Ozempic is flying off the shelves. As the medicine leads the latest weight loss trend, it’s important to pause the frenzy to consider its function and side effects.
Above: Ozempic manufactured by Novo Nordisk. Image courtesy of CNN.
What is Ozempic?
In 2017, the Food and Drug Administration (FDA) first approved Ozempic as a treatment for type 2 diabetes. The active ingredient in the medication is semaglutide, a molecule that mimics glucagon-like peptide-1 (GLP-1). Produced in the human intestine in response to eating, GLP-1 is a hormone that stimulates insulin creation.
Made by beta cells in your pancreas, insulin is a hormone that primarily modulates blood glucose levels. While glucose is the primary source of energy for our bodies, too much glucose in the bloodstream is life-threatening. Insulin functions by (1) transporting glucose into the cell for use and (2) signaling the liver to store excess glucose as glycogen in the liver. When we eat, the glucose levels in our bloodstream rise, prompting the pancreas to release insulin. The hormone binds to the surface of cells and recruits glucose transporters like GLUT4 to the membrane to allow glucose to enter the cell, where it can be used for energy production or stored as glycogen for future use.
Above: The role of insulin in facilitated diffusion. Image courtesy of Carlota Herrera Benito ’27.
In type 2 diabetes, the pancreas produces less insulin, causing less glucose to move into cells and more glucose to remain in the bloodstream. Ozempic treats type 2 diabetes by mimicking GLP-1, which is an incretin hormone that acts on the pancreas to upregulate insulin secretion
However, Ozempic has side effects on our digestive systems and brains. Chemicals that make up semaglutide—including propylene glycol, sodium phosphate dibasic dihydrate, phenol, and water—slow gastric emptying and make our bodies feel full for longer. Additionally, semaglutide sends false signals to the brain to curb the feeling of hunger, it is said to act on the hypothalamus to increase satiety. Together, these side effects can contribute to weight loss. Contrary to popular belief, however, Ozempic has not been approved by the FDA for weight loss. That said, other drugs that stimulate the production of GLP-1 in the intestine, such as Wegovy and Zepbound, have earned FDA approval. While Wegovy’s main active ingredient is also semaglutide, the latter two contain tirzepatide, they are all administered via weekly subcutaneous injections.
Increasing Ozempic Use
Nearly one in every three adults in the U.S. suffers from obesity; nonetheless, the surge in sales has been astonishing. Sales of Wegovy surged in 2021 following its approval for weight management in adults and further increased in 2022 when it was approved for adolescent use.
Ozempic’s trajectory has mirrored that of Wegovy—even though the FDA has not yet approved it for weight loss. A Michigan Medicine study analyzing 92% of all U.S. pharmacy sales data of both drugs from 2020 to 2023 revealed a 594% increase in the use by individuals aged 12 to 25. The use of Ozempic and Wegovy was also more pronounced among females: use among female adolescents aged 12 to 17 increased by 588%, compared to 504% in males, and use among females aged 18 to 25 increased by 659%, compared to 481% in males.
Despite their popularity, experts dispute the drugs’ efficacy, stating that existing studies are highly flawed. They argue that patients' health, dosages, and other factors are difficult to control and can prevent researchers from making accurate analyses. Moreover, the effects of these drugs can vary significantly among individuals, but studies suggest that Ozempic and Wegovy yield an average weight loss of 15-20% and 14.9%, respectively.
While many debate the drug's efficacy for all individuals, the majority agree that Ozempic does not offer a long-term solution. Once patients stop taking the drug, they typically return to their previous condition. Without semaglutide to suppress hunger signals or slow the digestive process, individuals often experience their natural appetites and are likely to regain some of the weight lost. Many emphasize the importance of traditional weight loss methods such as establishing healthy eating habits and engaging in regular exercise, as these practices are known to improve overall health and yield more sustainable results.
Prices continue to skyrocket as the use of Ozempic in the U.S. continues to grow. While a month’s supply of the drug costs between $80-$90 in France, the price ranges from $950-$1000 in the U.S. These high prices are due to the monopoly Novo Nordisk (Ozempic manufacturer) has on the medicine and the imbalance between the supply and demand of the drug at the moment. As a consequence, many new weight loss drugs are in development as producers try to fill the gap in the supply.
Use During Pregnancy
Excess weight can lead to pregnancy complications, including an increased risk of miscarriage. With over 80% of women being considered overweight (body mass index greater than or equal to 25 kg/m2) according to the World Health Organization, many women have turned to Ozempic and other weight loss medications as a solution. However, few studies have investigated the impact of these drugs on the fetus and pregnancy.
What’s more, many women on social media have begun sharing stories of “Ozempic babies,” or unplanned pregnancies that occurred while taking Ozempic or other GLP-1 receptor agonist medications. One Facebook group named “I Got Pregnant on Ozempic” has over 1,500 members. Some health institutions, such as UT Southwestern Medical Care, are saying that “we can add improved fertility to the list of surprise effects related to GLP-1 RAs, better known by the brand names Ozempic, Wegovy, Mounjaro, and Zepbound.”
Despite these assertions, Novo Nordisk has maintained that there isn’t enough data to determine the risks Ozempic poses during pregnancy or its impact on fertility. Still, the effect Ozempic has on slowing digestion poses the question of whether it limits the absorption of oral contraceptives. A physician at George Washington University, William Dietz, stated that the slower digestion “may mean that birth control medications are metabolized or ineffective.”
Side Effects and Risks
Ozempic can often cause gastrointestinal issues. Common side effects include nausea, abdominal pain, vomiting, and constipation. However, independent studies suggest that these risks are understated, as the side effects are far more numerous and dangerous than reported by official Ozempic marketing.
Just under a year ago, the FDA updated the risks of Ozempic to include ileus, or temporary paralysis of the intestine that prevents the movement of food and liquid. Left untreated, this condition can be life-threatening as it can cause blood supply to the intestine to be blocked, causing tissue death. The original previous lack of disclosure about this side effect has led to class action lawsuits against Ozempic and other similar drugs. Experts predict that the number of formal complaints will continue to rise.
Side effects can also be aesthetic. The rapid weight loss caused by the drug sometimes targets facial fat, resulting in changes in the patient’s physical appearance such as sagging skin, a hollowed appearance, and lipodystrophy.
Above: Comparison of the facial features before versus after using Ozempic. Image courtesy of Jason Hoffman and Medical News Today.
On the other hand, some side effects can help improve other existing comorbidities. For example, researchers have found that semaglutide in Wegovy can reduce the risk of cardiovascular diseases and complications with kidney disease. Likewise, researchers have found that Zepbound can lower blood pressure and help with sleep apnea.
Fake Ozempic
In light of their popularity, Ozempic and its peer drugs have become extremely expensive. In May 2024, the prices for a one-month supply of Ozempic, Wegovy, Mounjaro, and Zepbound were $968, $1,349, $1,069, and $1,059, respectively. In the high-demand market, counterfeit supplies have emerged, causing health concerns due to their visual similarity to the real drug and the potential presence of harmful chemicals. Thousands of illegal websites sell fake Ozempic with fraudulent labels. The uncertainty regarding the chemical composition of these injections and the dosage of semaglutide they contain poses significant risks for prospective—and potentially unsuspecting—users. Furthermore, taking a drug without a doctor's knowledge or prescription can be life-threatening due to the potential for interactions with other drugs or a patient’s medical history.
Above: The differences between real and fake Ozempic packaging. Image courtesy of Álainn Clinic.
Ozempic Use at Duke
Given the popularity of Ozempic nationwide, I wanted to explore its presence and use within Duke University. To that end, I conducted an anonymous survey of the Duke community. Based on 59 responses, 94.9% of people surveyed had heard of the drug, and over a third believed that Ozempic has been approved for weight loss (as of October 2024, Ozempic has only been approved to treat type 2 diabetes) Thus, the survey reflects widespread misinformation about the FDA-approved use of Ozempic.
Above: Over a third of survey respondents believed that Ozempic has been approved for weight loss by the FDA. Image courtesy of Carlota Herrera Benito ’27.
Furthermore, 20.3% of respondents reported that they or someone they know of at Duke between the ages of 18 and 25 has taken Ozempic. However, student opinions about Ozempic reflect a mixture of curiosity and concern.
For example, some students expressed concerns about the effects of Ozempic on body image in younger generations: “The only people who I know have used the drug at a young age very likely do not qualify for it. For example, I know they do not have diabetes and are not overweight. The conversation about [Ozempic] at Duke seems to be simply about aesthetics, not health.”
Another student expressed similar concerns: “Unless for a medical condition that needs its use (high blood pressure in diabetes for example), I believe people who use it at Duke for weight loss are driven by societal pressures to conform to a standard body weight and appearance, which are almost always extremely unhealthy.”
Others discussed the role of Duke’s socio-economic landscape, pointing to the intersection of wealth and competitive culture as potential drivers of the drug's popularity. “[Ozempic] will become more popular, especially because Duke is highly competitive (which lends itself to eating disorders) and wealthy (which is the main group of people with access to Ozempic),” one respondent said.
Although insights on Duke student opinions reflect only a small sampling of larger public opinion, these responses emphasize a growing trend of off-label Ozempic use for weight management, which is often driven by social expectations about appearance and financial privilege. These findings warrant a larger conversation and suggest a need for clearer information about Ozempic’s approved uses.
