The Dark Side of Ozempic for Weight Loss

When Kim Kardashian poured herself into Marilyn Monroe’s infamous ‘Happy Birthday, Mr President’ sheath gown at the 2022 Met Gala, the internet exploded with speculation: had she jumped on the Ozempic weight loss bandwagon to slim down for the event?

Hot on her high heels over the past year has come a roll call of other A-listers sporting suddenly-shrinking silhouettes, including Oprah, Jessica Simpson, Khloé Kardashian and Rosie O’Donnell. Each star has declared their whittled waistlines are Ozempic free and courtesy of a strict diet and exercise routine. Kim even shared how she dropped the startling seven kilos in just three weeks on a strict regimen of vegies and protein, treadmill running and sweating it out in a sauna suit twice a day.

Regardless of the disclaimers, rumours persist of Hollywood Ozempic parties and black-market pipelines to supply Tinseltown with the slimming drug. Though Danish manufacturer Novo Nordisk cautions that “Ozempic is not approved for chronic weight management,” the blockbuster medication has kickstarted a whole new quick-fix weight loss craze.

On Instagram, Ozempic is now an evergreen hit topic. On TikTok, #MyOzempicJourney before-and-after posts often go viral and are currently sitting at more than 230 million views. The drug de jour for weight loss is such an open secret that host Jimmy Kimmel riffed on the subject during the 2023 Academy Awards, quipping, “Everybody looks so great. When I look around this room, I can’t help but wonder ‘Is Ozempic right for me?’” His joke was met with knowing amusement, but the drug’s soaring prescription rate is no laughing matter.

Diabetes drug drought: the Ozempic shortage

In 2017, the US Food and Drug Administration (FDA) approved Ozempic for blood glucose control in people with type 2 diabetes. In 2019, Australia’s Therapeutic Goods Administration (TGA) followed suit, listing the weight loss drug on our Pharmaceutical Benefits Scheme (PBS) for a standard prescription fee of $30.

Headlines about the drug’s miracle weight loss benefits were soon popping up and piquing our interest. But Ozempic really took off in 2022, after its higher-dose sister drug, Wegovy, was approved by the FDA and our TGA, for reducing obesity. The subsequent social media frenzy has seen people sprinting to their GPs to snap up Ozempic to lose excess kilos or attain long-wanted thigh gaps and hip dips, even though the drug was not developed for that purpose.

Novo Nordisk has since enjoyed a 23% sales surge spike for Ozempic and about $12.5 billion in earnings at the end of 2023. By 2029, it’s projected Ozempic will be raking in $17 billion, a startling 83% increase in sales between 2022–2029. But its use has skyrocketed so fast, and demand is so strong, that there’s now a worldwide shortage of Ozempic. This means Aussie pharmacies are often having to import the drug, which can cost anywhere from $140 to $600 for a month’s supply, if you don’t have type 2 diabetes.

“The shortage means that many people who’ve had their diabetes type 2 and obesity stabilised by Ozempic may now be unable to access the drug,” says Professor Timothy Gill, research programs director for the University of Sydney’s Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders and a member of the Medicine Shortage Action Group.

To conserve the dwindling supply, the TGA has asked health professionals to avoid prescribing Ozempic to new patients “unless there are no suitable alternatives or there is a compelling clinical reason to do so”.

How does Ozempic work?

Semaglutide, the main ingredient of Ozempic and Wegovy, harnesses hormones to drop blood sugar. To do this, it increases insulin (which helps lower blood sugar after food) and lowers glucagon (which raises blood sugar if it falls too low, for example, after exercise or fasting), manipulating their levels via another hormone called GLP-1 (glucagon-like peptide), which we make in the gut. Semaglutide binds to the GLP-1 receptors all over the body, imitating and increasing their impact, which is why it’s called a GLP-1 agonist.

Currently, people on Ozempic self-administer the drug once a week via an injection pen in their thigh, stomach or upper arm. The dose usually starts at 0.25mg or 0.5mg for a month and may then be ramped up to 1mg (or 1.7 to 2.4mg for Wegovy). The upper Ozempic dose is regarded as the sweet spot for maxing weight loss, which, according to the manufacturer, is usually 4 to 6kg.

“Ozempic helped me finally get back from a size 14 to a size 10 after only four months,” says Madeline*, 52, who gained weight over decades, especially after having two children and undergoing menopause. “I used the drug after my sister, who lives in Asia, tried it and lost five kilos in a few months. I was staying with her for three months and the drug was easy to get and helped me lose four kilos easily.

“Slimming down made me so much happier and more confident – I felt like a new woman. When I came back to Australia, I was able to get Ozempic for a few more months, but then I found that no GPs would prescribe it to me.

“The doctors tell me that I need to manage my weight with exercise and diet, but I was doing that and the weight just wasn’t shifting.”

How Ozempic kick-starts weight loss

Though it’s not a diet drug, Ozempic’s slimming side effect has now become its biggest selling point. The drug helps turbocharge weight loss by impacting three main areas in your body:

Pancreas: According to Diabetes Australia, “Type 2 diabetes is a condition in which the body becomes resistant to the normal effects of insulin and gradually loses the capacity to produce enough insulin in the pancreas.”

Ozempic comes to the rescue by restoring pancreas function and therefore helping to maintain weight. But for those with no pancreas problems, the impacts haven’t been well researched.

Liver: Glucose is stored in the liver, but when there’s too much in the blood, it’s stored as fat. By lowering blood glucose levels, Ozempic prevents this fat storage and subsequent weight gain.

Digestive system: Ozempic switches the stomach into slow-mo by delaying gastric emptying. “So, when someone using the drug eats a snack or meal, the food is absorbed and digested at a much slower rate, making them feel full sooner and for longer and delaying hunger,” says Professor Gill. This means it can curb appetite, cut cravings and combat comfort eating.

While this all sounds very appealing, if you’re taking the drug to fit back into your skinny jeans, you’re essentially using it ‘off-label’ for a purpose the drug wasn’t originally studied for, which means you’re a guinea pig for the drug. And, as more people without diabetes road-test Ozempic, more unexpected side effects are coming to light.

Tummy troubles

In a 2022 study on semaglutide for weight loss, nearly half of participants experienced side effects. The most common of these digestive problems, including nausea, vomiting and diarrhoea.

Some brave Hollywood celebs have spilled about ditching Ozempic because it literally made them sick to the stomach. “A year ago, I tried Ozempic... I felt so sick I couldn’t play catch with my son,” 42-year-old comedian Amy Schumer told Andy Cohen on his live show.

TV host Sharon Osbourne, 71, echoed her comments. “The first couple of months, I just felt nauseous,” the wife of rock star Ozzy Osbourne told daytime TV program The Talk about her huge Ozempic weight loss over four months. “Every day my stomach was upset.”

“Nausea, vomiting, diarrhoea and constipation are commonly reported by people using Ozempic,” says Professor Gill. In fact, 

But these belly blahs are not always benign. After taking Ozempic and a similar drug called Saxenda, 56-year-old Australian mum Trish Webster died from acute gastrointestinal illness last year. She had endured chronic nausea, vomiting and diarrhoea for five months, but thought it was normal and stuck out the discomfort to fit into a special dress for her daughter’s wedding. Tragically, on January 16, she suddenly collapsed.

“She had a little bit of brown stuff coming out of her mouth and I realised she wasn’t breathing,” her husband, Roy, told the Nine Network’s 60 Minutes. “I started doing CPR… [and] it was just pouring out.”

Meanwhile, in September last year in the US, the FDA insisted that the Ozempic label warn of a serious complication called ‘ileus’. “This intestinal obstruction blocks movement of food through the colon,” explains Dr Michael Bonning, president of the Australian Medical Association (NSW). “In the US, two people taking the drug have died from the condition and another 31 have been affected.”

In Australia, the TGA is considering introducing drug label warnings after two people on Ozempic died from ileus. Worldwide, some doctors have also expressed alarm after patients on Ozempic developed gastroparesis, a complication where digestion slows so much it causes stomach paralysis.

Other Ozempic side effects to consider

“There’s this myth that Ozempic is a problem-free, quick-fix weight loss wonder drug,” says Dr Bonning. But in those who are weight-conscious and well, he believes that the negative knock-on effects could outweigh the benefits.

Day to day, the drug can cause many health blips. “Slow digestion can trigger bloating, which puts pressure on other organs and may cause acid reflux and contribute to incontinence, by weakening a woman’s pelvic floor,” Dr Bonning says. “Slow stomach emptying can also permanently reduce muscle tone in the bowel, which can lead to chronic constipation, even when the drug is stopped.

“Delayed bowel movements and impacts on pancreas function can lead to painful conditions, such as pancreatitis (from inflammation of the pancreas).

The drug can also substantially deplete the body’s fluid levels and this dehydration could cause kidney issues, acute injury or kidney failure.”

Some studies involving rats have also suggested that Ozempic could contribute to the development of thyroid tumours, so the FDA has insisted that a warning about thyroid cancer now appear on the packaging.

Another side effect to consider: ‘Ozempic face’ is a term coined for the sagging and ageing of facial skin that is can occur when taking the drug.

The Ozempic black market

Most people are clueless about these risks and some are now paying hundreds of dollars or more to get hold of Ozempic on the internet or black market. Some people are also getting copycat versions of the drug, which haven't been tested for safety or efficacy.

“This is very concerning, as people don’t even know if they’re taking Ozempic, sugar pills or some counterfeit substance that could harm them,” says Dr Bonning.

“If a GP hasn’t prescribed it, then no one’s checked the person’s medical history to ensure the drug is safe for them to use, unlike people with type 2 diabetes, who are carefully monitored on Ozempic by their endocrinologist and local GP.”

By October last year, the NSW Poisons Information Centre had received more than 120 calls about Ozempic – but many adverse reactions may go unreported. In the 24 months to the end of October 2023, the Victorian Poisons Information Centre got 82 calls about semaglutide; seven of those people went to hospital because of unintentional overdose.

PR guru Roxy Jacenko, 43, recently had a similar Ozempic health scare. Feeling down about the 15 kilos she had gained from taking a drug called Tamoxifen after breast cancer, she tried Ozempic and started at the maximum dose. In the next 12 hours, she vomited four times and was shaking so uncontrollably she thought she might have a seizure.

“I thought I was actually going to die,” she told The Daily Telegraph. “I’ve had cancer, radiation therapy, all of that. It doesn’t even compare to how bad I felt when I took this drug.”

After stopping Ozempic, is there rebound weight gain?

When people stop using Ozempic, research shows they may regain about 65% of the weight they lost. “After people diet, their metabolism often slows by 15 to 20%, as the body cuts back on burning energy because it’s stressed by signals it’s not getting enough food,” says Dr Bonning.

This could happen while taking Ozempic, but not be obvious until people come off the drug. “When you’ve become used to chemical appetite suppression, it may be a shock to suddenly start handling hunger again and some people may then overeat. The best way to lose weight and sustain it is still through a lifestyle that involves a healthy diet, regular exercise, good stress management and getting enough sleep.”