I'm A Weight Loss Nurse Who Prescribes GLP-1s: What The Ozempic Conversation Is Missing

It’s hard to make it through the week without hearing someone talking about Ozempic or Wegovy for managing blood sugar and achieving weight loss. In some ways, this is great—we are finally having conversations about the previously taboo topics of weight management and obesity.

On the other hand, it feels like people on these medications are dropping pounds in a way that might not be sustainable in the long run. 

Medications like Ozempic or Wegovy are in a class called GLP-1, or glucagon-like peptide-1, medications. The active ingredient in Ozempic is semaglutide. Semaglutide is an incretin, a hormone produced in the gut that helps signal to your brain that you are full. Semaglutide also helps regulate the transit time in your gut; if food passes more slowly through your body, then you feel full for longer.

For context, GLP-1 medications have been used since 2005 to treat Type 2 diabetes. They have been thoroughly studied and recognized by the medical community as an effective treatment of diabetes. In 2021, semaglutide was approved under the brand name Wegovy1 for weight loss.

One myth that has been circulating around the internet is that Wegovy is more effective than Ozempic. In reality, they are the exact same. They are equally effective for weight loss at the same dosage.

The thing is, until recently, Ozempic was typically prescribed at a lower dose when used for diabetes management. Wegovy, on the other hand, is prescribed with the intention of maximizing the dose to achieve optimal weight loss.

With the increase in demand for these medications, Ozempic started to be prescribed for weight loss and not just diabetes management, even though it’s technically only FDA-approved for diabetes2.

Ongoing research is also looking into new medications. One is CagriSema, which is a combination of cagrilintide and semaglutide. Cagrilintide emulates amylin3, a hormone that impacts satiety.

The second is Retatrutide which is a GLP-1, gastric inhibitory polypeptide 4(GIP), and glucagon agonist. It’s similar to Mounjaro but adds a glucagon agonist, which may help people burn more calories in addition to suppressing their appetite.

I believe these medications certainly have a place in the weight management world. However, they must be paired with foundational nutrition, exercise, sleep, stress management, community, and mental health knowledge.

I've been practicing medicine with a focus on weight management for over seven years. I've also struggled with weight myself, so I understand what my patients are going through. I do prescribe GLP-1 medications to certain patients.

To help clients achieve long-term weight loss (that may or may not involve long-term use of medications), I always start by reviewing the importance of nutrition, exercise, mindset, stress management, community, quality sleep, and even clean water before prescribing medications.

This is the only way they will effectively promote weight management and overall metabolic health. A randomized controlled trial of 1,961 people with obesity showed that patients can lose up to 15% of their body weight5 on a once-weekly dose of semaglutide when paired with lifestyle interventions.

If we choose to use a GLP-1 agonist or GIP, I always start low and slow and let the patient stay at the lowest dose as long as possible. Oftentimes, you’ll see practices going up to the highest dose right away. While this ensures quick weight loss (both muscle and fat), I find that going slow helps clients be more likely to maintain muscle mass6 as they implement new habits. This helps set them up for long-term success and even allows them to wean off medication or take it once a month in some cases.  

It's also important to note that these medications are not for everybody. In my practice, I consider each client's personal history when planning a weight loss regimen. For example, I just recently saw a mom who is one year post-partum with diastasis recti. I referred her to physical therapy to get her into the right routine before making other changes. I'm not telling her to “go to the gym” and calling it a day. Her foundations are critical.  

I've seen that GLP-1s medications are generally well-tolerated but some potential side effects include nausea, reflux, constipation, and early satiety (inability to eat a full meal). They also require a weekly injection, though oral versions are already being researched.7

One of the potential complications of using these medications for weight loss is the loss of lean muscle mass8. Lean muscle can be hard to regain once lost, especially as people age, potentially putting weight loss drug users at greater risk of sarcopenia9 (age-related muscle wasting). Even more concerning is the potential for loss of bone mass, which is infinitely harder to regain. According to DEXA body composition scans, up to 40% of the weight lost10 on semaglutide can be composed of lean mass (muscle, organs, and bone).

These are all reasons why it's essential to pair these medications with a holistic weight management plan. There must be a focus on maintaining lean muscle, building strength, and developing healthy eating patterns in order to feel your best.

Ozempic is also known to increase resting heart rate (an important measure of cardiovascular health) by 2-3 beats a minute, which may feel uncomfortable to some people.

Also, to be clear: these medications are for people who have obesity or type 2 diabetes. There is also some emerging research on the use of GLP-1’s for PCOS11 and heart disease. 12

Despite what you've heard about Ozempic or Wegovy, there is no such thing as a magic injection or pill for sustainable weight loss. Behavior change is hard, and in order to achieve sustainable weight loss, you need to have a comprehensive plan that combines exercise, nutrition, and, in some cases, medicine.

That's why I only prescribe GLP-1s in tandem with a program that is designed to set up patients for long-term health.