Good side effects, bad side effects
At first, weight loss was just a side effect. GLP-1 RAs were first developed to treat type 2 diabetes; their hormone-mimicking action provokes the production of insulin. In 2005, the US Food and Drug Administration approved the first drug of its kind, Exenatide, for diabetics. In the 2000s, more and more GLP-1 RAs came on the market. Immediately, patients noticed that these drugs not only cured their diabetes – they also helped them lose weight.
Ozempic and Wegovy, the brand names of the GLP-1 RA known as semaglutide, are manufactured by Novo Nordisk, a Danish pharmaceutical company. Although both contain the same active ingredient, the drugs have different indications, dosages, prescribing information, titration schedules, and delivery devices. In 2017, Ozempic was first approved as a diabetes treatment, and soon doctors began prescribing it off-label for overweight patients. Subsequently, Novo Nordisk developed Wegovy specifically for weight loss. In June 2021, it became the first new treatment for chronic obesity approved by the FDA since 2014.
Then, in May 2022, the FDA approved Mounjaro as a diabetes treatment; now the agency is officially “fast-tracking” an investigation of its active ingredient, tirzepatide, for obesity. A spokesman for the drug’s maker, Eli Lilly, said it is currently only approved for glycemic control in adults with type 2 diabetes, and the company “does not promote or encourage the use of Mounjaro outside of FDA-approved indications.” Nevertheless, since the drug came on the market, doctors have been prescribing it for reasons other than weight loss – there are almost 100,000 members in a Facebook group called “Mounjaro Weight Loss Success”.
Clinical trials showed that patients on tirzepatide lost at least 20% of their body weight in 72 weeks, while overweight adults on Wegovy lost an average of 15% of their body weight in 68 weeks.
Edenfield is one such success story. Unable to work at the height of the pandemic, he had stayed at home “eating lots and lots of junk.” He compared his diet to that of a teenager: regular consumption of fast food sandwiches, cheesesteaks and burgers accompanied by a “crippling addiction” to Coca-Cola. When his weight climbed to 357 pounds (he’s 6 feet 3 inches tall), he sought gastric sleeve surgery because his employer would cover the cost. Yet the doctor she met with suggested Ozempic instead. He lost 15 kilograms in his first month on the drug and switched to Wegovy in February 2022. He now weighs 228.
“It’s changed every aspect of my life,” says Edenfield — he no longer feels “kidnapped” by hunger and gasps on his way to work. “I feel like I’m 20 years old again,” he says.
The results may be enviable, but the daily reality of weight loss injections is not always pleasant. The most common side effects are gastrointestinal, including nausea, diarrhea, and constipation. Edenfield consulted Reddit for tips to ease the ‘brutal’ nausea. A number of subreddits dedicated to semaglutide have appeared or grown in popularity over the past year – the one Edenfield posts on was created in 2021 and today has almost 22,000 members. Meanwhile, countless Facebook groups were also created during the weight-loss injection boom. Here, people report experiencing vomiting, headaches, fatigue, “sulfur belching” and hair loss – although most seem to think that’s a small price to pay for losing weight.
During the 68-week Wegovy study, 4.5% of participants discontinued treatment due to gastrointestinal events. Peter Kurtzhals, Novo Nordisk’s chief scientific adviser, says such side effects usually diminish gradually as patients build up a tolerance to the drug. A company spokesperson adds that patients experiencing nausea on Wegovy “should contact their healthcare provider, who can offer guidance on how to manage it.”