If thinness is next to godliness, why is weight-loss wonder drug, Ozempic, not the miracle cure?

Last year, it was a slap that hogged the headlines at the Oscars; at this year’s awards show, it was all about a weight-loss drug. Host Jimmy Kimmel joked about it in his opening monologue: “Everybody looks so great. When I look around this room, I can’t help but wonder, ‘Is Ozempic right for me?”’

It is an open secret that Ozempic is the reason for many Hollywood luminaries’ newly svelte figures. Celebrities such as Kim Kardashian, Mindy Kaling, and Rebel Wilson are rumoured to have used it to shed pounds within a very short space of time, though none of them have confirmed this. The few who have admitted to using it include tech mogul Elon Musk, and TikTok influencer and plus-size model Remi Bader. Bader, who was pre-diabetic, started taking it in 2020 on the recommendation of her doctor, to address insulin resistance. This condition drives weight gain due to the body’s inability to regulate blood sugar levels—the excess sugar is converted and stored as fat, which makes the body less sensitive to insulin, thus perpetuating a vicious cycle that makes it harder to take the weight off. 

Some people are able to bring down their blood glucose levels and weight, with diet and exercise, but some, like Bader, may need extra help. That’s where Ozempic comes in. Part of a class of drugs known generically as semaglutide, Ozempic is an injectable prescription drug that mimics the effects of glucagon-like peptide-1 (GLP-1), a naturally-occurring hormone that stimulates the pancreas to secrete more insulin when blood sugar levels rise. GLP-1 also suppresses appetite by sending signals to the brain that you’re full, so you eat less. 

 

It’s not surprising then, that many who have tried Ozempic find that they lose a significant amount of weight. In a 2021 clinical study conducted with overweight and obese adults across 16 countries, it was found that those who were given Ozempic injections lost an average of 15 per cent of their body weight. Dr Sue Anne Toh, Senior Consultant Endocrinologist and Medical Director of NOVI Health, noted that her patients can lose anywhere from five to 20 per cent of their body weight while on Ozempic. “There is an often held perception that people who are not skinny have no willpower, but it may be because their signalling pathways involved in appetite regulation are dysregulated. Some people who have struggled with weight all their lives may never know what it feels like to know satiety. Ozempic sort of programmes you to recognise what foods suit your body better, and signals you not to go overboard,” says Dr Toh. 

But the drug’s intended purpose was not for weight loss. Ozempic was originally approved in 2017 to aid in blood glucose control for Type 2 diabetes, when used alongside diet and exercise. So how did a diabetes drug become a wonder weight loss drug? Some time last year, hashtags like #Ozempic and #OzempicChallenge began to pop up on social media, as celebrities and influencers who used it raved about its dramatic results. The celebrity- and social media-driven surge in demand for Ozempic has even created periodic shortages of the drug globally, which raised concerns among diabetics who do actually need it.

Although using Ozempic as a weight-loss solution for people without diabetes is considered an offlabel use of the drug, it is perfectly legal in Singapore. Doctors can prescribe it outside of its approved medical purpose, based on their clinical judgement. Patients can expect to fork out $300 to $500 a month, depending on the dosage prescribed. Dr Toh stresses that prescription of Ozempic should take a few factors into consideration. Firstly, the benefits of using the drug must outweigh the risks and is in the patient’s best interests. Secondly, there is a justifiable medical indication with rational basis for such use. Thirdly, patients must be properly informed and agree to its use. 

 

At her clinic, patients go through a screening process and consultation to assess if Ozempic is appropriate for them. She adds, “If you’re suitable for Ozempic and are prescribed the medication, we would also pair you up with a health coach who is a dietitian or a fitness coach. Patients are briefed on the potential risks and side effects to look out for.” 

The common side effects of Ozempic are related to its effects from delayed gastric emptying: nausea, vomiting, abdominal pain and discomfort and constipation. More rarely, it can cause pancreatitis, kidney failure, allergic reactions and gallbladder problems. An unexpected side effect is “Ozempic face”. Dr Rachel Ho, Medical Director of La Clinic, explains why this happens. “The disappearance of facial fat pads causes a gaunt face. The sudden deflation of facial volume can also result in loose, sagging skin. Loss of facial volume and stretch in the face also accentuates wrinkles and lines.” 

 

So while you may revel in dropping a couple of dress sizes, you may have to contend with hollow temples, sunken cheeks and tear troughs, deeper nasolabial folds and jowls. But these are nothing that aesthetic treatments can’t fix. To restore volume and lift facial contours, Dr Ho suggests a combination of therapies like facial fillers such as cheek, nasolabial and temple fillers; thread lifts; and high-intensity focused ultrasound (HIFU) to lift soggy skin and jowls. 

But what we really want to know is this: is the weight loss from Ozempic permanent? Some people, like Bader, regained the weight when they stopped the drug. Bader shared that her “bingeing got so much worse”, and reportedly put “double the weight back”. That is why Dr Toh emphasises medical guidance and holistic support as a vital part of the clinic’s health coaching programme with Ozempic. She says, “There is no known time limit on how long one can be on Ozempic, but we work hard to equip and empower people with the skill sets and the knowledge through personalised health coaching programmes at NOVI Health to help them maintain a healthy body composition and keep the weight off, without lifelong dependency on Ozempic.” 

Being overweight or obese puts one at risk of diseases such as diabetes, heart disease and fatty liver, and in Dr Toh’s experience, Ozempic can help improve health outcomes in people at risk of these conditions. “At the end of the day, it’s not just about weight loss and healthy body composition, but a long lifespan with good quality of life,” she says.