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Ozempic for weight loss: What you should know, according to a weight loss doctor

Dr. Sandy Van answers popular questions about Ozempic, Wegovy, GLP-1, BMI calculator and much more

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I can’t even blame my social media algorithm for this one – Ozempic and similar drugs are advertised all over the place, from television ads, public transit, audio streaming platforms and of course social media.

Ozempic is a brand name semaglutide, a medication used to treat type 2 diabetes. It’s also used as an off-label use for weight loss. Wegovy is another brand name with the same active ingredient (semaglutide) as Ozempic. Health Canada has approved Wegovy as a weight loss medication. These drugs and other similar ones including Mounjaro, Victoza and Trulicity, belong to the glucagon-like peptide 1 (GLP-1) agonists group.

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GLP-1 is a hormone that plays quite a few roles, including increasing satiety. GLP-1 is another buzzword used across media and among celebrities. Kourtney Kardashian’s brand Lemme even offers GLP-1 Daily Capsules, however, the supplements don’t actually contain any GLP-1 agonists.

All to say, there’s a lot of chatter about Ozempic and similar drugs for weight loss. To get to the bottom of what’s fact and what’s social media prattle, I connected with Dr. Sandy Van, a weight loss doctor trained in family medicine and a Diplomate of the American Board of Obesity Medicine.

Dr. Van first went into obesity medicine because she “found that obesity was something that permeated somebody’s life in such a profound way in all aspects — psychologically, mechanically, medically.”?

“At the time, people weren’t treating obesity as a chronic disease like they are now. They treated it as a lifestyle problem — telling people to eat less and move more, which was very insufficient and inappropriate because there was something more to it. So I focused my practice on [it],” she adds.

Dr. Van dives into the lives of people who have experiences with a higher weight. She addresses the stigma that they could have experienced and supports her patients throughout their physical and psychological journeys. “Being able to validate their experience through counselling is special to me. Also being able to provide them with the treatment that actually allows them to see robust weight loss outcomes that improve their quality of life.”

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Read on as Dr. Van addresses popular questions about weight loss drugs.

Dr. Sandy Van.
Dr. Sandy Van. Photo by Dr. Sandy Van.

Q&A with Dr. Sandy Van about Ozempic for weight loss (and other popular weight loss questions)

Q: What are your thoughts on the BMI (body mass index) scale?

A: The reason why I think it’s been adopted so widely is because it’s simple and easy to use – it accounts for height and weight alone. It’s a practical tool for population-level health assessments and epidemiological studies, and it gives us a really quick way to categorize individuals to broad weight statuses like underweight, normal weight, overweight and obese for stat analysis.?

Despite its limitations, research does show an association with certain health risks like cardiovascular disease and type 2 diabetes.

Its main limitation is that it doesn’t differentiate between muscle and fat, so it can misclassify individuals with high muscle mass as overweight or obese. As a result, we often use additional measures like weight, circumference, body fat percentage and clinical assessments like blood sugars and blood pressure to gain a more comprehensive understanding of that person’s health.?

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Q: What are your thoughts on the Ozempic, Wegovy and similar drugs when used exclusively for weight loss/management? (Versus diabetes.)

A: People living with obesity have historically been told to eat less — it’s such an antiquated message and fails to address the underlying complexity that’s associated with obesity. Appetite hormones can be different in everybody.?

Obesity is highly heritable, meaning that if you have two parents with obesity your risk of developing obesity yourself is up to 70 per cent. We know that some people will describe needing more calories to feel satiated.

There’s this reflexive process that occurs in the brain that’s trying to compensate for that loss [lower calorie intake], so you naturally get increases in hunger hormone [and] decreases in fullness hormones like GLP-1 amongst others – and then you get a slowing of your metabolism.?

The effort to clamp down on that energy deficit and try to close that energy out in itself makes it unhelpful to tell somebody to just eat less, move more. Being able to offer evidence-based medication like Wegovy (the Health Canada-approved medication for weight loss) is a privilege because these people have often tried so much to lose weight. The greatest benefit of these medications is that they’re meant to help people. Also, not only lose weight but keep the weight off.?

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Q: What is GLP-1?

A: A hormone that’s produced in the gut when you eat to regulate fullness. We only know of one hormone that stimulates hunger right now, it’s called ghrelin. GLP-1 is amongst a number of hormones that regulate fullness.?

Q: What are the risks of taking GLP-1 medications?

A: Common risks associated with GLP-1 medications are gastrointestinal. Most common are nausea, vomiting, diarrhea, constipation and heartburn. They’re not meant to be long-term. They’re meant to be temporary side effects when you’re initiating or if you’re dose-escalating, but there’s some set of patients who just don’t tolerate it.

Q: Once you’re on a GLP-1 medication are you on it for life?

A: If you have obesity, which is considered a chronic medical condition similar to hypertension or diabetes, you apply the chronic disease management paradigm, which is long-term use of the treatment. We don’t currently have a cure. I think that that’s one of the misconceptions about the GLP-1 drugs is that they’re cures for obesity, but they’re actually not cures. They’re just another tool to help manage weight.

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The benefit is sustained only when it is with ongoing use, so when you lose weight on the medication, ideally that person remains on that treatment to sustain that benefit — because we often see in the clinical trials that with discontinuation the patient’s weight relapses.?

And so there is a small subset of patients who seem to be able to keep the weight off, like at the year out from discontinuation. But we don’t really know what happens two to three years out.

Q: Are there foods that can mimic the effects of GLP-1??

A: While some foods, particularly those high in protein and fibre, can modestly stimulate GLP-1 release, the effect is minimal compared to medications like semaglutide. The GLP-1 we make ourselves has a really short half-life [how long it takes a substance to reduce to half of its initial value], lasting only one to two minutes.

When people talk about mimicking GLP-1 through diet, I think that they’re usually referring to foods that will enhance satiety, and so protein-rich foods like lean meats, fish and legumes, along with fibre-dense options like vegetables and whole grains which can help regulate appetite by slowing digestion and promoting fullness.?

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Long-term weight loss through diet is often challenging due to the body’s natural resistance, including increased hunger and metabolic adaptation. I often ask patients to consider from a behavioural standpoint, like focusing on satiety-provoking foods if they’re going to take a behavioural route with managing their weight. I often counsel them on the fact that you might see weight loss with this, but let’s continue to monitor your appetite signals because we might find that your hunger is going up or your cravings are becoming more intense and difficult to manage.

Q: Are there any supplements on the market that mimic the weight management effects of GLP-1 drugs?

A: I do not recommend supplements for GLP1. These pharmacotherapy agents have been so rigorously studied — it takes at least a decade before these drugs hit the shelves. But for a supplement to be put on a shelf, it requires very little screening.?

I don’t believe that there’s any supplements that are currently available that will simulate the effect of a pharmacotherapy agent. I really caution on supplement use ’cause there’s a lot out there without any substantiated evidence for their use or safety.

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Q: What’s one less-known misconception about Ozempic and the other drugs above?

A: The most common misconception is that people think they’re going to lose way more than the drug is actually able to offer. I think that these medications have been so sensationalized in terms of their effect that I see patients all day on these medications and I often find that despite them showing clinically significant weight reduction — I’m talking like 10 or 20 per cent weight loss — and they’re completely dissatisfied.?

I often have to dig a little bit deeper. Like what’s with the dissatisfaction I’m seeing here? They see people on social media or TV losing way more weight. Those are numbers that are complete outliers — they’re totally sensationalized and exaggerated.

I have to bring the patient back to the centre and anchor them to the realistic expectations that these weight loss medications provide benefits that come from weight reduction. They’re seeing reduction in osteoarthritis pain and improvements in mobility, reductions in blood sugar and improvements in cholesterol and blood pressure. All these metabolic parameters are improving, but that person is still moving the goalpost.

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Q: Anything else you’d like to share about GLP-1, the drugs above or weight management?

A: I often notice that patients are coming to me for consultations and they might have a higher BMI, like over 30, but they’re totally healthy. Meaning that there’s no psychological impairment, there’s no mechanical limitations, there’s no medical impact and they are seeking out these medications thinking that they need them – in part because they feel like they should be at a lower weight.?

But obesity is characterized by excess fat that’s impairing somebody’s health in some way. I often find that they breathe a sigh of relief when I tell them they don’t need this treatment right now – it’s a long-term use medication and it’s not without its risks. My bottom line is really that it’s a helpful medication when it’s clinically indicated for the right person who needs it, but not everybody needs to be on these treatments just because they’re available.

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