Losing to Gain
December 14, 2023
Are Weight Loss Medications the New Norm?
Sometimes, effort is not enough.
Weight loss has long been touted as the results of sheer willpower, but recent research wonders if that’s really true. So many factors play into weight management, and lately there has been a wave of options for those looking to lose weight.
It sounds magical.
You mean that I don’t have to spend all that effort and energy to see the numbers on the scale go down? I can just pop a pill, and the pounds will disappear?
Too good to be true?
These are the murky waters of weight loss assistance.
What is Ozempic?
Lately, the word Ozempic has been bandied around with increasing frequency. It’s practically the latest fad.
But what is it exactly? And who is it really for?
Ozempic was designed for people with type 2 diabetes and has never been approved for weight loss.
It’s a weekly injection containing semaglutide and is supposed to be taken long term. However, people can get approved for it without having diabetes as long as they meet the necessary requirements.
Our bodies have a natural hormone that tells us when we’re full, but it gets abused as the world around us keeps encouraging us to eat without taking our body’s rhythm into account. Semaglutide acts to fill that gap and sends a signal to the body to stop eating.
In addition, Ozempic slows the gastric emptying, allowing you to feel full longer.
On paper it sounds great—a simple, effective way to lose weight without surgery or intense restrictions.
But is it really?
Who should be taking it?
“Ozempic has gone through many trials and has been deemed safe. However, every drug brings potential side effects in its trail,” explains Meira Waldman, a Lakewood nutritionist.
Many factors come into play when it comes to weight. Environment, emotional health, and genes all contribute.
What‘s more is that losing weight becomes a vicious cycle. The more a person has to lose, the harder it seems, and the worse a person feels about themselves, leading to a lack of desire to try. Even if someone is very motivated, losing upwards of fifty pounds—while doable—is incredibly daunting. And of course, the more a person has dieted in the past, the more difficult it is to lose weight each time.
“That’s where Ozempic is helpful,” Meira explains. “If someone has only 10 pounds to lose, then the potential risks and side effects are not worth it. But if someone is measuring in at obese with a BMI of 30 and has recurring health issues such as high blood pressure, cholesterol, high blood sugar, and high triglycerides, Ozempic can give them that boost to lose the weight and improve their health”
Being heavy often comes with all sorts of health risks. High blood sugar and heart issues tend to rear their ugly heads. “Yes, Ozempic is risky, and it‘s not perfect, but the dangers of being obese are greater.”
Atara Davidson, founder of NuBo, a weight-loss program, concurs—to a point. “Being heavy is generally unhealthy. I personally am a big believer in preventative measures. The 10 pounds often creep up to 15 and then 20. And of course, the more you have to lose, the harder it is. The goal of the drug is to help patients establish a routine so it‘s easier to lose weight afterwards.”
At what price?
It’s not that simple to take, though. Most insurances will not pay for Ozempic unless the patient has either diabetes or a BMI of over 30. The starting price can be $1,000 per month. Can patients who don‘t fit the guidelines afford it?
There is another option that many weight-loss practices are offering.
“We prescribe compounded medication for our patients.” Atara explains. “Compounded medications take the same ingredients as the original drug with slight changes and sell it for much cheaper. I would call it an off brand. This version is much cheaper but delivers the same results.”
However, not everyone is a fan of this route.
“Compounded drugs are not FDA approved, and personally, I am wary of them,” Meira warns. “I really think that people need medical oversight when taking this drug. There are other cheaper ways to get this medication. Canadian pharmacies will ship it straight to your door for a much lower price.”
Compounded medications qualify as a vitamin, so they legally cannot be FDA approved. According to the FDA’s website there is no legalized generic version of these drugs. Although a drug can be legally compounded if it’s on the shortage list—which Ozempic is—it’s unclear if the compounded versions are as effective. While some have reported adverse effects, there are many who have easily lost weight with off-brand prescriptions.
“I took the compounded version of Ozempic myself and found that it worked beautifully.” Atara shares. “I didn’t have a ton of weight to lose, but I lost 20 pounds in three months, and now, six months later, I‘m still maintaining my weight. We encourage patients to take the drug once a week for maintenance. I personally take it once a month, and it helps.”
The medicine can stay in the body for up to two weeks after taking it.
Not all peaches and cream
“I struggled with my weight for years,” Sari says. “I tried more diets than you can imagine. Ozempic seemed like the next logical choice.”
This is the thought process of many who turn to it.
But many struggle, resisting the temptation to take the drug, feeling like they are giving in.
Additionally, it’s clear that Ozempic is no wonder drug. “I can’t tell you numbers, but I definitely have patients who had to stop because of side effects,” Meira states “I can’t stress enough that you need to be using it under the guidance of someone who knows what they’re doing. If you do it too fast, you can have terrible side effects. If someone is seeing an amazing effect on a low dose, then it’s not necessary to go higher just for the sake of going higher.”
“I didn’t have major side effects,” Sari reports. “Just feeling a bit nauseous and queasy, a little like being pregnant but less extreme.”
But the side effects can be extreme for others, especially if they are on a high dosage. Some patients have had such an extreme level of nausea that they needed to go off the drug. People have reported this even when taking the lowest possible dose. Gallstones and pancreatitis can be other potential side effects.
Another con? It can’t be taken for up to six months before one wants to get pregnant, or when one is pregnant or nursing.
Where is this leading? Will this be the norm for our high school students eager to lose a few pounds? As of yet, Ozempic has not been cleared for teenagers, but who knows what the future holds?
Does it work?
With many diets, people tend to plateau at a certain point. Is Ozempic the same way?
“There are people who won’t lose weight when on Ozempic,” Atara explains. “Or they’ll stop losing weight because they are not careful with their calorie intake. They might be eating less in quantity, but if they are downing milkshakes and chocolates and ingesting millions of calories, they won‘t lose weight.”
So far research has shown that once people stop taking the drug, the weight loss stops and most of the weight comes back. This may be because lifestyle changes are not made.
“Our goal is to establish a healthy lifestyle when it‘s easy to do so that the habit continues even if you stop the drug.” Atara says
Many doctors are claiming that Ozempic is supposed to be taken long-term—basically forever. When you take into account that the drug is designed for those with diabetes, that makes sense.
“It’s very hard to know,” Meira says. “Ozempic is still too new to have much data on it. But I personally believe that for someone who doesn’t struggle with any sort of eating disorder, it doesn’t need to be taken long-term. If someone gained a lot of weight due to external reasons, Ozempic is a good option, and I don’t believe it needs to be taken forever.”
The emotional piece
Eating, weight, and emotions are wrapped together so tightly that it’s hard to tell where one ends and the other begins. Many are hesitant to turn to this drug because they feel it’s like waving a white flag. It’s official. I’m overweight and can’t control myself.
Many nutritionists feel that Ozempic can be a Band-Aid, giving someone an easy way out without forcing them to confront their real relationship with food.
“These are not drugs to be taken on impulse,” warns Dina Cohen, a nutritionist who specializes in eating disorders. “Shutting off hunger and slowing down digestion does not magically result in good health; it can turn into medically caused malnutrition. And if someone is taking semaglutide just to lose a few pounds, then the drug is functioning like an injectable eating disorder. It‘s no different than any other restrictive behavior.”
In addition, Ozempic has also been linked to a higher risk of depression and anxiety.
Keep an eye out
As the research stands, it seems that weight loss drugs are something to be wary of, only to be taken when there is a desperate need. But public pressure about our images may sway these cautious thoughts.
Ozempic is too new on the market to make definitive statements about it yet. The research hasn’t been collected long term. Will this drug mean the end of the obesity epidemic? Or will it lead to a rise of eating disorders, physical issues, and other problems we can’t even guess?
Only time will tell.
The weight loss journey: Avigayil’s experience
Adolescence was okay. I never was that petite, skinny teenager, but the doctors never frowned when I stepped on the scale. I was always hovering just by the okay mark, never thin but never overweight either.
That changed once I had kids. I gained weight. A lot of it. I would lose weight, gain it back, and then lose it again. I never stopped trying. I tried practically every diet in the book, and I also exercised very frequently.
I tried OA, and I saw some success, but the program was too rigid for me. Every time I fell off track, it messed with my head.
At some point, I tried making peace with my size, telling myself that this is the way I am, this is my body, but I felt so uncomfortable with myself. At every doctor‘s appointment they would tell me I need to lose weight.
I started researching eating disorders, and the doctors diagnosed me with a binge eating disorder. It‘s a result of constant dieting; the more you restrict, the more you want to binge. I joined an eating disorder clinic that totally changed my mindset. The idea of the program was that no food is bad. More than that, I was told that eating regularly until I felt full but not stuffed would help my eating patterns stabilize. It took some time, but it really gave me peace of mind. I developed a much healthier relationship with food. I joined the program at a challenging time in my life, and the program helped a lot. I didn‘t really lose any weight, but that wasn‘t the goal. The goal was to maintain my weight and to develop a healthier mindset and relationship with food, which is what I was doing.
I left the program, considering it a major success, but life sent me another loop. I ended up suffering from a lot of chronic pain and over time fell off the program.
My doctor suggested that I go to an endocrinologist. “I’m not having stomach surgery,” I said flatly. I had heard enough about it and knew it wasn’t for me. He encouraged me to go just to have a conversation with him.
The endocrinologist had a new suggestion for me: Weight loss medication. “The bad news is that you have diabetes,” he told me. “But the good news is that your insurance will cover the medication because you need it.”
I’m a very cautious person, and I don’t really trust the medical system. I feel that each doctor only looks at one piece instead of looking at the body holistically. I’ve found that everything’s safe until they find out 20 years later that it’s not.
But at the same time, I was under so many health risks, and I’d be healthier if I was thinner. We asked da’as Torah, and my husband and I decided to go ahead with it.
I started with daily injections, and right away my sleep was affected. My doctor said it made no sense, no one complains about that, but I did some research and discovered that it quickens your heartbeat slightly, which can cause you to have a hard time sleeping. I tried another weekly injection, but that also affected my sleep. Then the doctor mentioned Ozempic. I started on the 0.5 dose (which is the recommended starting dose) but within a week, I felt terrible side effects. I was very nauseous, my stomach hurt, I had headaches and just felt weak. I said, “I can’t manage this! I’m not functioning!”
So the doctor suggested I start with just a few pen clicks, and I was able to tolerate it. After approximately two weeks, the weight just started to fall off. I completely lost my appetite and wasn’t feeling well from the meds. After a few months of slowly increasing the dose until I was at a full dose of 1 mg, I was down 35 pounds.
With time, my body began to adapt to the medication and my weight loss slowed, eventually stopping completely. The medication curbed my appetite, and I felt full faster. But there were also certain foods I just couldn’t eat, like fresh raw vegetables. I totally stopped eating salads, and that bothered me. I wanted to eat in a healthy way, not just lose weight. I ended up eating very little, skipping meals. I would eat breakfast, then skip lunch and have a late supper. Everything I had learned in the eating disorder clinic just went right out the window.
Today, 18 months later, I’m still on it, but I plateaued. I haven’t regained any weight but haven’t been losing more either. I’m not hungry, but at the same time I occasionally dream of junk food. Some of the cravings that I stopped having have come back, maybe because I’m not eating right. I’ll binge and eat six cookies instead of a meal.
There are definite benefits even though I’m not at my ideal weight. My blood sugar has gone back to 100 percent normal. I feel healthier, more energetic, and don’t have sugar crashes—even with my not-so-regular eating. I just visited an endocrinologist, and my numbers have improved even more.
Now the doctor is pushing me to take an even higher dose, saying that stronger doses have been approved by the FDA. I’m very wary of it though. On the one hand, I’m fairly comfortable with myself. I look okay; I can fit into clothing in Jewish stores. On the other hand, I’m not really at peace with myself, wondering if I could lose more.
They say you have to be on this medication for life, but I don’t know. For now, I’m taking it one step at a time.