called Multiple Endocrine Neoplasia syndrome type 2, it’s advised that you do not take semaglutide, Dr Ashrafi says. ‘Those under the age of 18, and those with type 1 diabetes or suffer from pancreatitis are also advised not to take Ozempic,’ he adds.
Could we see a day where semaglutide is available over the counter without a prescription? ‘I think they probably need to fulfil a number of criteria to hit that mark,’ says Dr Yeo, who sees the injectable element, a lack of longer-term clinical studies – when it comes to semaglutide specifically – and the existence of side effects as the main barriers to unrestricted access.
There’s also a question about resistance or sensitivity to GLP-1. By taking chronically high levels of semaglutide over the long-term, ‘does it mess up your endogenous GLP-1?,’ he ponders. ‘Evidence so far indicates probably not. Safety is no issue. But longer term, we need to ask the questions. Those are legitimate questions to ask and make sure we do.’
And in 10 to 15 years, when semaglutide is likely to become available in pill form, the waters are likely to become murkier still. ‘Say someone with anorexia decides, “I'm going to enhance my anorexia by taking this drug” – that's going to be a big problem,’ says Dr Yeo. ‘So how are we going to protect against that? It's an interesting societal discussion.’
What Happens When You Stop Taking Semaglutide?
Due to its biological mechanisms, semaglutide is a life-long medicine, not a short-term fix. The clinical trials to date show that ‘when you withdraw the drug, the body just returns back to its baseline – whatever that was,’ says Dr Stanford. Your blood sugar levels may increase if you have type two diabetes, and your appetite will return in full force. Without implementing alternative weight management strategies, you’re likely to regain any weight you lost.
Is this rebound weight gain as harmful as the effects associated with yo-yo dieting? ‘First principles indicate probably, because it’s just another way of reducing your food intake,’ warns Dr Yeo. As well as fostering feelings of guilt, shame and anxiety around food, cyclical weight fluctuations can diminish your muscle mass, slow your metabolism and increase your risk of chronic health conditions like heart disease, diabetes and high blood pressure.
Should You Take Semaglutide?
Semaglutide isn’t a silver bullet for a healthy lifestyle – nor is it intended to be. It won’t fix an inequitable food system or lack of access to preventive care. ‘This particular drug is just designed to make you feel fuller,’ says Dr Yeo. ‘It won’t improve your diet if you happen to like lots of ice cream, it will just make you eat less ice cream. It’s a powerful tool for helping someone lose weight. But there is far more to health than your weight.’
It’s vital to recognise obesity ‘as the complex multifactorial disease that it is,’ says Dr Stanford. There’s a much larger microcosm at play encompassing environmental, maternal, developmental, economic, psychological, social, genetic and epigenetic issues and more. ‘We hyper-focus in one area while neglecting the whole pie,’ she says. ‘I think that's where we fail.’
Given that biology is just one piece of a far larger and more complex puzzle, it’s useful to consider semaglutide as a spanner. Treating obesity requires a toolkit. ‘Use the spanner for what the spanner is designed to be used for,’ says Dr Yeo. ‘Don’t use it as a hammer. This drug doesn’t fix societal problems. It doesn’t fix inequality. It certainly doesn’t fix your diet.’
For more information on dealing with obesity consult your GP or the NHS website.
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