The worldwide hype about the Ozempic and Wegovy weight loss injections is still continuing. Its active ingredient, semaglutide, was originally developed for diabetes patients. What are the preparations good for?
The diabetes drug Ozempic made headlines as a “weight loss injection”. Due to the strong demand, there were supply bottlenecks worldwide. (picture alliance / AP / Joe O’Connal)
Ozempic was originally developed for diabetes patients. However, the drug is making headlines worldwide as a means of reducing weight safely and easily. In addition, the higher-dose variant Wegovy, which was explicitly developed for severely overweight people, is in high demand worldwide. In Germany, too, there are repeated supply bottlenecks.
The weight loss injections are on the road to success. In 2023, the drugs were not only named the scientific breakthrough of the year by the renowned Science magazine. Novo Nordisk is now the most valuable company on the stock exchange in Europe due to the weight loss injections alone. But doctors warn against misuse of the drugs.What exactly are Ozempic and Wegovy or Semaglutide?
Semaglutide is an active ingredient that was developed for the treatment of type 2 diabetes. The prescription Ozempic is therefore approved in the United States and Europe as a drug for the treatment of so-called adult-onset diabetes.Semaglutide is also approved as a drug for people who have “morbid obesity”, reports Karsten Müssig, chief physician at the Clinic for Internal Medicine and Gastroenterology at the Franziskus-Hospital Harderberg in Münster. The drug Wegovy contains the same active ingredient as Ozempic, but is much higher dosed and is approved by the European Medicines Agency (EMA) as a weight loss supplement. People with a body mass index (BMI) over 30 or with a BMI over 27 are considered extremely overweight or obese if they have comorbidities.
Before those affected are prescribed Wegovy, they must have tried conservative therapeutic measures, such as exercise therapies or nutritional counseling. This means that you should only take the weight loss injection if no other therapy has worked.How does Ozempic or Semaglutide work?
The active ingredient, which is contained in both Ozempic and Wegovy, promotes the release of insulin in the body and ensures that you feel really full quickly. In people with type 2 diabetes, the body’s cells no longer respond well to the hormone insulin. This is a problem, because insulin is a key messenger substance in energy metabolism. It comes into play when food is digested and a lot of sugar passes from the intestine into the blood.
Semaglutide helps here in several ways, namely by mimicking the effect of an intestinal hormone (GLP-1). This ensures that the pancreas releases more insulin. And only after eating, when the blood sugar level is high and insulin is actually needed. Therefore, the risk of the patient becoming hypoglycemic, as can happen with some other diabetes medications, is low.However, semaglutide also acts on a second hormone in the metabolism: glucagon, the antagonist of insulin. Semaglutide inhibits the release of glucagon, which further lowers blood sugar levels. In addition, semaglutide slows down the emptying of the stomach. The sugar is absorbed less quickly from the intestine into the blood, the blood sugar level rises more slowly and the pancreas is relieved.
The drug also works centrally in the brain by acting as a brain messenger to report that enough has been eaten. Patients feel less appetite, eat less and then lose weight significantly. If you take semaglutide, you have to inject the drug once a week, for example into abdominal fat.
It is important to note that the possible weight loss of ten to 15 percent, according to studies, really only applies to people with obesity – it will be significantly less for slimmer people.
The drug is not entirely new. Similar active ingredients have been used in diabetes therapy for some time – but so far none has been as effective as semaglutide. And the approval of the active ingredient explicitly for weight loss is new.
Similar diabetes drugs are also being tested for the treatment of other diseases, such as Parkinson’s.What are the side effects of Ozempic or Semaglutide?
There are certainly side effects, even quite strong ones, which occur only temporarily in some people, but last throughout the entire treatment period in others: constipation, bloating, nausea, fatigue, diarrhea, abdominal cramps.
Gallstones also seem to be a problem when taken for a long time. Pancreatitis is also said to occur – albeit rarely. According to the U.S. Food and Drug Administration (FDA), Ozempic increases the risk of thyroid cancer.
The side effects are known from approval studies with people who suffer from diabetes and obesity. What semaglutide does to normal-weight people when they use it for the beach figure is not yet known. Ozempic became known as a popular weight loss drug by Hollywood stars and other celebrities who want to get rid of a few kilos quickly.
Why are there supply bottlenecks?
Semaglutide has been approved in Europe since 2018 under the drug name Ozempic. Since 2022, the semaglutide drug Wegovy has also been approved in the EU, which is intended to help people with obesity and overweight people with comorbidities manage weight. However, since Wegovy is significantly more expensive than Ozempic in Germany, doctors apparently often prescribe the diabetes drug instead of Wegovy to those who want to lose weight. This then exacerbates the shortage of the drug.
A month’s dose for a thousand dollars
A monthly dose of Ozempic costs around a thousand dollars in the United States without insurance. According to US media reports, the run on the syringe was so great in the meantime that diabetics had difficulty getting hold of the preparation developed for them. According to official reports from the Federal Institute for Drugs and Medical Devices (BfArM), supply bottlenecks also occurred repeatedly in Germany in 2024.
Wegovy currently has to be paid for by interested parties themselves in Germany. According to the German Diabetes Society, this is due to the fact that obesity is not a disease that entails a right to drug treatment in any case according to the Social Security Code.
How do doctors assess the situation?
“It’s a huge mess what’s happening at the moment,” says Stephan Martin, chief physician for diabetology and director of the West German Diabetes and Health Center at the Association of Catholic Hospitals in Düsseldorf. He criticizes that people who “only” have obesity take the drug away from patients who urgently need it for their diabetes treatment.Another aspect that is often omitted from the public debate: In the studies, semaglutide was always combined with exercise and a change in diet. This is also emphasized by endocrinologist Matthias Blüher. He heads the obesity outpatient clinic at Leipzig University Hospital: “The medication alone can’t fix it,” he says.
Doctors also warn against untested and unsafe Ozempic copycat products sold on the Internet – and against misuse as a lifestyle drug. In the meantime, the Freiburg Regional Council has pointed out counterfeits of the drug, which may be in circulation nationwide. If used, there would be “considerable dangers”.What happens if you discontinue Ozempic?
If you want to maintain your weight, you will probably have to take the drug for your entire life. The physician Stephan Martin says: “We have very good data that if you stop injecting these drugs, the starting weight is reached again within one to one and a half years. And the improvement in blood pressure caused by weight loss is also gone after a year and a half if you stop taking the drug.”
What other drugs are being tested?
The run on Ozempic and Wegovy ensures that other pharmaceutical companies smell profits. The Danish biotech company Zealand Pharma and its German partner Boehringer Ingelheim are working on the development of a weight loss drug. In a phase 2 clinical trial, treatment with the drug led to weight loss of up to 14.9 percent after 46 weeks, the companies announced in May 2023.According to experts, companies could produce up to ten competing products with annual sales of up to 100 billion dollars within a decade, especially in the United States.
