Ozempic’s a “Game Changer,” but Only if You Can Get Your Hands on It

The TikTok hashtag “#ozempic” has at least a billion views on the platform, with many crediting it as a “game changer” in their weight loss journey. Ozempic is approved by the U.S. Food and Drug Administration (FDA) as a type 2 diabetes injection medication to lower blood sugar levels. It was rebranded as Wegovy and approved by the FDA for weight management in individuals with a body mass index (BMI) of higher than 30 or higher than 27 in individuals with weight-related health conditions. Wegovy can be used to help adults and children with obesity lose weight. When asked on X (formerly Twitter), Tesla CEO Elon Musk credited fasting and Wegovy for his “fit, ripped & healthy” appearance. 

Both Ozempic and Wegovy contain the active ingredient semaglutide, a drug that belongs to the Glucagon-like peptide-1 (GLP-1) receptor agonist, or GLP-1. These agonists mimic the natural hormone, GLP-1, that is synthesized by the gut. When one eats a meal, GLP-1 enhances insulin production in the pancreas as a response to the glucose in the food and signals satiety to the brain. Insulin is a vital hormone released by the pancreas that helps blood sugar enter the body’s cells to be used as energy. In the case of type 2 diabetes, cells do not respond normally to insulin, causing the pancreas to pump more insulin to try to get cells to respond. The body is unable to keep up, so blood sugar rises. Semaglutide also helps the pancreas produce insulin, explaining its use for managing type 2 diabetes, and is also able to induce the feeling of being “full” after a meal—successfully suppressing appetite. 

The FDA’s approval for Ozempic was based on results from the SUSTAIN clinical trials that enrolled more than 8,000 adult patients with type 2 diabetes. The SUSTAIN 1 trial enrolled 388 participants who were randomly assigned weekly subcutaneous, or injected under the skin, semaglutide or placebo. HbA_1c, or glycated hemoglobin, levels are used to diagnose diabetes. A high HbA_1c indicates too much sugar is in the blood. At week 30, HbA_1c levels decreased by 1.45% in the 0.5 mg semaglutide group and 1.55% in the 1.0 mg semaglutide group. SUSTAIN FORTE enrolled 961 patients who were randomly assigned 1.0 or 2.0 mg of semaglutide, and showed that patients with the latter dosage achieved a 0.3% greater HbA_1c reduction, as well as a 0.9 kg greater body weight reduction.

Clinical trials have also confirmed the link between semaglutide and weight loss, explaining the drug’s recent fame. A trial conducted by the New England Journal of Medicine enrolled 1961 adults with a BMI of 30 or greater—27 or greater in people with weight-related health condition(s)—all without diabetes. They were given a weekly dosage of 2.4 mg of weekly subcutaneous semaglutide or placebo for 68 weeks, and the primary endpoint was -14.9% mean change in body weight in the semaglutide group and a -2.4% mean change in the placebo group. Secondary endpoints included a -13.54 cm mean change in waist circumference in the semaglutide group compared to -4.13 cm in the placebo group and a BMI change of -5.54 in the semaglutide group compared to -0.92 in the placebo group.

A study conducted by the STEP 1 Study Group observed the effects of discontinuing semaglutide dosage. 1961 adults of the same criteria were given 2.4 mg of weekly subcutaneous semaglutide or a placebo for 68 weeks. At week 68, lifestyle intervention and treatments were discontinued and off-treatment extension analyses were conducted on 327 participants. The observed mean weight loss was 17.3% in the semaglutide group after 68 weeks, but semaglutide participants regained 11.6% of baseline weight by week 120. After semaglutide treatment is discontinued, appetite suppressed by the drug may return, increasing calorie intake, leading to weight regain. The findings in the STEP 1 study suggest that maintaining improvements in weight may require ongoing treatment of semaglutide. 

Thanks to the recent demand for the drug, a single Ozempic pen costs $935.77 out of pocket. With insurance, it is generally cheaper, but it is usually not covered without a type 2 diabetes diagnosis. Medicaid and Medicare only cover the drug for treatment of type 2 diabetes, but not weight loss. For those who are overweight or obese, Ozempic is not approved for weight loss, and while Wegovy is, it is not covered by most insurance. Only about one-quarter of corporate health insurance plans offer coverage for use of GLP-1s to treat weight loss, meaning many who could benefit from semaglutide for weight loss face the burden of paying out of pocket. 

As the drug has become a weight loss sensation, those who desire vanity to feel “healthier” prevent those who truly need the drug to control chronic obesity or diabetes. Shortages of injectable semaglutide have been ongoing since March 2022, as demand has outstripped the capacity of manufacturers. The University of California San Francisco’s weight management program’s Medical Director Diana Thiara explains that patients who have finally been able to access GLP-1s and have started to lose weight regain the weight in the time it takes for them to find another prescription covered by their insurance. 

In October 2023, Ozempic manufacturer Novo Nordisk warned online users against acquiring counterfeit versions of Wegovy and Ozempic. Due to the increased interest in the drug and global shortage, many illegal online pharmacies advertise the sale of injected semaglutide without a prescription, while others sell fraudulent Ozempic. In some cases, fake versions contain insulin, which Dr. Jill Waggoner explains “in somebody who does not have elevated blood sugar and who is not a diabetic is literally life-threatening.” With 41.9% of Americans dealing with obesity and 38 million Americans dealing with diabetes, the people who truly need the medication to be healthy are overshadowed by those driven to meet beauty standards.