Deep Dive

OZEMPIC: The good, the bad and the downright UGLY

Ozempic has changed millions of people's lives. But is it really a good idea for people who just need to shed a few pounds? Here's what the experts say.

Ozempic semaglutide injection pens and box (Photo: Shutterstock / Marc Bruxelle)

Move over, keto diet and juice cleanses - there's a new weight loss sensation captivating everyone from TikTok influencers to A-list celebrities. But this trendy treatment wasn't designed for the red carpet; it was created for managing blood sugar.

Ozempic, a diabetes medication approved by the FDA in 2017, has become the talk of the town for its dramatic weight loss effects.

With approximately 42% of American adults classified as obese according to the Centers for Disease Control and Prevention, the allure of this seemingly miraculous solution has created a perfect storm of soaring demand, nationwide shortages, and growing concerns about its long-term effects. As diabetes patients struggle to find their prescribed medication, and users report their faces aging seemingly overnight, medical experts are raising red flags about the implications of this weight loss phenomenon.

Originally approved by the FDA for type 2 diabetes treatment, Ozempic's active ingredient, semaglutide, works by mimicking a naturally occurring hormone called GLP-1. The drug performs multiple functions in the body: it stimulates insulin production from the pancreas, slows down food movement through the stomach, and sends signals to the brain indicating fullness - similar to the effects of bariatric surgery.

The Facial Aging Phenomenon AKA OZEMPIC FACE

Among the drug's notable side effects is a condition that cosmetic dermatologist Dr. Paul Jarrod Frank has dubbed "Ozempic face." The rapid weight loss induced by the medication can lead to significant changes in facial appearance, including increased signs of aging, loss of facial volume, and skin sagging. Medical experts explain that facial fat serves a protective function, affecting both aesthetics and elasticity. When this fat diminishes rapidly, the skin loses its natural cushioning and structural support.

The resulting changes can include more pronounced lines and wrinkles, loose and sagging skin, and a hollowed-out appearance. These effects occur because the skin loses its ability to retract after rapid weight loss, due to reduced levels of elastin and collagen, proteins essential for maintaining skin structure and elasticity.

Ozempic vs. Wegovy: Understanding the Distinction

Adding to the complexity of the situation is the relationship between Ozempic and Wegovy, both manufactured by Novo Nordisk. While both medications contain semaglutide, Wegovy, approved by the FDA in 2021, contains higher doses and is specifically designed for chronic weight management. It represents the first FDA-approved drug for this purpose since 2014.

Despite their similarities, insurance coverage varies significantly between the two medications. Ozempic is typically covered by health insurance plans due to its diabetes indication, while Wegovy often faces coverage limitations. This disparity has contributed to the increased off-label use of Ozempic for weight loss purposes.

Side Effects and Safety Concerns

Beyond facial changes, Ozempic users may experience a range of side effects varying from mild to severe. Common side effects include nausea, vomiting, diarrhea, flatulence, constipation, stomach ache, abdominal pain, fatigue, and injection-site reactions. In rare cases, more serious adverse effects have been reported, including vision changes, kidney problems, gallbladder disease, severe allergic reactions, and an increased risk of thyroid cancer.

The medication carries a boxed warning for thyroid cancer risk, based on animal trials. While the human risk remains unclear, healthcare providers advise patients to watch for symptoms such as difficulty swallowing, neck lumps or pain, wheezing, shortness of breath, or worsening hoarseness.

Long-term Implications and Weight Regain

Research has shown that discontinuing Ozempic can lead to significant weight regain. A 2022 study examining 1,961 participants found that stopping the medication resulted in increased food cravings and blood sugar spikes, along with weight regain. This phenomenon raises questions about the long-term viability of using semaglutide-based medications for weight management.

The FDA Warning and Supply Issues

The situation has been further complicated by the emergence of unauthorized "generic" versions of both Ozempic and Wegovy. The FDA has issued warnings about these unregulated alternatives appearing in compounding pharmacies across the United States, following reports of adverse reactions. As of July 2023, both medications face ongoing supply shortages.

Medical Community Response

Healthcare providers emphasize that while semaglutide can be effective for weight loss, it should be used under proper medical supervision and in conjunction with lifestyle modifications. The degree of weight loss achieved through traditional bariatric surgery typically exceeds and maintains better than medication-based approaches.

Prevention and Management

For those prescribed Ozempic, medical experts recommend several strategies to minimize facial aging effects, including maintaining adequate hydration (1-2 liters of water daily), following a protein-rich diet, and considering dermatological fillers when appropriate. Some patients may benefit from dosage adjustments or alternative medications if facial changes become concerning.

The medication takes approximately five weeks to clear from the system after discontinuation, and healthcare providers stress the importance of monitoring for any adverse effects during both use and discontinuation periods.

FDA Warns: Surging Health Risks from taking Fake Ozempic

Federal health regulators are sounding the alarm over a growing crisis of unauthorized and potentially dangerous versions of popular weight loss medications flooding the market, with hundreds of Americans reporting serious side effects.

The Food and Drug Administration has received more than 392 reports of adverse reactions to compounded versions of semaglutide (sold as Ozempic) and 215 reports linked to compounded tirzepatide as of November 2024, according to a new safety alert. Some cases were severe enough to require hospitalization.

Health officials warn that patients seeking these drugs for weight loss are increasingly turning to unapproved sources, including compounding pharmacies and online sellers marketing counterfeit versions. The FDA has identified multiple cases of fake Ozempic being sold in the United States.

"These illegally marketed drugs may be counterfeit, could contain the wrong ingredients or harmful ingredients, or could contain too little, too much or no active ingredient at all," the agency stated in its warning.

Of particular concern are dosing errors with compounded versions. Multiple patients required emergency care after measuring and self-administering incorrect doses. Healthcare providers have also miscalculated doses, leading to serious adverse reactions including severe nausea, vomiting, diarrhea, abdominal pain and constipation.

The agency also warned about companies illegally selling unapproved versions labeled "for research purposes" or "not for human consumption" directly to consumers with dosing instructions.

To protect themselves, regulators urge patients to obtain prescriptions only from licensed doctors and fill them at state-licensed pharmacies. The FDA emphasizes that while compounded drugs might be appropriate in some cases where approved versions aren't available, they do not undergo FDA review for safety, effectiveness, or quality before reaching the market.

The warning comes amid ongoing shortages of FDA-approved Ozempic and similar medications, which has driven some patients to seek alternative sources despite the risks.

FDA Warns of Intestinal Blockage Risk

The U.S. Food and Drug Administration has revised the warning label for the Ozempic to include reports of intestinal blockage. The update aligns Ozempic's labeling with its sister drug Wegovy and competitor Mounjaro, which already carry warnings about ileus, a condition where the intestines become blocked.

The labeling change comes amid broader concerns about gastrointestinal side effects, including reports of gastroparesis, or stomach paralysis, though manufacturers maintain these cases are rare. Novo Nordisk, which produces both Ozempic and Wegovy, emphasizes that gastrointestinal events are well-documented side effects of this drug class, known as GLP-1 agonists, and are typically mild to moderate and temporary. However, the issue has sparked legal action, with at least one lawsuit filed against Novo Nordisk and Eli Lilly over alleged severe gastrointestinal complications from using these medications.

With the drug's rising popularity showing no signs of slowing down, America's battle between the scale and the mirror rages on, leaving many to wonder: is the trade-off between a slimmer waistline and a younger-looking face worth it? For now, that's a question each patient will have to face - quite literally - in the mirror.

Healthline, CNN and UC Davis Health contributed to this article.


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