Humankind has long sought the Fountain of Youth, but for many, the quick solution for weight loss holds greater appeal, even for those aiming to shed just a few pounds. Beyond juice cleanses or weight loss surgery, there have been numerous prescription options in recent years—often accompanied by side effects ranging from detrimental to outright embarrassing.
Consider fen-phen (fenfluramine-phentermine). It was the preferred weight-loss medication in the ’80s and ’90s... until it was withdrawn from the market due to causing heart valve damage. Orlistat, known by the brand names Xenical and Alli, has been approved by the U.S. Food and Drug Administration (FDA) for over 20 years—and available over the counter for approximately a decade—and can trigger urgent and uncontrollable oily bowel movements. However, a new treatment option now has providers and patients alike feeling optimistic that science has provided a safer solution for losing weight, whether you’re classified as obese or merely hoping to lose a few pounds: semaglutide.
Semaglutide, rumored to be the secret behind the sudden slimmer figures of some celebrities, was approved by the FDA in December 2017 under the brand name Ozempic for the treatment of type 2 diabetes. A member of a class of drugs called GLP-1 receptor agonists, semaglutide is a once-weekly subcutaneous injection (meaning injected into soft fat) that stimulates the pancreas to produce more insulin, aiding in the control of glucose levels. Nevertheless, “one of the positive side effects we discovered with the medication was that it enabled people to lose weight,” states Dr. Steven Batash, a board-certified gastroenterologist in Rego Park, New York. After several years of being prescribed off-label for weight loss, the FDA granted approval to use the same medication from the same manufacturer for weight loss under a new name, Wegovy. (Note: A medication approved in the summer of 2024, known as Mounjaro, or tirzepatide, functions similarly but is more potent than semaglutide. It is FDA approved solely for diabetes, but Dr. Batash anticipates that its manufacturer will follow in Ozempic’s footsteps and receive FDA approval for weight loss. Tirzepatide is not nearly as readily accessible as semaglutide.)
How Wegovy and Ozempic for weight loss work
Semaglutide operates for weight loss through two channels. The first is appetite suppression, achieved by reducing the rate of gastric emptying, or how quickly food moves through your stomach. Instead of remaining in your stomach for up to an hour, food stays there for approximately six or seven hours when you take semaglutide. The other is enhanced satiety, or the sense of fullness—a process controlled by the brain. “Many people mention that when they commence eating a meal, they reach a point where they know their stomach is full, but they still feel hungry,” says Dr. Batash. “The stomach is desperately attempting to send a message of fullness or satiety to the brain, but this feedback mechanism is either delayed or disrupted—and unfortunately, it’s the brain that decides when you’re hungry and when you’re not.”
This makes semaglutide an effective weight-loss option for nearly everyone, whether they are prediabetic, diabetic, have polycystic ovarian syndrome (which causes insulin resistance and often, weight gain), or are obese, overweight, or even have a normal BMI and merely wish to lose a few pounds. Although the medication yields more significant results when supported by a healthy diet (more on this shortly) and when taken by overweight patients, studies indicate that in four months, semaglutide can lead to weight loss of around 10% and up to 20%. “My patients tell me they’re not constantly hungry or focused on food,” says Dr. Jessie Cheung, a board-certified dermatologist in Chicago specializing in aesthetics, regenerative medicine, and hormone replacement therapy. “They get full after three or four bites, don’t have a craving for junk foods, and don’t find satisfaction in eating them. It’s almost magical.”
Houston-based registered dietitian nutritionist and content creator Dana Omari, aka @igfamousbydana, has been documenting her experience with semaglutide on her platform. Despite always maintaining a healthy lifestyle, she struggled somewhat during the pandemic (as many of us did), gaining 30 pounds in two years. “As a dietitian, I know the traditional way of losing weight is very gradual—about two or three pounds a month,” she remarks. Her primary care provider suggested semaglutide as a potential option, and after a few months of working on her weight, Omari decided to give it a try and filled her Wegovy prescription.
The first day, she was extremely nauseous and couldn’t eat. “I had dinner before my injection, and I ended up throwing it up,” she recalls. “After that, I didn’t really have nausea unless I ate too quickly.” Omari experienced several other common side effects, including constipation at the beginning of her treatment. But many other side effects of this medication can be caused by patients not consuming enough during their treatment. “You’ll experience the effects of low blood sugar or feeling very hungry without actually being hungry,” she explains. “Headache, dizziness, fatigue—things that would occur if you felt like you were starving—but without that rumbling in your stomach.”
Before initiating treatment with semaglutide, Omari was already modifying her habits and working on losing weight; the medication has served as a boost to her efforts. “I gained weight because I stopped eating and exercising as I typically do,” she says. [Otherwise,] I have always been capable of maintaining my weight because I eat very healthily.” For those who have never had ideal eating habits, it’s advisable to collaborate with a nutritionist to understand how to eat healthily and control portion sizes. Not only will this assist you in losing more weight, but it will also reduce your likelihood of feeling unwell from the medication. “If you overeat on semaglutide, you’re going to be miserable for at least three or four days because the food will just remain in your stomach,” warns Dr. Batash.
You’ll also want to ensure you’re obtaining all the nutrients you require, which you might not be if you’re consuming much smaller meals than before. “I started taking an easily digestible multivitamin, I’m on a once-a-month vitamin D—50,000 IU—and a good fish oil, and I stay hydrated with a lot of water and electrolytes,” says Omari, highlighting that dehydration slows down weight loss. “Your body needs water to help break down fat into the energy you need. Electrolytes balance your hydration inside and outside your cells.” To support this process, she incorporates Liquid I.V. products into her routine every few days.
As of early October, approximately two months into her semaglutide journey, Omari has lost nearly 20 pounds, a rate of weight loss that most people couldn’t achieve safely within the same period. (Dr. Cheung notes that this is common among the patients in her practice, depending on how much weight her patients need to lose.) She has also witnessed numerous additional benefits: “Every single day, I needed a piece of chocolate or wanted a cookie—if I saw it, I wanted it,” Omari says. “I’ve had my favorite cookie dough in the refrigerator the entire time [I’ve been on semaglutide], and I’ve only made myself two cookies.” Her pants fit better, and she has noticed her stomach flattening. Although rapid weight loss can often cause problems, she has observed no negative effects on her skin or hair and, aside from some occasional nausea, has only noticed that she’s more tired in the evenings than before.
Ozempic risks and side effects
This is not to imply that there are no risks associated with taking this medication, which could be more pronounced in thinner or healthier patients. “I find that my patients with a prediabetic risk don’t seem to notice as many side effects,” says Dr. Cheung, a sentiment echoed by Dr. Batash. Pancreatitis, although rare, is a potential side effect that would immediately disqualify you from continuing your treatment course. You’ll know immediately if you have it—you’ll not only “appear” sick but also experience severe abdominal pain after eating, have a fever, and vomit. Dr. Batash also notes that it should be used with caution in patients with gallstones, which can trigger pancreatitis.
Studies also reveal a connection between this medication and the development of thyroid cancer. Dr. Batash was quick to point out that this occurred only in lab tests on mice. “What I typically tell our patients is that if the patient or their family has a history of medullary thyroid cancer, we would advise against taking this medication,” he says. Currently, it is unknown whether taking semaglutide can lead to the formation of thyroid tumors in humans. A recent clinical study on the use of GLP-1 receptor agonists (including semaglutide) and their impact on thyroid health shows that the drugs neither increased nor decreased the risk of thyroid-related conditions, but more studies are necessary to reach a comprehensive conclusion.
What should I eat while taking Ozempic?
Since you won’t be able to eat as much as you once could, pay close attention to your diet. “I recommend healthy fats, protein, and plenty of vegetables,” says Dr. Cheung, as well as an abundance of fiber. Eating clean and drinking plenty of water will not only support the results of taking Ozempic but also make you feel good on the drug. “As you’re eating less, you won’t defecate as frequently and you might experience constipation,” she says. Fiber will assist with this, as will remaining hydrated. “When you’re not hungry, you might not feel thirsty, and you need water to help prevent constipation,” she adds.
Broccoli and leafy greens such as cabbage, kale, and spinach are rich in B vitamins, which can help with the nausea you might encounter while taking semaglutide in addition to boosting depleted energy levels. Dr. Cheung also recommends obtaining sufficient vitamin D. “Vitamin D aids in fat metabolism, and many patients are deficient in it anyway,” she says. Fish like salmon, tuna, and sardines, along with fortified dairy and plant milks, will assist you in adding more vitamin D to your diet. Dr. Cheung suggests incorporating glutathione as well, which you can obtain by consuming avocado, cruciferous veggies, and alliums like garlic and onions. This antioxidant supports your liver’s ability to detoxify your body. “Fat stores toxins, and as fat breaks down, toxins are released and need to pass through the liver and kidneys for proper excretion,” explains Dr. Cheung. “You don’t want to stall or regain all the weight if your body can’t expel the toxins.”
You can also enhance your levels of these vitamins and other nutrients with supplements. It’s best to collaborate with your provider to undergo bloodwork—your lab results can assist them in analyzing deficiencies and creating a customized plan for you to enhance your weight loss and maintain your weight once you taper off Ozempic.
Foods to avoid while taking Ozempic
If you’re already on Ozempic, you likely already know which foods cause your body discomfort. “Your body will punish you for having a carb-heavy, junky meal, as that can lead to loose stools and indigestion,” says Dr. Cheung. Similarly, overly sugary, fatty, greasy, and fried foods will have the same effect, making you physically uncomfortable while making it more challenging to achieve your weight loss goals. You might also want to avoid consuming spicy foods, as they can cause heartburn. If you enjoy a cocktail or two, be aware that alcohol can definitely cause heartburn too, but many people find that they lose the desire to drink alcohol on Ozempic, as the medication reduces cravings.
The size and timing of your meals are also important. Although you won’t have the same desire or ability to eat a large meal, doing so might lead to nausea and indigestion. Instead, focus on consuming more frequent meals that are closer in size to a snack. Adds Dr. Cheung, “semaglutide will assist you with intermittent fasting, as one meal in the late afternoon is sufficient for most patients.” Regardless, ensure you eat your last meal several hours before going to bed. Because Ozempic causes your GI tract to slow down, eating late at night could result in heartburn or acid reflux.
How much does Ozempic cost?
Despite the risks, it’s difficult to deny the benefits of this medication; in addition to the obvious goal of weight loss, semaglutide can help improve patients’ cholesterol levels, says Omari. But for many, there is one significant drawback: the price. Some can have Ozempic or Wegovy covered by insurance (which, truly, is possible only if you have a health condition like diabetes or PCOS). Omari was not one of those patients. “Little did I know it would be nearly $2,000 [a month] out of pocket,” she says. “I went back to my doctor and told her, ‘That’s insane, I can’t do that.’”
That’s when Omari learned about compounded semaglutide. This means that instead of using the brand-name medications, which are dispensed in auto-inject pens, pharmacists will blend their own solutions for patients. “They take the semaglutide molecule and compound it with something else—commonly, it’s vitamin B12,” says Dr. Batash. Though not all providers prescribe compounded semaglutide—out of an abundance of caution, Dr. Batash prefers adhering to the branded product—you’ll find that opting for this route significantly reduces the treatment cost. Omari pays $129.
In addition to not potentially depriving diabetes patients of necessary medication—there is currently a shortage of Ozempic and Wegovy, due to increased demand and manufacturing issues that are believed to persist through the end of 2024—compounded semaglutide comes with the added advantage of customizable dosage. “It is very challenging to change the dose with the auto-inject pen,” the dosage of which starts at 0.5 milligrams, says Dr. Cheung. “If you start at half a milligram, you’re just miserable—we start at approximately a quarter of that dose.” She then increases patients’ dosages every week until they reach the maximum they can tolerate.
How long do you have to use Ozempic to see results?
Regardless of whether your doctor adjusts your dose of semaglutide weekly or monthly, that increase is crucial for seeing success on the scale. “You must increase the dosage until you reach the maximum dosage or the maximum tolerable dosage,” says Dr. Batash. “Just taking the smallest dose and then determining whether the medication works is not a genuine attempt.”
The big question: Does this genuine attempt have to last indefinitely? That depends. When semaglutide is not prescribed in combination with another weight-loss measure, such as endoscopic sleeve gastroplasty, Dr. Batash believes so. “In most patients, the weight that was lost will be regained, whereas the combination of the procedure with taking the medication for 6 to 12 months allows the brain/stomach connection to be reset.”
However, as both a provider and patient of treatment with semaglutide (and someone who has had gestational diabetes and a family history of diabetes), Dr. Cheung disagrees. “At my practice, we give you two months to start with; I would say 75% are quite satisfied after that,” she says. Patients who desire more weight loss are prescribed additional treatment on a month-to-month basis. However, some of her patients do wish to remain on it long term—whether that’s to combat cravings and lose weight or simply feel better on the medication. “I take a low dose every so often,” adds Dr. Cheung. “My blood tests have returned much better—my hemoglobin A1C, my cholesterol, other things we look at to assess the levels of inflammation in the body.”
Is using Ozempic for weight loss safe?
Although every patient is different, all of our experts concur that this is a safe medication, especially when prescribed by a provider who will monitor your progress. Semaglutide can also transform lives. “I’ve witnessed over a hundred pounds of weight loss in a single person,” says Dr. Cheung, recalling a patient who has gone from qualifying for gastric bypass surgery to approaching a normal BMI. That weight encompasses not only soft subcutaneous fat but also the dangerous and more challenging to lose visceral fat around the organs. “Fat is inflammatory and very detrimental to many disease processes,” she says. Plus “it’s not crash dieting—you’re still eating, you just naturally limit yourself.”
Dr. Cheung points out that patients who are already quite slender should not be prescribed this medication. Otherwise, whether you’re within just a few pounds of or still have a considerable distance to go before reaching your desired weight, semaglutide might be worth considering. If you’re exploring how to obtain Ozempic for weight loss, the first step is scheduling a consultation with a trusted provider—whether that’s a GP or a plastic surgeon—to determine if it’s suitable for you. They can evaluate your medical history and assess whether semaglutide can assist you in achieving your goals—safely and effectively.
