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Last updated: Aug 16, 2022
5 min read

How does Ozempic work?

chimene richaAmelia willson

Medically Reviewed by Chimene Richa, MD

Written by Amelia Willson

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Even with exercise and diet, it can be challenging to lose weight and sustain that weight loss long-term. Thankfully, some medications can help. Ozempic, a diabetes medication, is one medication that can be prescribed off-label for weight loss. Let’s break down how the weekly diabetes injection works and how it can lead to weight loss.

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What is Ozempic?

Ozempic (semaglutide) is a diabetes medication manufactured by Novo Nordisk. Ozempic is prescribed to treat type 2 diabetes when dietary changes and exercise do not adequately lower blood sugar levels. Adding Ozempic to a treatment plan that includes lifestyle changes like diet and exercise, or other diabetes medications such as metformin or insulin, can significantly improve glycemic control in people with type 2 diabetes (Chamberlin, 2019). For people with type 2 diabetes and heart disease, using Ozempic also reduces their risk of stroke, heart attack, or death from a cardiovascular event (FDA, 2020).

Ozempic is a prefilled prescription pen that you inject subcutaneously (under the skin) into your abdomen, thigh, or upper arm weekly. You can take Ozempic with or without meals (FDA, 2020). 

Common Ozempic side effects include nausea, vomiting, diarrhea, abdominal pain, and constipation. Serious side effects may include pancreatitis, diabetic retinopathy (vision loss caused by diabetes), hypoglycemia (low blood sugar), kidney failure, or an allergic reaction to the ingredients in Ozempic (FDA, 2020). 

Ozempic should not be used by children, people who are pregnant or breastfeeding, or anyone with (Chamberlain, 2019; FDA, 2020):

  • Pancreatitis
  • A personal or family history of thyroid cancer
  • Multiple endocrine neoplasia syndrome type 2

The US Food and Drug Administration (FDA) has issued a “black box” warning for Ozempic, the most severe advisory they give for a medication. Animal studies have found that Ozempic increases the risk of thyroid tumors in mice and rats. While it is not known if Ozempic has the same effect in humans, people with a personal or family history of thyroid cancer or who have multiple endocrine neoplasia syndrome type 2 should not use Ozempic (FDA, 2020).

What does Ozempic do?

Ozempic is a glucagon-like peptide-1 (GLP-1) receptor agonist, which means it mimics the GLP-1 hormone produced in your gut. When GLP-1 binds to GLP-1 receptors, it tells your pancreas to release insulin whenever your blood sugar levels get too high, which brings your blood sugar back down (Shah, 2014; Phillips, 2022). In type 2 diabetes, your body develops insulin resistance, which allows sugar to build up in the blood. Antidiabetes medications like Ozempic encourage the release of more insulin to keep blood glucose levels in check (Thota, 2022; Phillips, 2022).

How does Ozempic help you lose weight?

In addition to stimulating insulin release, Ozempic reduces the amount of sugar released from your liver. Ozempic also slows down the digestion process, so it takes longer for your stomach to empty fully, a process known as gastric emptying. This helps prevent your blood sugar from spiking. At the same time, it keeps you feeling full for longer, which can lead you to eat less and lose weight (Shah, 2014; Phillips, 2022).

Because GLP-1 receptor agonists like Ozempic have led to weight loss in people with type 2 diabetes, researchers have looked into whether they can help treat obesity and lower some of the cardiovascular risks associated with obesity. Indeed, long-term GLP-1 medication usage seems to lower blood pressure and cholesterol (Phillips, 2022). Some adults with obesity may be prescribed Ozempic off-label for weight management. Combined with diet and exercise, Ozempic can help people with obesity lose weight faster (O’Neil, 2018; Wilding, 2021).

How long does it take for Ozempic to work?

Ozempic is a long-acting medication, and it may take up to eight weeks for you to fully feel its effects. Health providers prescribe Ozempic at a lower starting dose, such as 0.25 mg. The lower starting dose may make it easier for your body to adjust to using Ozempic, which can help reduce side effects. After four weeks of using Ozempic, your dose may increase to 0.5 mg. After another four weeks, they may increase to your final dose if additional glycemic control is needed (FDA, 2020).

When it comes to weight loss, it’s more of a gradual process that depends on your current body weight and health conditions (Phillips, 2022). Clinical trials looking at the effects of Ozempic for more than a year often found that people with type 2 diabetes and a body mass index (BMI) of 27 or higher lost nearly 10% of their body weight when taking semaglutide (the active ingredient in Ozempic). Those taking a placebo lost less than 4% (Davies, 2021).

In another study, people who had obesity but not diabetes lost between 6% to 13.8% of their body weight by the end of one year, with those who took a higher dose of semaglutide losing more weight. Up to 65% of those taking semaglutide lost at least 10% of their body weight within the trial period (O’Neil, 2018).

In a clinical trial of people taking Ozempic for type 2 diabetes, participants lost around eight to 10 pounds by week 30. Similar to the other study, participants who took a higher dose of Ozempic lost more weight than those taking a lower dose (DailyMed, 2022). 

Research shows that people with type 2 diabetes experience more weight loss when they take Ozempic in addition to metformin or insulin (Chamberlin, 2019). For example, individuals with type 2 diabetes taking both Ozempic and metformin lost around 12 to 14 pounds by week 40 (DailyMed, 2022). 

How to get Ozempic for weight loss

Semaglutide, the active ingredient in Ozempic, is available in other diabetes and weight loss drugs (FDA, 2021). Some of these drugs, like Wegovy, are approved for chronic weight management, while others, like Ozempic, are approved to treat type 2 diabetes but may be prescribed off-label in adults for weight loss. Health care professionals usually recommend starting with increased exercise and a lower-calorie diet, but if sufficient weight loss is not achieved within six months, they may recommend prescription medications (Phillips, 2022).

Talk to your healthcare provider about using a drug like Ozempic for weight loss. 

References

  1. Chamberlin, S. & Dabbs, W. (2019). Semaglutide (Ozempic) for type 2 diabetes mellitus. American Family Physician, 100(2), 116–117. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31305048/
  2. Davies, M., Færch, L., Jeppesen, O. K., et al. (2021). Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomized, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet (London, England), 397(10278), 971–984. doi:10.1016/S0140-6736(21)00213-0. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33667417/ 
  3. DailyMed. (2022). OZEMPIC-semaglutide injection, solution. National Library of Medicine. Retrieved on Jul. 30, 2022 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79 
  4. Collins, L. & Costello, R. A. (2021). Glucagon-like peptide-1 receptor agonists. StatPearls. Retrieved on Jul. 30, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK551568/  
  5. Goyal, R. & Jialal, I. (2020). Diabetes mellitus type 2. StatPearls. Retrieved on Jul. 30, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK513253/ 
  6. O’Neil, P. M., Birkenfeld, A. L., McGowan, B., et al. (2018). Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet (London, England), 392(10148), 637–649. doi:10.1016/S0140-6736(18)31773-2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30122305/
  7. Phillips, A. & Clements, J. N. (2022). Clinical review of subcutaneous semaglutide for obesity. Journal of Clinical Pharmacy and Therapeutics, 47(2), 184–193. doi: 10.1111/jcpt.13574. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34964141/ 
  8. Shah, M. & Vella, A. (2014). Effects of GLP-1 on appetite and weight. Reviews in Endocrine & Metabolic Disorders, 15(3), 181–187. doi:10.1007/s11154-014-9289-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24811133/ 
  9. Thota, S. & Akbar, A. (2022). Insulin. StatPearls. Retrieved on Jul. 30, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK560688/
  10. U.S. Food and Drug Administration (FDA). (2020). OZEMPIC (semaglutide) injection, for subcutaneous use. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/209637s003lbl.pdf 
  11. U.S. Food and Drug Administration (FDA). (2021). WEGOVY (semaglutide) injection, for subcutaneous use. Retrieved Jul. 30, 2022 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf 
  12. Wilding, J., Batterham, R. L., Calanna, S., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine, 384(11), 989–1002. doi:10.1056/NEJMoa2032183. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33567185/