The way some doctors handle Ozempic and other weight-loss peptides is basically malpractice. And health influencers often make matters worse by spreading misleading information.
I prescribe these medications in my clinic. When handled correctly, they can be a game changer for my patients. I want to ensure you get accurate information about these revolutionary therapies and know what you should expect from a healthcare provider. By the end of this article, you’ll be equipped to make a smart decision about whether they’re a good option for you or a loved one.
Table of Contents
Section 1: Malpractice
Let’s start with my charge of malpractice. That sounds pretty harsh. But some physicians ignore the guidelines for providing proper care for their patients. Here’s how. (And if you encounter any of these issues, it’s time to find a new doctor.)
First, let me briefly tell you how doctors should handle prescriptions for GLP-1 medications like Ozempic. The clinical guidelines recommend several steps.
1. Assess BMI and health risks: A doctor should assess a patient’s body mass index (BMI), waist circumference, and other health comorbidities.
2. Set realistic goals: They should discuss weight loss goals. These should be realistic and specific.
3. Recommend lifestyle changes: A doctor should help patients select a set of appropriate lifestyle changes to address their weight. This will always involve adjusting their diet and increasing exercise.
4. Wait 3–6 months: Then they should wait 3–6 months to see how these changes help.
5. Consider medication: In most cases, beginning treatment with a medication like Ozempic would only be recommended if the patient has a BMI over 30 and hasn’t met weight loss goals despite making the recommended lifestyle changes. And it should only be started after making sure the patient thoroughly understands the risks and benefits.
But here’s what is happening instead.
Some doctors are giving out prescriptions for GLP-1 medicines after patients just fill out a short questionnaire. If you meet certain qualifications, they write a prescription for Ozempic and charge between $50–$200 per script. And they just bank this check every month. That’s not medicine. That’s drug dealing.
Many physicians also fail to tell patients about a key aspect of using GLP-1 medications for weight loss. Specifically, they don’t tell them that these medications generally need to be used long-term. Studies show weight will usually return if patients stop using them [1].
It’s essential for patients to know this so they can properly weigh the benefits and potential risks of the medication, especially when considering costs because these medications aren’t cheap.
Finally, some doctors don’t monitor patients who are taking GLP-1 medications adequately. Often, it’s the same doctors who are quick to write a prescription without following clinical guidelines. At best, they might have a periodic telehealth consultation.
As with any medication, though, there are potentially serious adverse effects with this treatment. (And we’ll be discussing some of those in a moment.) In my clinic, I work with patients who are taking GLP-1 medications very closely. We want to be able to spot and respond to potential problems right away.
GLP-1 medications are a powerful tool. But they need to be used judiciously. So if we’re considering a GLP-1 medication like Ozempic, we need to choose a doctor carefully. We should look for someone willing to follow best practices to guard our long-term health. Beginning a prescription medication is a serious decision. We want someone beside us who will equip us to make it wisely.
Section 2: Misinformation
At this point, I know what some of you might be thinking: If we have to be so cautious about starting to take Ozempic, is it really safe?
Here’s where we come to the problem of influencers spreading misinformation. Yes, there are potential adverse effects with Ozempic and similar medications. But there are some serious misconceptions out there we need to clear up. And then we’ll paint a realistic picture of the potential risks and benefits.
1. Muscle Loss
The first misconception has to do with muscle. Here’s the worry: that GLP-1 medications cause us to lose it [2].
Do they?
Yes. But here’s the thing. Losing muscle usually happens when we lose weight. This is true whether we’re just changing our diet, taking medications, or undergoing bariatric surgery. This is because we lose weight when we’re taking in fewer calories than we’re using. The body has to make up the shortfall from somewhere. One of the resources it uses is stored fat. But it will tend to break down some muscle tissue as well.
So the question we need to ask is this: Do GLP-1 medications cause us to lose more muscle than other weight-loss interventions?
Let’s look first at how much lean body mass is lost by those taking semaglutide (known by the trade names Ozempic and Wegovy). In the STEP 1 Study — semaglutide’s primary clinical trial — they examined the body composition effects of the treatment in a subgroup of the study. Over 68 weeks, those taking semaglutide lost an average of 16.86% of their weight [3].
This included a loss of lean body mass of 3.61%.
So far this is a number without context. We don’t know if that is high or low without comparing it to a different weight loss intervention. So let’s look at another study. This one was specifically designed to see how weight loss affects lean body mass. There were three groups. One was put on a calorie-restriction diet. A second used the diet and added exercise. The third group just did exercise.
So what happened? The group on a calorie-restricted diet lost about 7% of their weight. This included lean mass of about 2% in the upper body and 4% in the lower body [4].
Recall the numbers from the semaglutide trial. Participants there lost 16.86% of their weight and 3.61% of lean body mass. In this second study, participants lost 7% of their weight and 2–4% of their lean body mass. Comparing the two, the lean mass losses from semaglutide, given the much larger weight loss percentage, were lower.
So while the evidence supports the claim that using GLP-1 medications leads to muscle mass loss, this isn’t something unique to this form of weight loss.
But I want to highlight one more thing about the study we just looked at. It found that the group that used a calorie-restricted diet with exercise lost less lean mass. Instead of 2% and 4%, the numbers were 1% in the upper body and 2% in the lower body [5].
In other words, adding exercise cut the lean mass loss in half. This is why adding resistance training (and getting adequate protein) are strongly recommended when undertaking any weight-loss program.
2. Thyroid Cancer
Here’s a second concern people raise about GLP-1 meds: thyroid cancer. Early studies in rodents found semaglutide could cause a form of thyroid cancer. But rodents and humans are obviously quite different. Effects seen in rodent studies often do not show up in human populations. So what evidence do we have in human studies?
A recent meta-analysis looked at 10 randomized controlled trials involving over 14,000 people. They concluded there is no significant risk for thyroid cancer associated with semaglutide [6].
Another analysis was broader. It took into account both clinical trials and other kinds of studies. Its conclusion was the same [7].
3. Pancreatitis
The next worry is about pancreatitis. Pancreatitis is an inflammation of the pancreas, an organ that makes digestive enzymes and hormones. This condition is listed as a possible side effect for semaglutide. But how likely is it?
A meta-analysis published last year looked at existing trials to investigate the adverse effects of GLP-1 medications. The authors found pancreatitis was no more common among those taking these medications than those who weren’t [8].
4. Gallstones
What about gallstones? Having problems with your gallbladder, like gallstones, is also listed as a possible side effect. And unlike the other issues we talked about, studies show that people taking GLP-1 medicines have a higher chance of getting gallstones and other gallbladder problems [9].
How much greater is the risk? This meta-analysis found those using GLP-1 medications had a 27% higher risk of developing a gallstone.
Gallstones are actually quite common. An estimated 10 to 20% of Americans will develop them at some point [10]. Interestingly, they are usually symptom free.
So if we take a middle figure of 15% risk in the general population, increasing that risk by 27% gives us about a 19% risk. It’s not a big difference. But is the increased risk worth it? Well, we’ll pick up that question in just a minute.
5. Mental Health
Finally, you may have heard they cause mental health problems like depression. So let’s look at what the evidence says. An analysis of several major trials for semaglutide found there was no difference in symptoms of depression or suicidal thoughts between those taking the medication and those receiving a placebo [11].
Section 3: Risk and Benefit
So we’ve seen there are common misunderstandings out there about GLP-1 medications. When it comes to muscle loss, the problem is real but no different than with other weight-loss strategies. Worries about thyroid cancer, pancreatitis, and depression appear to be overblown. From the current evidence, it doesn’t look like these problems show up more often among those taking GLP-1 meds. And then with gallstones, the risk is indeed elevated but doesn’t end up being that much higher than it is anyway.
And this is where patients I talk to often feel confused. How should we think about the whole issue of side effects when it comes to these medications? Do we really want to start taking a medication that might cause health problems?
Here’s what I tell them:
First, I’m really honest about the fact that side effects with GLP-1 medications are common. And I explain what the most common side effects are: nausea, vomiting, diarrhea, and constipation [12]. Symptoms are usually mild to moderate. For most patients, they improve over time as their bodies adjust to the medication. As we’ve already discussed, there are some more serious side effects, like gallstones, that are possible.
So those are the risks, and it’s important that patients understand them. Careful monitoring helps us detect and respond when problems emerge. But it can’t eliminate all risks of adverse effects.
So is it worth it to start taking these meds? Here’s where we need to ask a second, equally important question: What are the risks of not taking these medications?
Recall that GLP-1 medications will typically only be considered when we have a BMI of 30 or above. We know being overweight is associated with higher risk of death from all causes. In fact, above a BMI of 25, that risk was about 30% higher for every 5-unit increase of BMI [13].
A high BMI is connected to several serious health problems, ranging from heart disease to diabetes. As one study put it, an elevated BMI is connected to almost every category of mortality outcome [14].
So being overweight poses serious risks to our health. The higher our BMI, the greater those risks.
And losing weight can be a challenge. With lifestyle changes alone, people usually find they can lose between 5% and 7% of their weight. But they often struggle to maintain this loss [15]. If our BMI is above 30, we’re likely to need a more aggressive approach to reach our goals.
And this puts the decision about whether to use GLP-1 medications in context. Yes, they have potential risks. But being overweight has risks that are even more serious. It’s going to be up to the individual patient, though, to ultimately decide what’s best for their health. And it’s the job of physicians like me to give patients all the information they need to make that decision wisely.
Section 4: Tirzepatide
And there’s one more piece of information I talk to my patients about. There’s a newer medication similar to semaglutide but with a twist.
GLP-1 medications, like semaglutide, work by mimicking a natural hormone. It bonds to receptors on certain cells and helps regulate blood sugar and appetite. This newer medication, however, works on two different types of receptors at once. This appears to boost its effectiveness. According to the results we have so far, it looks like it produces an even stronger weight loss than semaglutide [16].
This newer medication is called tirzepatide. It goes by the brand names Mounjaro and Zepbound. If we’re considering weight-loss medications, it may be worth discussing this option with our doctor as well.
Close
As powerful as our newest weight-loss medications are, however, diet is always the foundation of weight management. As I mentioned earlier, clinical guidelines tell us to start there and only consider medications after we’ve tried lifestyle changes. And even if we’re taking medications, we still need to adopt a healthier diet if we want to see long-term results.
Reference List
Below are the study links in the order they appeared in this article:
1. https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.14725
2. https://www.sciencealert.com/experts-are-concerned-drugs-like-ozempic-may-cause-muscle-loss
3. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC5161655/
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC5161655/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC11050669/
7. https://pubmed.ncbi.nlm.nih.gov/37531876/
8. https://onlinelibrary.wiley.com/doi/10.1111/obr.13717
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC8961394/
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC3343155/
11. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2823084
12. https://www.uptodate.com/contents/obesity-in-adults-drug-therapy
13. https://www.uptodate.com/contents/obesity-in-adults-overview-of-management
14. https://pmc.ncbi.nlm.nih.gov/articles/PMC6249991/
15. https://www.uptodate.com/contents/obesity-in-adults-overview-of-management
16. https://www.uptodate.com/contents/obesity-in-adults-drug-therapy
