Ozempic is a serious drug with serious risks. Here’s what to know.
The diabetes medication semaglutide has recently become a trendy weight loss treatment. But like every drug, there are downsides—and potentially serious side effects.
What is it? A medication called semaglutide, which is sold under different brand names, including Ozempic, approved in 2017 for treating type 2 diabetes, and Wegovy, approved just last year for weight loss.
The buzz about these drugs has created a shortage of both, according to the U.S. Food and Drug Administration, which is expected to last for several months—causing alarm among patients with diabetes who rely on Ozempic to help control their blood sugar. Experts caution that it’s important to understand these are not miracle drugs—and that there are risks to taking them outside of their intended use.
Here’s what you need to know about semaglutide, including how it works and the risks.
What’s the science behind the drug?
Semaglutide helps lower blood sugar by mimicking a hormone that’s naturally secreted when food is consumed, This medication, administered through injection, helps people feel full for longer, helps regulate appetite, and reduces hunger and cravings. There is significant demand for the drug. In 2019, more than 11 percent of the population was diagnosed with diabetes, while more than four in ten adults classified as obese in 2020.
Patients with type 2 diabetes often have impairments in insulin, a hormone that helps break down food and convert it into fuel the body can use. Semaglutide signals the pancreas to create more insulin and also lowers glucagon, which helps control blood sugar levels. This can result in weight loss but experts point out that Ozempic has not been approved for that purpose, though semaglutide at a higher dose (Wegovy) has been.
Wegovy is the first drug since 2014 to be approved for chronic weight management. The difference between the two drugs is that Wegovy is administered at a higher dose of semaglutide than Ozempic. Wegovy’s clinical trials showed more weight loss but only slightly greater improvements in glycemic control compared to Ozempic, Chao says.
The FDA sees Ozempic and Wegovy as two different medications for different uses. Chao says many insurance companies cover Ozempic for diabetes but don’t cover Wegovy for obesity—a prime example of weight bias in health care. That’s why some medical providers use the two doses somewhat interchangeably, as obesity and type 2 diabetes are inextricably linked–obesity is the leading risk factor for developing type 2 diabetes.
What are the risks?
Like every medication, there can be downsides. The most common side effects are gastrointestinal issues, such as nausea, constipation, and diarrhea, Chao says—and more rarely, pancreatitis, gallbladder disease, and diabetic retinopathy.
Recent reports of extreme vomiting and gastroparesis (delayed emptying of the stomach) are to be expected.
Gastroparesis just means the food’s in your stomach longer, which then makes you feel fuller longer.
Nausea is one of the biggest side effects of medications like Ozempic and Wegovy, and that can always lead to vomiting. In June, the American Society of Anesthesiologists recommended patients stop taking these medications before surgery to avoid aspiration and vomiting.
Normally, in my experience, it’s tolerable. But then there are times what happened?’ And they [say] they ate too much and ate too quickly. And then yes, the body will vomit it up, because it just can’t tolerate that much food anymore.
These drugs have been extensively studied, but their relatively recent approval means researchers still don’t know what the effects of taking them long-term might be.
Continuing research is helping us understand more about what happens when people stop taking these medications—which many may be forced to do amid current shortages. Research does suggest that stopping use of this medication could cause patients to regain weight, especially if they didn’t make any lifestyle changes.
In almost all weight-loss studies, it really depends on your foundation, Your efforts at lifestyle will determine how much weight you lose. If you have your foundations like food, exercise, and sleep, you’re gonna do well. If not, you might regain as much as 20 percent of the weight lost per year.
These medications can also be incredibly expensive, especially without insurance. Kim says an injection pen can run more than $1,000.
What does it mean to use this drug off-label?
Using a drug off-label means using it in a way other than its intended and its FDA-approved purpose, which may not be safe or effective. Ozempic has been approved only for type 2 diabetics, and Wegovy has been approved only for patients with a BMI above 30, or 27 if they have a weight-related comorbidity like high blood pressure.
There is no scientific evidence to show whether this medication will be effective or of benefit to those who do not fit the criteria from the FDA-approved label indications, such as people with a BMI lower than 27. We also do not know the side effects or risks in these populations—there could be unknown drug reactions. These medications are not meant to be a quick fix.
Even if you meet the criteria, experts warn against trying to obtain the medication without a prescription by traveling to countries that don’t require them.
When the medication’s not used under supervision of a health-care provider, then they can come into misuse. There could be more serious adverse events that can happen.
Godwin says recent reports of extreme vomiting and gastroparesis are a reminder that patients should schedule regular checkups with their doctor when taking these medications.
I think it’s so popular now that practitioners might be tempted to just prescribe more freely, and then maybe not monitor patients as frequently.
Patients should not increase their Ozempic dose without doctor approval—which is possible because there are multiple doses in one pen. They could definitely have a lot of poor side effects, because they didn’t titrate up to that level yet. The same could be said for Wegovy, which comes in a pack of four one-dose pens.
Robert Gabbay, the American Diabetes Association’s chief scientific and medical officer, said the organization is “very much concerned” about the Ozempic shortage.
The medication has been an important tool for people with diabetes. Not only does it lower blood glucose and weight but it has been shown to decrease cardiovascular events—heart attacks—one of the leading causes of death for those living with diabetes.
A last resort?
Still, prescribing drugs like Ozempic and Wegovy to patients who are desperate for a new approach to weight loss can make her feel “like a superhero.” By the time patients come, they’ve often tried methods like Weight Watchers and following the advice of dieticians. In that case, she says, medications like Ozempic and Wegovy can be a great option.
Sometimes as they’re becoming successful at losing weight, it really does feed into their lifestyle too, and then they’re able to be more active. It’s hard to lose weight. Seventy-five percent of the U.S. population is overweight or obese. I feel that we shouldn’t be holding this back if this can help.
These medications are a good alternative for those who are unable to lose 5 percent of their body weight within about three months of making lifestyle changes. Still, it is recommended trying those approaches before turning to medication.
Patients should make sure that they’re focusing on a healthy dietary pattern, reducing calories, as well as increasing physical activity. It’s important they know that even if they are taking the medication, it’s not an easy way out: They’re still going to have to make lifestyle changes.
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The Other Ozempic Revolution
Weight-loss drugs affect identities and relationships as much as waistlines.
She and a friend, Erica Chiseck, had created Camp RoundUp to counter the shame and stigma that fat Americans report experiencing because of their size. They wanted to establish somewhere that “ladies and theydies” could feel comfortable in shorts or a swimsuit, with no awkwardness in the lunch line over portion sizes or second helpings.
But even somewhere as body-positive as Camp RoundUp couldn’t avoid a subject that has captivated the American media and divided couples, communities, and friendship groups. At a session called “Compassionate Conversations,” someone eventually said the word: Ozempic—the best-known name in a class of new weight-loss drugs.
At Camp RoundUp, the discussion began with bariatric surgery, a more established medical intervention. But the conversation quickly drifted toward Ozempic. “A couple of the girls were talking about how either they had been on it or they had been offered it by their doctor,” Chiseck told me. “They were just all sharing horror stories, basically,” Rampa told me. Known generically as semaglutide, the drug causes nausea and other side effects in some patients, a fact that Rampa found “triggering.” It meant that people “are voluntarily making themselves ill—to not look like us.”
Spend any time in communities dedicated to weight and Ozempic, however, and you will also hear about the opposite experience. Kristen Hall, 52, a member of Reddit’s Ozempic forum who has taken semaglutide since May, told me she felt stigmatized by those who didn’t want medication. As her weight loss became apparent, some of her friends peppered her with questions. “These were not questions asked out of curiosity,” she said via email. “I heard nothing but judgment in their voices … The ironic thing is that it wasn’t the naturally thin friends that I felt judged me (they were happy for me), it was the friends who ALSO struggled with their weight and/or had disordered eating. Like I was cheating.”
So far, much of the news coverage of Ozempic and similar drugs has focused on whether they work—and what their side effects might be. But the real story will begin when this emergent form of treatment becomes utterly routine, as it almost certainly will. Most people in America, the richest country in the world, are fat. Almost three-quarters of adults older than 20 live with obesity or overweight. And given the popularity of existing weight-loss treatments, we can deduce that most of those people would rather not be fat. The consequences of the Ozempic revolution will be economic and social, as well as medical. The new drugs will transform people’s relationship with eating—and with one another.
Ever since a series of studies showed semaglutide’s effectiveness for weight loss, Novo Nordisk has developed a problem. The Danish company simply cannot make enough Ozempic and Wegovy—its other brand name for the drug. In September, Novo Nordisk overtook the luxury-goods retailer LVMH to become Europe’s most valuable company. Its market capitalization—an estimated $450 billion as of Friday—was higher than Denmark’s annual GDP.
Originally approved to treat diabetes, semaglutide falls into a category of drugs, called GLP-1 agonists, that slow digestion, control blood-sugar levels, and suppress the appetite. Other pharmaceutical companies are now joining the gold rush by introducing their own GLP-1 agonists. On November 8, the American firm Eli Lilly got FDA approval for Zepbound, a weight-loss version of its diabetes drug Mounjaro (tirzepatide). The potential market is enormous: In Europe, 59 percent of adults qualify as overweight or obese, according to the World Health Organization. (Throughout this article, I have used interviewees’ preferred terms. Although doctors have moved toward terms such as living with overweight, some activists like the unapologetic nature of fat.) In China, obesity rates tripled from 2004 to 2018. Overall, analysts estimate that by the end of the decade, GLP-1 agonists could be worth $100 billion a year worldwide.
After decades of helping clients laboriously control their calories, WeightWatchers has already conceded defeat, acquiring a telehealth company to dispense semaglutide alongside its established diet—sorry, “wellness”—plans. Chris Edson, who runs the British weight-loss-support start-up Second Nature, has made a similar pivot. “A lot of our narrative was: no drugs; we’re going to help you do this through behavioral science alone,” he told me. “And I remember pitching venture-capitalist investors and them saying, Have you seen this thing in the States?” The investors were talking about semaglutide, and that prompted Edson to look into the available research. “And then I completely changed my mind,” he said. Second Nature now offers straightforward lifestyle support, as well as support plus semaglutide—at least, as much of the drug as it can, given the supply shortages.
Spend any time in online weight-loss forums, and you will hear ecstatic reactions to the new drugs. “The first shot I took, I was cured of all the food noise that was siphoning off my mental energy,” one 35-year-old New Yorker told me, adding that she had gone from 247 pounds to 200 pounds since starting Ozempic in February. Her knees hurt less, she said; she was more focused on spending time with her friends instead of thinking about food, and she felt less “invisible.” (Many of the people I interviewed had positive experiences with semaglutide. But I was struck by how many requested anonymity to discuss their decision to take the drug, its effect on their personal relationships, or both.)
Not everyone who struggles with weight will benefit from the drug. Some people have insurers that won’t cover it. Others find the results underwhelming or the side effects intolerable. “One minute I would be fine, and the next minute I would be talking to Ralph on the big white phone,” former British Prime Minister Boris Johnson wrote in June, in typically lurid prose. “I am afraid that I decided that I couldn’t go on.” The plus-size influencer Remi Bader said in January that after she stopped using Ozempic, she binged her way to a higher weight than before.
The Ozempic revolution is, therefore, also creating an Ozempic divide. Until now, very few people living with obesity could lose enough weight, and maintain that loss, to satisfy their doctors. But now a gulf has opened up not just between naturally thin people and the plus sizers, but within communities dedicated to larger people—whether those are groups for weight loss or body positivity. Do you take Ozempic or not?
At the individual level, Ozempic and its sister drugs might also rewire millions of personal relationships, changing the dynamics of a family that has always had a “thin sister,” or a couple who bonded over a shared love of nachos and beer, or friends who stay in touch by sharing a restaurant meal. “I have quit drinking and my partner has not, and honestly, our relationship had a pretty strong foundation based on our shared love of wine and cocktails,” Kristen Holloway, 42, from Kansas City, Kansas, told me. (A lack of interest in alcohol is a widely reported side effect of semaglutide.) She hadn’t realized how much of their social life revolved around drinking. Even the couple’s in-jokes—such as a spoon rest that reads tea is my daytime wine—were predicated on alcohol. “It’s been an adjustment, and we’re working through it,” Holloway said.
Even many ozempic enthusiasts are coy about disclosing why they’re looking slimmer. Nathan, a 41-year-old Redditor who asked to be identified only by his first name to discuss his medical history, told me that he lost 40 pounds on Rybelsus, another brand name for semaglutide. He began to notice that he could once again wear his favorite rings, button his collar, and cross his legs. His family and friends were supportive, as was his pastor, he told me via email. “Even at church, one of my priests saw me at the communion rail and she said: ‘This is the Body of Christ … BTW—you look great.’ Talk about validation.”
But Nathan was still concerned about the wider reaction. “It seems like if the drug were used for diabetes, no one expressed any opposition. The moment weight loss became the goal, everyone had an opinion, and it was overwhelmingly hostile,” he said. “The general consensus was that it was a ‘cheat,’ a ‘shortcut,’ or the ‘easy way out.’” Notably, when Remi Bader spoke about her experience with the drug, she said she had taken it because of “actual health issues.” The Reddit Ozempic forum has an explicit rule that states: “No posts pitting diabetic patients against weight loss only patients.”
Not long after his pastor complimented his weight loss, Nathan received a text from a longtime female friend. He was on vacation, on a guided tour, and didn’t respond immediately. So the friend messaged again, Nathan recounted, “saying my silence and not texting her back fast enough was me thinking I was too important to talk to her. She actually said: ‘I’m so glad your life is getting fuller and you’re getting thinner, and now you want to cut me out of your life.’” They had never discussed his weight loss, or the methods he was using. “All I can figure is she saw my photos and side-by-sides on social media.”
Nathan decided to block her number, reasoning that he cared more about his weight loss—and the health benefits it brought, such as reduced cholesterol and better sleep—than easing his friend’s hurt feelings. “It’s beyond ridiculous for her to act like this,” he said. “But as Samantha Jones said [on HBO’s Sex and the City]: ‘I love you, but I love me more.’”
Envy was a drumbeat of many Ozempic stories that I heard, because guess what, life is easier if you’re more conventionally attractive. “Being the chubby guy was part of my personality—my identity,” Tim, a British 40-something who asked to be identified only by his first name, told me. He had dropped from 224 pounds to 190, having been overweight since sustaining a sports injury as a teenager. He found that people were much more enthusiastic about talking to him, and he received far more attention from women at parties. “I always had the feeling of being outside everything, like there was a velvet rope. And there is.”
These sentiments can be hard for Ozempic refusers to hear. Being fat is not like having high blood pressure, or cancer, or even athlete’s foot. Being fat has always meant living in a blizzard of other people’s opinions. And one of those opinions now is: Why don’t you just take Ozempic? Tigress Osborn, the executive director of the National Association to Advance Fat Acceptance, is concerned that these drugs might roll back years of work by the fat-liberation movement, such as lobbying tech companies to provide more inclusive images in search results. She wants to warn people about “this narrative that weight loss is easy, anyone can do it, now there’s a magical pill; so if you’re not doing it, you deserve whatever happens to you.” In an interview, she ticked off ways in which people might be pressured to use the drugs and punished if they don’t: “Why don’t you just take that pill and lose weight, when your boss is not giving you the promotion because you’re too fat? Why don’t you just take that pill and lose weight, when your landlords are threatening to evict you because they say your footsteps are too heavy?”
NAAFA believes in bodily autonomy—if you want to take Ozempic, the group doesn’t judge—but argues that the current atmosphere is coercive. “We believe that in a culture that is so fat-hating, it’s not really an informed-consent choice to opt in to a drug like this,” Osborn told me. She also warned that even if the initial results from studies are borne out, and patients lose 20 percent of their body weight, many people “are still going to be fat, even if they lose the weight that the drug is promising them to lose.”
Body-positivity communities, fat-liberation groups, and even informal support groups have been particularly challenged by Ozempic—as evidenced by the emergence of I’m only taking it for my diabetes discourse. Many of the disagreements are about the drugs’ long-term effectiveness. “I know how Atkins went,” Alison Rampa of Camp RoundUp, who is firmly in the skeptic group, told me. “I know how South Beach went. I know how whole foods went. Yeah, I know how intermittent fasting went. I know how cleanses went; I know how Fiber Factor went. I know how SlimFast and Special K and uppers and cabbage soup—I know how all of them went.” She and Chiseck worry about people who cannot tolerate semaglutide, or cannot afford it, or just plain don’t want to try another weight-loss solution after being burned before.
On the other side are people like Chris Edson of Second Nature. After overcoming his own skepticism of semaglutide, he then had to win over everyone else in his business. His company was founded with the aim of getting people off diabetes drugs that have to be injected daily, by bringing down their blood sugar using behavioral interventions. For that reason, Edson’s decision to embrace weight-loss drugs alongside lifestyle changes was controversial with his employees. “We’ve had people leave as a result of it,” he told me.
Personally, i’m an Ozempic optimist. I do not believe that Americans simply lost their willpower 40 years ago, when obesity rates began to climb. It seems more likely that our bodies, which evolved to navigate constant scarcity, are struggling to deal with the abundant calories and deliciously engineered food of the modern world. Our appetites push us toward sugar and fat, even if we have sedentary jobs. Semaglutide silences that mechanism.
Talking with people who have taken Ozempic—many of whom note the reduction in “food noise”—is a revelation. Suddenly, they have the appetites of the naturally slender. Effortlessly thin people don’t have more willpower than the rest of us. Instead, they don’t need it. They don’t nobly refrain from another helping of cookies; they don’t even want to eat them in the first place. One of my interviewees told me that before she went on semaglutide, “the back of my mind was always focused on food: Should I eat the leftovers; should I order on Grubhub?”
But even the new experience of self-restraint can be alienating. Kristen Holloway, who has lost 75 pounds since May last year, became “repulsed” by the TikTok cookery videos that her husband likes to watch. She also zoned out during a family discussion of restaurant recommendations: “I just found myself completely disengaged and thinking how weird it is to have a whole conversation like that—even though it’s probably not, really.”
One of the most fascinating subplots in Ozempic discourse—and part of the reason that it’s tearing communities and even former friends apart—is the sheer amount of money involved. Each side suspects that the other is being hoodwinked by vested interests. “What we’re up against is the marketing budget of Eli Lilly and Novo Nordisk,” NAAFA’s Osborn said. “So of course, they get more media coverage. I can’t hire Queen Latifah to speak on behalf of my campaign.”
On the other side, several Reddit forums I visited complained about what they saw as constant knee-jerk negativity by the media, for example in reporting every possible rare side effect, or even likening Ozempic to fen-phen—the drug withdrawn in 1997 because of its links to valvular heart disease. (Ozempic has reported no equally severe side effects, despite extensive clinical trials.) “The more rabid the opposition, the more I realized this drug might actually work,” Nathan told me. “I started to wonder, only somewhat tongue-in-cheek, who was so threatened? Big Fast Food? Big Bariatric? Big Pharma (that aren’t Novo Nordisk)? Big Gym? Big Fad Diet? Those only thrive if people stay overweight … and fail.”
Rising rates of obesity have created two Americas. Most residents of the Republic of Thinness want to attribute their size to willpower and personal responsibility, rather than wealth or genetic luck. And if thinness is available to everyone, their social capital is devalued. In the Republic of the Fat, there is an unequal distribution of hope. Some people feel that the miracle they’ve been praying for is finally here, and they are glad to leave behind their identity as the “chubby friend” or the “gentle giant” and cross the border to Thinness. In turn, those who stay put feel doubly judged—by the thin people who always looked down on them, and by their former comrades who have now abandoned them.
I asked Rampa and Chiseck whether anyone at Camp RoundUp felt betrayed by those who took weight-loss drugs. “We would not feel betrayed by anybody who wants to choose to do whatever they want with their body,” Chiseck said. Equally, though, she expects that lack of judgment in return—even from Ozempic evangelists. “It’s my body. It’s no one else’s business. I’m not hurting anyone. The only one I’m truly hurting is the airplane creators that are making the seats smaller and smaller and telling me it’s my fault.”
