The big O: The world craves Ozempic, the miracle weight-loss drug

Is happiness a seven-letter word? The type-2-diabetes drug Ozempic has had the wellness industry abuzz for the past two years, with the phenomenon threatening to topple the infamous BBL (Brazilian butt lift) as the most in-demand aesthetic tool.

With stars such as Oprah Winfrey, Kelly Clarkson, and Whoopi Goldberg admitting to using weight-loss medication, it’s no surprise that the public also want a taste.

But what is Ozempic? How does it work? Where do we get it? And what are the risks? “Ozempic is a semaglutide that works by mimicking the GLP 1 [glucagon-like peptide-1] hormone. Once you inject it, it increases insulin secretion and lowers your blood sugar,” says registered dietician Aziwe Booi. “The weight-loss benefits come in because it reduces your appetite and hunger cues, which means you feel less hungry than normal, leading you to reduce your portions and resulting in you achieving a caloric deficit more easily.”

The injection also causes “delayed gastric emptying”, which means it gives you a prolonged sense of fullness that in turn leads to a reduced frequency of eating throughout the day.

“It also helps reduce cravings for sugary sweets or beverages, so you are less likely to overeat those specific foods. Essentially, what makes people gain weight is… high-energy, high-sugar refined starches, so by reducing that craving it helps you lose weight,” adds Booi.

Ozempic (and other variants containing semaglutide) was initially prescribed for type-2 diabetes, as it increases insulin secretion in the body, and has been used as an off-label weight-loss drug since 2021. Research on its weight-loss effects was first published more than 10 years ago.

In South Africa, it is currently only registered for use in diabetes treatment. Weight loss, however, helps control diabetes and, in some cases, can reverse the disease. The medication is accessed through a doctor’s prescription and is self-injected into the stomach, arm or thigh every seven days, with an increase in dosage each week.

Tebogo* has been on the sister drug Saxenda (a liraglutide that works in the same way as Ozempic) since April and has lost 9kg thus far. “I have always been someone who tries the latest diet on the market. For the past two years I’ve done intermittent fasting but had gotten to a stage where I was no longer seeing any results on the scale — I had plateaued,” she explains. “I went to my doctor for my annual check-up, and she found that I had gained 3kg since my last visit. I was also very uncomfortable with my weight and wanted to get onto a quick weight-loss regime.”

Although initially scared to mention Ozempic, eventually Tebogo asked her doctor about it, who explained how it works as well as the pros and cons. “For me, the pros outweigh the cons, which is why I decided to start the journey,” Tebogo says.

The side effects of these weight-loss drugs include gastrointestinal symptoms such as nausea, diarrhoea, vomiting, constipation, reduced absorption of certain foods, heartburn, indigestion, fatigue, and dehydration. Abdominal pain, low blood sugar (hypoglycaemia), and dizziness have also been reported.

“It really worked on my mental state. I found myself getting into a bad mood very quickly and having hectic mood swings and nausea when I was on a higher dosage,” Tebogo says. “My doctor explained that I had to figure out the right dosage for my body. I lowered my dosage back to 0.6 ml and felt way better. When I’m on it, I cannot stand fatty foods like takeaways. I also stay away from alcohol because I find I get tipsy very quickly.”

The 40-year-old notes clearer skin and feeling more energised as positive side effects of the regimen.

Jabu* had been struggling with weight gain and was looking to experiment with different options. Referred to Ozempic by his mother, who had found success in the injections and minimal side effects, Jabu embarked on a two-month journey that led him to a 4kg loss. Although he saw results, his experience was not fun.

“As an actor, I was under pressure to lose weight, but I did not enjoy the way it took my hunger away. My stomach was very sensitive and I suffered from nausea, diarrhoea, and vomiting,” Jabu says. “I felt like a zombie for the most part because I was not eating enough and could not keep anything down. I think the mistake was that I started on an extremely high dose — on 1ml. I think my experience would have been different had I been supervised by a doctor instead of just getting the prescription and doing it on my own.”

Unlike Jabu, Tebogo checks in with her doctor once a month while on the injections.

“Ozempic is a prescription medication, so it’s important for patients to consult with their healthcare providers to ensure it is right for them and to help find the dose that works best. It also needs to be taken as prescribed,” says Dr Carmen Briner. “Side effects need to be discussed with a doctor, as there are management strategies to help.”

The biggest concern is that not enough research has been done on the long-term side effects in non-diabetic individuals.

“Studies in animals suggest that semaglutide may increase the risk of thyroid cancer. While there is no definitive proof that the drug causes thyroid cancer in humans, there is enough uncertainty to warrant caution, especially for people with a personal or family history of this type of cancer,” says Briner. “For them, it is generally recommended to avoid taking the drug.”

Other long-term side effects include temporal face wasting and sunken cheeks, caused by an excessive loss of fat in the face.

Tebogo’s biggest fear, however, is the number of women overseas who have reportedly fallen pregnant, even after menopause. “There have been increased cases of pregnancy in women who had fertility issues. This is because weight loss can improve fertility by correcting hormonal imbalances and metabolic disorders. Also, Ozempic may reduce the effectiveness of birth control pills. Birth control pills are metabolised in the liver and some drugs are known to impact liver metabolism of various medications.” 

“A friend of mine who is in her 50s went into menopause and stopped having her period, but since she has been on it her period came back. I guess it is a positive for those who want to conceive,” Tebogo laughs.

Studies have also shown that individuals on the medication regain two-thirds of the weight they have lost within a year of stopping the course. “One of the biggest misconceptions is that Ozempic is a quick fix for weight loss. While it is a valuable tool, it works best when combined with healthy eating and exercise,” says Briner.

Booi adds, “I would not recommend the use of Ozempic as an aesthetic thing. It is useful for those struggling to lose weight because of medical conditions such as hormonal issues, metabolic syndrome or insulin resistance.”

Booi emphasises that the most important thing is to educate people about it so they can make the right choices for themselves.

Tebogo initially spent about R3 800 a month on the injection, but since she lowered her dosage, one pack lasts her two months. If you have a prescription for the drug, medical aid covers it with the option to buy one pen at a time for just over R1 000.

“Off-label use of Ozempic for weight loss in South Africa has significantly increased demand for the medication. Disruptions in the supply chain have created challenges in meeting the current demand for Ozempic,” says Briner. “This limited availability presents difficulties for diabetic patients who rely on the medication for managing their blood-sugar levels. Furthermore, shortages lead to price fluctuations, as pharmacies and suppliers attempt to navigate the constrained supply.”

*Not their real names