Registered Dietician Kathleen Meehan joins me again for a conversation about the hot (and controversial) topic of semaglutide weight loss medications you know as Ozempic, Wegovy, and Rybelsus. We dive into the science of glucose, the often overlooked side effects and risks of these drugs, and the bombardment of marketing at every turn.
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Key Takeaways
Introductions
- Kathleen’s philosophy is anti-diet, fat positive, and weight inclusive. She believes body liberation should be accessible to all and incorporates the principles of Intuitive Eating and Health at Every Size.
- Located in Los Angeles, Kathleen (she/her) has New England roots, an undergraduate nutrition degree, and a Master’s of Science from Boston University in Nutritional Sciences. She has practiced as an RD in Boston, Houston and Dallas, and is licensed in many states across the country!
- Kathleen now partners with clients virtually, and is passionate about weaving evidence-based science with lived experience. Together, you will explore what it means to heal your relationship with food and body!
Semaglutide for Weight Loss
Semaglutide is the ingredient of Ozempic, Wegovy, and Rybelsus, the brand name. It has been on the market for 15 years for Type 2 Diabetes, but recently the doses have changed, and it’s being used off-label for weightloss.
- Stacy notes that this bonus show stemmed from getting an Instagram ad that asked “have you been harmed by weight loss injection drugs?” Somehow society is willing to overlook increased risk of cancer, long-term blood sugar dysregulation, and on and on to justify weight loss. Which we conflate with health, which clearly is not what weight loss injectables help with.
- Glucose is the essential metabolic fuel for the brain. Acute and severe reduction of brain glucose leads quickly to impairment of cognitive and reflex function, autonomic failure, seizures, loss of consciousness, and permanent and irreversible brain damage and, if not rapidly corrected, can be lethal. [source]
Type 2 Diabetes
- There is there a cultural belief that Type 2 diabetes is “deserved” for people in larger bodies or that lack of self control is the cause of their disease. How do these injections ultimately activate Incretins?
- 2021 Study: 68 weeks, 2.4mg weekly: The mean change in body weight from baseline to week 68 was -14.9% in the semaglutide group as compared with -2.4% with placebo… Participants who received semaglutide had a greater improvement with respect to cardiometabolic risk factors and a greater increase in participant-reported physical functioning from baseline than those who received placebo. [source]
- 2022 Study: 3-6 months + 6 month follow-up, 1.7 or 2.4mg weekly: “Studies with longer periods of follow-up are needed to evaluate prolonged weight loss outcomes.” [source]
- 2022 Efficacy and safety of semaglutide on weight loss in obese or overweight patients without diabetes: A systematic review and meta-analysis of randomized controlled trials. The meta-analysis enrolled 4,567 patients in eight studies, which validated that the results were stable and reliable with dose-dependence. [source]
Ozempic Face
- Rapid weight and fat loss with Ozempic can lead to the characteristic “Ozempic face,” where facial volume and fat are depleted, resulting in wrinkles and sagging skin. Providers prescribing Ozempic seldom counsel patients about the potential impact on the face. As a result, the plastic surgery community faces a challenge in managing facial changes associated with rapid weight loss. Dermal fillers, skin tightening techniques, and surgical interventions are useful for both restoration of facial volume and to manage excess skin. [source]
- Dermatologists are well positioned to counsel patients receiving or discontinuing GLP-1 agonists and recommend appropriate countermeasures, as appropriate [source]
Long-Term Use of Semaglutides
- 2022 Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. In Dr. Asher Larmie’s assessment of this final analysis, which they point out as specifically NOT addressing the weight gain and shut off the study once it starts to steadily increase, “ after 10 months people begin to regain weight and if we extrapolate that rate at 2 years out to 5 years then 100% of the weight from everyone would be gained back – even if still on the medication.”
[source]
- 2022 Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Furthermore, the follow-up to the first 68-week study validates this. Following treatment withdrawal, semaglutide and placebo participants regained two-thirds of their prior weight loss with similar changes in cardiometabolic variables returning to baseline. The findings confirm that obesity is chronic, and they suggest that ongoing treatment is necessary to maintain improvements in weight and health.
- And, unsurprisingly, now in 2023 we start to learn a lot more. Let’s start with the 2023 case report of associated depression. Multiple cases noted where patients had no history, depressive symptoms and recurrent depressive disorder set in around 1 month after semaglutide treatment and then dissipated upon ceasing use. “Possible psychiatric adverse effects of depression should be taken into consideration when semaglutide is administered to patients.” [source]
FDA Warnings
The FDA has issued a boxed warning (previously called a Black Box Warning) due to its potential to cause thyroid tumors and thyroid cancer as well as increased risk of hypoglycemia and insulin secretagogues. The FDA issues a boxed warning, which is the most serious safety warning, and it is not something to take lightly.. [source]
- Gastrointestinal Disorders: Ileus
- Hypersensitivity: anaphylaxis, angioedema, rash, urticaria.
- Hepatobiliary: cholecystitis, cholecystectomy
- Acute gallbladder disease such as cholelithiasis or cholecystitis
- pain in your upper stomach (abdomen)
- fever
- yellowing of skin or eyes (jaundice)
- clay-colored stools
- Hypersensitivity and serious allergic reactions: anaphylaxis, angioedema, rash, urticaria.
- major birth defects and miscarriage
- Increased risk of hypoglycemia, including severe hypoglycemia
Other Side Effects & Claims
Last but not least – if we consider this overall we can see how semaglutide is contributing to weightloss and regain: weight cycling. Dr. Larmie defied this as dropping more than 10% of your body weight and then regaining it, which Stacy notes that she has done multiple times in her life and can identify with all of the severe negative health effects they outlined: gut health, muscle ratio, oxidative stress and reduced cellular health, increasing cortisol causing inflammation which negatively affects hormones (PCOS) , and increases risk of insulin resistance.
And, according to Dr. Larmie, we also don’t see in any of the studies some of the purported claims:
- Claims that do NOT have support:
- Protect the heart
- PCOS
- “Pre-Diabetes” which they clarified only CDC defines only in the US; WHO does not
- Fatty Liver Disease
- Insulin Resistance – in fact, Dr. Larmie postulates that one of the negative outcomes of this popularity for weight loss will cause insulin resistance and that in 10-15 years we’ll see a spike of Type 2 diabetes in users of the injection drug if used with someone who had a healthy pancreas because it will cause the hormones to skew. And, why previously it’s only ever been tested on diabetics who need life-long medication. Dependency is not the intention for weight loss.
Studies, References & Products
- Once-Weekly Semaglutide in Adults with Overweight or Obesity, The New England Journal of Medicine
- Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity, JAMA
- Efficacy and safety of semaglutide on weight loss in obese or overweight patients without diabetes: A systematic review and meta-analysis of randomized controlled trials, Frontiers in Pharmacology
- Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons, FPS
- Natural Weight Loss or “Ozempic Face”: Demystifying A Social Media Phenomenon, Journal of Drugs in Dermatology
- Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial, Nature Medicine
- Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension, Diabetes, Obesity, and Metabolism
- Case Report: Semaglutide-associated depression: a report of two cases, Frontiers in Psychiatry
- Appetite and Food Intake: Central Control; Chapter 9: Monitoring and Maintenance of Brain Glucose Supply
- FDA: Ozempic
- Find Food Freedom: Weight Loss Injections 101 with Dr. Asher Larmie (Webinar)
- ScienceDirect: Incretin
- Concierge MD: What Are The Types of Weight Loss Injections You Can Get From Your Physician?
- American Psychological Association: The psychology of hunger
- The Renfrew Center: The Minnesota Semi-Starvation Experiment: What It Teaches Us About Eating Disorders
- The Whole View, Season 3, Ep 42: No Noom New Years w/ Kathleen Meehan, RD
- Maintenance Phase: Ozempic
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