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Should You Take a Diabetes Drug for Weight Loss?

The medications can help many patients improve their health, but they come with some risks

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Malte Mueller / Getty Images

It’s hard to read the headlines or watch TV these days without seeing an article or ad praising the weight-loss wonders of Ozempic.

The injectable drug, whose technical name is semaglutide, first gained federal approval in 2017 for the treatment of type 2 diabetes, a condition that affects more than 35 million Americans. The U.S. Food and Drug Administration (FDA) has also approved a version of semaglutide with a slightly higher dose and a different name (Wegovy) as a treatment for obesity.

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However, more and more people who don’t have diabetes or obesity are turning to the semaglutide drugs for their slimming effects. People taking semaglutide lose, on average, 15 percent of their body weight, studies show. Some shed even more.

But health experts warn that semaglutide and other drugs like it shouldn’t be used as a quick fix for weight loss in people who don’t need or qualify for it. Besides potential health risks, their increasing use may be contributing to the drugs’ shortage. Both Ozempic and Wegovy are on the FDA’s list of medications in short supply, along with a similar type 2 diabetes drug, tirzepatide (Mounjaro), which in clinical trials also helped people lose a significant amount of weight. 

Taking these drugs to lose weight could set you up for some unpleasant side effects, not to mention a blow to your bank account. Semaglutide is expensive (upwards of $1,000 a month), and insurance coverage is hit or miss, even for people who meet the FDA’s criteria. Many Medicare Part D plans will cover Ozempic for its intended use in type 2 diabetics, but Medicare does not cover medications just to treat obesity.

What is semaglutide?

Semaglutide belongs to a class of drugs known as glucagon-like peptide 1 (GLP-1) receptor agonists that have been around since 2005 but “keep getting better and more powerful,” says Brian Burtch, M.D., an endocrinologist with University Hospitals in Mentor, Ohio.

These drugs work by helping the pancreas release the right amount of insulin when blood sugar levels are high. They also slow digestion, causing you to feel fuller faster, and help the brain control hunger and cravings, explains Dina Hafez Griauzde, M.D., an assistant professor of internal medicine at the University of Michigan Medical School and an internist at the VA Ann Arbor Healthcare System. 

“So for a diabetes medication, [GLP-1 receptor agonists] are outstanding because they allow us to aggressively control blood sugar, not have to worry about low blood sugars, and allow our patients to lose weight,” Burtch says. Studies show that the vast majority of people with type 2 diabetes are overweight or have obesity.

Other well-known type 2 diabetes drugs in the GLP-1 category include dulaglutide (Trulicity) and liraglutide (Victoza, Saxenda). These have also been shown to help people lose weight.

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Who can benefit from semaglutide?  

Semaglutide can be a powerful tool for overweight adults. Losing just 5 percent of your body weight can reduce your risk of cardiovascular disease and other chronic health issues, Griauzde says. “And we know greater weight loss correlates with greater health improvements,” she adds. Dropping 10 to 15 percent of your body weight can improve one’s liver function and reduce sleep apnea, for example.

Only adults with type 2 diabetes are eligible for Ozempic, based on the FDA’s approval. Wegovy was approved for people with a BMI (body mass index) of 30 or greater and for people with a BMI of 27 or higher who also have at least one weight-related health issue, like high blood pressure or cholesterol.

If this is you and you’ve been struggling to lose weight, talk to your doctor about your options, Griauzde recommends. You’ll also want to check with your health plan to see what’s covered and for how long. If semaglutide doesn’t make the cut, Griauzde says there are older weight-loss medications that can be just as effective for some patients.

What about people who don’t have diabetes or obesity?

Physicians can prescribe FDA-approved medications for uses not spelled out by the agency. When they do, it’s called “off-label” prescribing, and according to the federal Agency for Healthcare Research and Quality, about one in five prescriptions written today are for off-label use.

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But when it comes to semaglutide, Griauzde says there’s really no indication for its use in people who don’t have type 2 diabetes and who don’t have excess weight.

For one thing, health experts stress that the weekly injections are not meant to be a quick fix for somebody looking to drop a few pounds. “This is something that you commit to long term,” Burtch says, the same way you would commit to a medication used to treat another chronic health issue. Stopping the medication will cause you to regain the weight you lost. 

Semaglutide can also cause some unpleasant — sometimes serious — side effects, including nausea, diarrhea, vomiting, constipation, stomach pain, headache, fatigue and more. “Typically, those let up as you’ve been on the medication and your body gets used to it, but not in all instances,” Burtch says.

In rarer cases, taking these drugs may increase the risk of pancreatitis, and their labels warn about the potential risk of thyroid C-cell tumors, so they’re not recommended for people who have a personal family history of medullary thyroid carcinoma or of what’s called MEN, which stands for multiple endocrine neoplasia, Burtch says.

“We hope that patients consult with a doctor who’s either an endocrinologist or an obesity expert who is familiar with the risks and benefits of these medications, and how to use them properly,” Burtch says. “Because we do see patients who are just trying to lose a little bit of weight, who are already at a reasonable weight, just wanting to get skinnier, and that is not who these medicines are made for. These medicines are made for patients who have [excess] weight, who have other metabolic risk factors, and by losing this weight will improve their health.”​​

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