Ozempic isn’t for everyone: The suite of drugs we need to advance obesity care

Ozempic®, an injectable GLP-1 receptor agonist (GLP-1 RA), has recently stolen the spotlight—and not for its intended purpose of lowering blood sugar in those with type 2 diabetes. But, with the hashtags #ozempic and #ozempicweightloss racking up over 700 million views on TikTok, the medication has sparked some intense curiosity. 

You’ve seen Ozempic everywhere, with some celebs touting it as a miracle (drug) for weight loss by reducing appetite and helping you feel fuller faster. But it has a lot of people wondering: What happens when you stop taking Ozempic? 

Using medication for weight loss isn’t a new phenomenon. In fact, working as an endocrinologist and being in the field of obesity medicine for nearly a decade, I have seen real-life scenarios in which medication was the bridge, connecting people to a healthier life. But should people be able to get their hands on Ozempic and other GLP-1s (short for GLP-1 RAs)  for weight loss without the help of a physician? Working with an experienced physician is important before diving in. Because while GLP-1s like Ozempic can help with weight loss, it isn’t the right medication for everyone. And with numerous medications out there, providers trained in obesity medicine can help patients find the pharmaceutical treatment that targets their biology and unique needs. 

Weight loss medication: Who it’s for and who it’s not

Not everyone is deemed eligible for anti-obesity medications (AOMs)—and for good reason. The current criteria for prescribing AOMs are those with a body mass index (BMI) at or above 30, or a BMI of 27 or above with at least one obesity-related condition such as diabetes or cardiovascular disease. Research has shown that medication can help those with obesity lose up to five to ten percent of their body weight, which may reduce the risk of cardiovascular and metabolic diseases. 

And while these drugs are effective at helping people lose weight, there are some instances where the benefit of weight loss may not outweigh the risk. This is especially true for those who are otherwise metabolically healthy and just looking to lose a few pounds for appearance purposes—which underscores the importance of working with an experienced provider.

Why medication for weight care? 

Research suggests that we may have a set weight point determined by age, genetics, hormones, and environment. While we can’t always change this, we can challenge it. Those who are unsuccessful in getting metabolically healthy with lifestyle changes alone may benefit from the addition of medication, and off-label prescribing has expanded the accessibility to medications for many.

Off-label prescribing is when a health care provider, such as myself, relies on their clinical judgment to prescribe a drug for a use that has not yet been approved—but where there’s substantial clinical evidence suggesting its effectiveness. 

One study found that an estimated 62.5 percent of those who took weight-loss medication while participating in a weight-loss management program lost at least 5 percent of their body weight, compared to an estimated 44.8 percent in the program alone. 

What are some of the medications available, and what do they do?

Understanding that everyone’s needs are different, there are a variety of medication options available, including medications that are approved by the US FDA to treat obesity and excess weight, and off-label medications that are supported by clinical evidence suggesting their effectiveness for weight management. But in the end, only a health care provider familiar with a patient’s medical history can determine what is right for a particular patient. I’ll walk through some of the options below, which include both non-GLP-1 anti-obesity medications and GLP-1 medications used for weight loss.

Non-GLP-1 medications

•  Metformin

Often used in combination with other medications to manage type 2 diabetes, metformin works to regulate the body's response to insulin. This can lead to less hunger and a lower tendency to store fat, promoting weight reduction, and making it a great off-label option.

The FDA also has a “black box warning” on metformin as it carries a serious safety risk of lactic acidosis. This rare but potentially fatal condition is when too much lactic acid builds up in the bloodstream. It can lead to low blood pressure, breathing issues, heart failure, and even death.

Additionally, metformin may stimulate ovulation in those with PCOS or who are premenopausal and may increase the risk of unintended pregnancy.  If you’re in a sexual relationship that can result in pregnancy, use at least one form of birth control unless you’re planning on getting pregnant. Find detailed side effect and risk information on our dedicated metformin page.  

•  Topiramate

While it’s FDA-approved for treating seizures and preventing migraines, there’s also evidence supporting the use of topiramate in weight care due to its ability to reduce appetite and cravings. One meta-analysis looking at topiramate for weight loss found that those prescribed topiramate for longer than 16 weeks lost an average of nearly 12 pounds more than those given a placebo (dummy pill). And when topiramate was used for longer than 28 weeks, the weight loss results were even greater.

Many people experience no side effects while taking topiramate, but there are both side effects and risks. Some of the most common side effects are anorexia, dizziness, fatigue, difficulty concentrating, psychomotor slowing, speech difficulty, nervousness, abnormal vision, and fever. Topiramate may cause some people to sweat less, so it’s important to avoid alcohol and stay hydrated. Don’t drive or operate heavy machinery until you know how topiramate affects you. Do not take topiramate if you are planning to become pregnant or if you are pregnant or breastfeeding. Read more about taking topiramate here. 

•  Zonisamide

FDA-approved for treating partial seizures through its ability to target certain areas of the brain, zonisamide has also been shown to aid in weight loss by acting on areas of the brain responsible for appetite control. In other words, it can help reduce cravings and suppress appetite.  

Zonisamide is not advised for people with certain conditions or risk factors. People who are allergic to sulfa drugs should not take zonisamide, because a potentially fatal reaction can occur including a life threatening skin rash or a blood cell condition.

GLP-1 receptor agonist and GLP-1/GIP dual agonist medications

GLP-1 receptor agonists and the GLP-1/GIP dual agonist are a class of medications used in the treatment of type 2 diabetes. Researchers are still exploring the mechanism behind GLP-1s and how they can help with weight loss. Nevertheless, they work by mimicking a naturally occurring hormone in your body (GLP-1), which may slow gastric emptying to help you feel fuller. GLP-1s may also help reduce appetite and cravings through a series of brain-gut interactions (and stabilize your blood sugar). All of which can help with weight loss. GLP-1/GIP dual agonist medications mimic two hormones in the body, GLP-1 and gastric inhibitory peptide (GIP), working to increase satiety and lower blood sugar.

GLP-1 and GLP-1/GIP medications do have some known potential side effects. The most common are nausea, vomiting, diarrhea, and acid reflux. More serious but less common side effects include pancreatitis, gallbladder disease, and worsening of diabetic eye disease. And those with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasias should not use them. Find detailed side effect and risk information for specific medications by name on our dedicated medication page.

While there are only a few GLP-1s that are FDA-approved for treating obesity—semaglutide (Wegovy®) and liraglutide (Saxenda®)—the others may be prescribed off-label. Zepbound®, a GLP-1/GIP dual agonist, is also FDA-approved for treating obesity.

•  Semaglutide

Brand names Ozempic, Rybelsus®, and Wegovy

Research on weight loss In one clinical trial looking at the effectiveness of semaglutide, those prescribed 2.4 mg of once-weekly semaglutide alongside lifestyle interventions lost an average of almost 15 percent of their body weight after 68 weeks, compared to 2.4 percent in the placebo group. The average weight loss was roughly 34 pounds in the semaglutide treatment group and 6 pounds in the placebo. 

•  Liraglutide

Brand names Saxenda or Victoza®

Research on weight loss When reviewing five randomized, placebo-controlled trials, liraglutide consistently resulted in a nine to thirteen-pound weight loss when paired with a healthy diet and exercise. Liraglutide helped more participants achieve a five to ten percent weight loss compared to the placebo group.

•  Dulaglutide 

Brand name Trulicity®

Research on weight loss In a randomized, double-blind study assessing patients who were previously unsuccessfully treated with metformin for type 2 diabetes, 4.5 mg of dulaglutide was superior for weight loss when compared to 1.5 mg of dulaglutide, helping patients lose an average of just over 10 pounds at the higher dose compared to an average of 6.5 pounds at 36 weeks on the lower dose.

•  Tirzepatide

Brand name Mounjaro® or Zepbound

Research on weight loss In a 72-week phase 3 double-blind, randomized, controlled trial looking at the effectiveness of once-weekly tirzepatide on weight reduction, 2,539 participants were assigned to the placebo group or to one of three tirzepatide treatment groups where they were given 5 mg, 10 mg, or 15 mg doses of tirzepatide, a dual agonist. Weight loss was significantly higher in each of the tirzepatide groups compared to the placebo. And the higher the dose of tirzepatide, the more weight the participants lost. The placebo group experienced a weight reduction of 3 percent. In comparison, those on tirzepatide lost an average of 15 percent body weight in the 5 mg group, 19.5 percent in the 10 mg group, and 21 percent in the 15 mg group. 

The importance of working with a physician trained in obesity medicine 

I wish more people understood that obesity is a disease that poses health risks and needs to be managed long-term just like other chronic diseases. Meaning: You can’t always just stop taking the medication when you hit your healthy weight. And just like other medications used for various ailments, AOMs are not without risks. By working with a board-certified physician, you’ll know that the recommendations you receive are made with your biology and personal journey in mind. The physician can assess personal and family history, and lifestyle, and determine if the health benefits resulting from clinically significant weight loss outweigh the risks of taking medication.

About the author: Dr. Rekha Kumar is Chief Medical Officer at evidence-based weight care platform Found, the former Medical Director of the American Board of Obesity Medicine, and a practicing endocrinologist in New York City.

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