Written by Dr. Daniela Steyn
I help many patients lose weight. My patients often ask me if I will prescribe Ozempic to them. Today, I saw two patients in the hospital who were admitted for another reason, who wanted to know whether it is safe to continue their Ozempic after their illness. In case you have wondered (and because I can not see everyone in person who has been emailing our clinic), I would like to answer here.
Ozempic (Semaglutide) is a prescription drug approved to treat adult patients with type 2 diabetes mellitus. It's marketed in Canada by Novo Nordisk. It became super popular in the US as celebrities lost a lot of weight with Ozempic. It is now so popular that we have a shortage of Ozempic. Weight loss is not an indication for Ozempic approved by Health Canada, however, the decision to prescribe a drug for off-label use is part of the "practice of medicine". It involves the healthcare professional diagnosing a patient's symptoms and deciding which treatment would be most appropriate for that patient. A recent survey published three days ago on CBC.ca found that between 25-50% of Ozempic prescribed in Canada is for weight loss.
What is Ozempic?
Ozempic (Semaglutide injection 0.5mg, 1mg, 2mg) is a once-weekly GLP-1 RA (glucagon-like peptide receptor agonist) injection.
Wegovy (Semaglutide, also manufactured by Novo Nordisk) is specifically indicated for obesity and approved in Canada. However, due to the high demand and supply restraints has never been available in Canada.
What is GLP? Glucagon-Like Peptides, are hormones produced by the intestines that regulate appetite, food intake, intestinal mobility, and blood sugar levels. Medications based on GLP-1 are synthetic versions of these hormones designed to elicit a stronger response. These types of medications were developed to treat diabetes, and their effect on weight loss is a great secondary benefit.
Does it work?
Yes. GLP-1 is highly effective for some people. Every patient I have seen who is on Ozempic has lost weight on it.
Weight loss then further benefits patients due to improved blood sugar levels for diabetics and reduced metabolic syndrome because of a lower food intake. Additional benefits include lower cholesterol and improved upregulation of certain pancreatic hormones and liver function.
Unfortunately, people don't only lose fat but also muscle mass. People lose, on average, 15-18% of their body weight over 68 weeks on this medication. Maintaining lean muscle mass is achievable through weight training at least three times a week and consuming approximately 1 gram of protein per pound of body weight daily.
Ozempic must not be used in patients who:
Have a personal or family history of medullary thyroid cancer.
Have multiple endocrine neoplasia syndrome type 2 (also called MEN 2)
This is a rare condition that causes tumours in the thyroid and parathyroid glands, adrenal glands, lips, mouth, eyes and digestive tract.
It should also not be used during pregnancy and breastfeeding.
Ozempic is not approved for use in individuals under 18 years of age.
Common side effects of Ozempic may include nausea, vomiting, diarrhea, stomach pain and constipation.
Ozempic may also lead to serious side effects, such as:
Changes in vision
Severely low blood sugar levels when used with diabetes treatments
Kidney problems, such as kidney failure
Severe allergic reactions
Thyroid tumours, including cancer
Do you or other doctors at Wellness MD prescribe Ozempic?
As per Canadian guidelines, Ozempic is indicated in Diabetic patients with a body mass index (BMI) of more than 30, or a BMI over 27 AND certain weight-related medical conditions such as high blood pressure and high cholesterol.
A 2022 study found that most people taking Semaglutide who did not have diabetes gained much of the weight back within a year of stopping the medication.
That is why, at Wellness MD, we will only prescribe weight loss medication if our client agrees to follow up with our team very regularly (twice a month), follow a healthy nutrition plan as recommended by us for their individual needs and implement the six pillars of lifestyle medicine —a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections. This is a mouthful, but do not worry. Your health coach will take you by the hand and support you each step of the way.
I find that obesity medication might be very helpful for some patients to adjust to a new lifestyle. However, the new healthy lifestyle is critical to keep the weight off after discontinuing the medication.