The Skinny on Weight Loss Injections

Ozempic and Wegovy and Zepbound — oh my. Are these medications groundbreaking and life-changing tools or overhyped and understudied? We explore the newest innovations in weight loss

*The information herein does not and is not intended to constitute medical advice – please contact your healthcare provider for your specific needs.

In the ever-evolving landscape of weight loss solutions, the emergence of semaglutide injections has prompted both intrigue and skepticism.  Between celebrity endorsements, online health platforms offering access to their middle-aged women cliental, and even “traditional” weight loss companies (such as Weight Watchers) adding these injections to their repertoire – you can’t escape the chatter and undeniable hype.  But beneath the noise, what’s the real deal? Are these medications a groundbreaking tool - or just another fleeting promise in the quest for shedding pounds?

Weight-loss drugs like Ozempic, Wegovy, and Zepbound belong to a class of drugs known as GLP-1 agonists, which mimic a hormone that suppresses appetite and controls blood sugar. Prescriptions for Ozempic and similar weight loss medications increased 300 percent between early 2020 and the end of 2023.

With access to thinness just a shot away (albeit with a $1,500 + price tag), some may argue it’s undoing decades of work in the body positivity and fat acceptance movements. Others may argue that although these medications are indeed efficacious that the true cost of having little long-term data surrounding usage may be too high to pay.

The facts

In the ongoing quest for successful yet safe weight loss solutions, the spotlight now shines on semaglutide, the active ingredient in Ozempic and Wegovy, which is the latest addition to the arsenal of anti-obesity medications. Ozempic, originally indicated for the treatment of type 2 diabetes, can lead to weight loss as a side effect due to its effect on appetite control and slowing down of gastric emptying. However, Wegovy is specifically formulated and intended for weight management in individuals who have at least one weight-related condition due to obesity or being overweight, and it is a higher dose of semaglutide compared to what's used for diabetes treatment. Although both medications can help with weight loss, Wegovy is specifically formulated and approved for this purpose.

Another consideration is that it's likely easier for a woman who wants to lose weight to obtain Wegovy, as it's intended for weight management and may have more straightforward prescription pathways for that purpose. Physicians, including Med Spas, may be more likely to prescribe medications like Ozempic for weight management than Wegovy. This is because Ozempic is also intended for the treatment of type 2 diabetes, and most healthcare providers are more familiar with prescribing medications for diabetes management than for weight management.

The pros

While research underscores the positive impact of GLP-1 meds on weight loss, it also underscores a crucial shift in perspective. Treating obesity as a chronic metabolic disease, rather than solely relying on willpower and lifestyle modifications, underscores the evolving landscape of healthcare interventions. 

Amidst the buzz surrounding these weight-loss injections, success stories abound, and they often come from women approaching or experiencing menopause who feel that despite “doing all the right things,” such as restricting calories and exercising, are unable to lose excess pounds.

Take, for instance, Amanda, 49, a sales advisor determined to reclaim her health. Multiple health diagnoses led her to Ozempic: “I had hypertension, high cholesterol, Type 2 diabetes, fatty liver and morbid obesity,” she said. “I was taking blood thinners, cholesterol medication and three blood pressure pills per day.”  Despite a rocky start on Ozempic, which included dealing with severe GI upset for the first few months of treatment, she’s now thrilled with her results. “My appetite decreased significantly, and my food cravings are gone,” she said. “I feel full after a few bites at mealtime. My weight dropped 70 lbs. My blood work is almost perfect.  No fatty liver, A1C (a blood sugar marker), no high cholesterol and slowly weaned off all blood pressure medication.”   Her doctor was equally thrilled. “My doctor has been so happy with my progress that she has said I have probably added 10 years to my life,” Amanda recalled. “My energy levels are higher, I feel better, I am more alert and active. This drug to me has been life changing.”

With the aid of semaglutide injections and a commitment to lifestyle changes, Amanda not only shed excess weight but also cultivated sustainable habits for long-term wellness. For many like Amanda, these injections serve as a catalyst, jumpstarting their journey towards healthier living and bolstering their motivation to persevere. Healthcare providers often recommend combining these medications with lifestyle changes to enhance weight loss and improve metabolic health.

The questions

Yet, as with any intervention, GLP-1 injections come with caveats. While they may offer initial success, there's a looming risk of weight regain upon cessation. Moreover, concerns arise regarding their safety, and the trend of non-specialized providers prescribing them without proper evaluation. Many med spas offer these medications on their dossier, alongside Botox and laser hair removal.

Even when prescribed for people who do have weight-associated health conditions, GLP-1 drugs can elicit side effects, including gastrointestinal distress, headaches, pancreatitis, and obstructions of the digestive system. Some researchers have also raised concerns that they may contribute to an elevated risk of thyroid cancer, and the FDA revealed data in 2021 showing Ozempic specifically causes thyroid tumors in rodents.

Experts in the fitness industry caution that GLP-1 induced weight loss is mostly muscle loss, not just fat, which raises concerns because losing muscle can significantly decrease your metabolism, thus making it harder to maintain the pounds lost when eventually going off the medication.

Questions also linger regarding the long-term effects and potential consequences of this intervention. It is important to note that these medications have been extensively studied for diabetes use, which contributes to our understanding of their long-term safety profile. Long-term side effects when used solely for weight loss may continue to be evaluated as more data becomes available from continued research, post-marketing surveillance, and real-world use.

Ozempic and Oprah

Oprah Winfrey’s recent TV special, now available on Hulu, titled "Shame, Blame and the Weight Loss Revolution", recently delved into the topic of weight loss drugs and the obesity epidemic. Oprah’s commitment to the benefits of these drugs is a marked departure from her years as a Weight Watchers brand ambassador, when the company focused on reducing calorie intake through a point counting system.

With Weight Watchers now offering Wegovy, Oprah stepped down from her role with the company before the special, explaining that she didn’t want to appear conflicted or that she had a financial stake as she shared her positive thoughts on the drugs. Remember her declaration years ago “I LOVE BREAD!”? But as noted during the special, now she doesn’t want the whole bagel, she “only wants half.” And it’s not just about will power and portion control; now Oprah relies on her semaglutide dose to regulate hunger.

Some view GLP-1 weight loss injection drugs as symbolizing a new understanding of obesity, aiming to eradicate associated shame and guilt. Oprah Winfrey, aligning with this perspective, advocates for a comprehensive approach to weight management, emphasizing empathy and empowerment over stigma.

While the special aimed to change the conversation about obesity and weight loss, it also raised questions about Oprah’s involvement and the perspectives presented by medical consultants. Notably, Oprah did not interview any skeptical doctors but instead focused on only two perspectives from those connected to the pharmaceutical companies, including Scott Butsch, MD, who serves as the director of obesity medicine at the Bariatric and Metabolic Institute at the Cleveland Clinic in Ohio; and Amanda Velazquez, MD, who holds the position of director of obesity medicine at Cedars-Sinai in Los Angeles.  Both Velazquez and Butsch have served as paid consultants to makers of GLP-1 drugs. Velazquez downplayed the side effects of these drugs, including GI issues and vomiting of blood, denoting them as “overhyped.”

Be your own advocate

In our pursuit of wellness, skepticism becomes our ally. While semaglutide injections present a promising avenue, we should approach them with discernment and a critical eye. Let's be our own advocates, delving deeper into the intricacies of weight loss solutions and questioning the narratives presented to us. As women, we wield the power to navigate through the noise, deciphering the truth from the hype. When considering these medications, pros and cons should be thoughtfully considered, as well as duration of use. "The dose makes the poison" is a principle in toxicology that as a nurse, I often reflect upon when asked my opinion on medications.  The phrase means that the toxicity or harm of a substance depends on the dosage or amount administered; in other words, any substance can be toxic if taken in a large enough quantity, even substances that are generally considered safe or beneficial in smaller doses. Conversely, even potentially harmful substances can be safe or even beneficial when administered in appropriate, controlled amounts. It’s also important to consider the source when it comes to who is prescribing them and why.

Thorough research should be conducted and ample consideration should be taken to empower ourselves to make informed decisions - not just for weight loss, but for our overall well-being. After all, our health is our greatest asset, and its high time we become the experts of our own narratives.

Elise Cedrone is a nurse, writer and consultant. A proud mom to three boys, she enjoys reading all the global research and writing content that empowers women in their health choices. Follow her on Instagram @cedronee_lise if you like to laugh and learn.