Like a tidal wave, the word “Ozempic” has suddenly permeated our everyday. Once known only among those this medication intended to serve—type 2 diabetics—it’s now a resident of the pop culture lexicon. We’re searching for it 1,220,000 times a month on Google (up nearly 400% from last year), tracking its use among Hollywood stars, writing The NYT Magazine ethicist columnist with moral qualms about it, and probably know a friend (or at least a friend-of-a-friend) on it.
The only problem: Doctors worry the popularity of Ozempic is going too far—and bringing with it a slew of unintended consequences. Yes, it’s a life-changing and life-saving medication for those it’s designed to treat. Yes, it helps you lose weight quickly. And yes, people have been getting their hands on it without prescriptions or compelling medical needs at an increasingly rapid pace. Which begs the question—what do diet drugs like Ozempic do to your body if you’re not diabetic or obese?
Put simply: off-label or casual use comes with dangerous, long-term risks that can impact your longevity and healthspan. Here, we explain how Ozempic and other GLP-1 weight-loss drugs work—and why they should only be taken together with a healthy, nutritious diet and a regular exercise plan emphasizing resistance training.*
*Ozempic and other GLP-1 medications should only be used for approved conditions under medical supervision. obé Fitness does not endorse off-label, short-term use.
Ozempic and other GLP-1 medications, explained
While Ozempic is undeniably having a moment, it’s just one of a new wave of GLP-1 medications—like Wegovy, Ryblesus, and Mounjaro—that all work in the same way. These drugs contain (and flood the brain with) the active ingredient semaglutide, which mimics the naturally occurring GLP-1 gut hormone responsible for suppressing appetite. This can curb appetites so dramatically that some Ozempic users admit they set alarms to remember mealtimes.
In addition to blocking your brain’s hunger signals, semaglutide also slows down the speed at which your stomach empties, making you feel fuller for much longer. Essentially, it recalibrates processes responsible for the hormone-driven weight gain behind diabetes and obesity. Patients begin to lose weight not because the drug burns fat but because these effects put them in a caloric deficit.
When these medications treat the conditions they’re designed to—diabetes for Ozempic and obesity or weight-related medical problems for Wegovy—they can significantly improve healthspans and a patient’s relationship with food. Ozempic, in particular, has been shown to reduce the likelihood of heart attacks, strokes, and other coronary events for those with type 2 diabetes. For those with obesity or obesity-related complications, this is a safe drug—and the benefits outweigh any potential risks. These are the people who need semaglutide the most (and because of high demand and over-prescription, can’t always get it).
However, when they’re used for cosmetic reasons in otherwise healthy individuals, they can drastically disrupt the metabolism, burn off muscle mass, lead to malnutrition, and more.
How your body handles rapid weight loss from Ozempic and GLP-1 drugs
To start, it’s important to note that no large-scale data exists measuring the safety of Ozempic and other GLP-1 medications when taken for cosmetic weight-loss purposes. Regardless, doctors know enough about what happens during rapid weight loss to be concerned.
Whether you’re taking a GLP-1 medication by prescription or not, the resulting weight loss can significantly reduce your muscle mass. It’s normal (and expected) for one-quarter to one-third of lost weight to be muscle mass. Anything above that is alarming since most chronic disease is accelerated by low muscle mass and inactivity, not necessarily fat.
Peter Attia—a physician known for championing longevity—has observed that Ozempic may prompt equal muscle-to-fat loss (and sometimes, up to two-thirds muscle). Nearly all of his Ozempic patients have lost muscle mass at a disproportionate rate, meaning they develop a higher fat ratio, even if the scale shows a smaller number.
In a caloric deficit, the body has to start pulling more energy from those muscle reserves (in addition to fat) to function properly. The faster you lose weight (think: 5 to 10 pounds a week instead of the expert-recommended 1 to 2), the more muscle mass comes with it. In short, you’re altering your body’s metabolic process.
This attrition can reduce bone density (especially considering 81% of GLP-1 prescriptions are written for women, an already susceptible population for osteoporosis) and lower resting metabolic rate. A slowed metabolism can lead to unwanted side effects like hair loss, brain fog, extreme fatigue, irritability, and poor immune system functioning.
Working together, these changes can result in sarcopenia—a condition typically associated with aging—which brings the gradual loss of muscle mass, function, and strength. Sarcopenia tends to impact your quality of life, reducing your stamina for even the most basic daily activities. These aging effects even come with cosmetic repercussions (yes, “Ozempic face” is real).
Dramatic appetite suppression can also come hand-in-hand with malnutrition, doctors say. Without proper check-ins with your healthcare provider to assess whether your nutritional needs are being met, GLP-1 medications can instill, magnify, or exacerbate disordered eating habits. Finally, dehydration and electrolyte imbalances can creep in, as thirst regulation can also be impacted.
What happens once you stop taking GLP-1 drugs
The biggest caveat of taking Ozempic and other GLP-1 medications: You’ll need a lifetime supply. Due to the way they regulate gut hormones, clinical trials show the body starts to return to its baseline as soon as you stop taking them.
Most patients regain the weight they lost within a year. One doctor has reported that only about a quarter of his patients can sustain their weight loss post-medication. The ones who succeed stuck with healthy lifestyle changes like a consistent exercise routine and nutritious eating while on the drug.
If you’re not using the medications to treat diabetes or obesity, the cyclical weight fluctuations and yo-yo dieting effect of going on and off GLP-1s (likely, since supply is not secure) can heighten your risk of developing chronic health conditions. Heart disease, high blood pressure, and (ironically) diabetes are all on the table—especially if you’re not exercising or eating consistent, nutritious meals.
A rebounding metabolism can also make it more challenging to lose weight—particularly without medication—in the future. When the metabolism slows during rapid weight loss, it can erroneously contribute to a misdirected neural loop once weight gain returns, damaging regulation. Leptin—a hormone found in fat—oversaturates the body and leads it to believe it’s starving, slowing the metabolism even more. Consequently, you can keep gaining weight even while in a dramatic caloric deficit.
How to lose weight in a safer, more sustainable way
If you’re taking GLP-1 medication by prescription to treat an approved condition, there are key lifestyle modifications you should make to support your body through the changes. And if you’re using it off-label, these exact lifestyle modifications can help prevent long-term harm.
While less sexy than “get thin fast” schemes, lifestyle-first weight loss methods will always be safer, more sustainable, and more effective in the long run. There’s a reason why Ozempic and other GLP-1 drugs were FDA-approved in combination with diet and exercise!
First, regular strength and resistance training (classes like Strength, Power, Pilates, Sculpt, and Barre) should be at the top of your to-do list. According to a recent study, this type of training mitigates muscle mass loss while building strong, healthy bones to offset the risk of osteoporosis. Bonus points: Higher muscle mass has been linked to a lower risk of heart disease, diabetes, and dementia (plus, it makes you look more toned).
In particular, lifting weights will boost your metabolism (more muscle mass = better resting metabolic rate), ensure you’re losing more fat than muscle, and extend your healthspan. Experts suggest starting with 2-3 strength workouts per week, then leveling up to 3-4 as you get stronger. Remember: the goal is to improve your body composition (the ratio of fat to muscle), not just lose weight. Strength-based obé programs like BodyComp, Simply Strong, Training Essentials, and Gym Strong are designed to do exactly that.
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To offset your risk of cardiovascular issues, opt for 2-3 cardio sessions each week. Fun fact: mixing aerobic-based cardio with resistance training in your routine will deliver more benefits to your heart than either one done alone, according to studies. You’ll also increase insulin resistance with more movement, another perk—especially for those at risk for diabetes.
On the nourishment front, increasing your protein intake is essential (and can help avoid sarcopenic obesity). Studies have shown that higher-protein diets lead to less lean muscle loss and more fat loss. One expert recommends adding 25-30 grams of protein to every meal—with a 60-gram daily minimum. (Need more guidance? Check this protein Q&A.)
Since your appetite is influenced and you’re eating less, each bite counts more, so reach for whole, non-processed foods, plenty of fiber, plus fruits and vegetables to replenish vitamins and minerals. You should also aim to include more vitamin C-rich and zinc-rich foods, suggests a dietitian. GLP-1 drugs tend to reduce your stomach acid levels—a vital immunity barrier that keeps bacteria at bay. On that front, it’s also crucial to eat your probiotics (yogurt, kefir, and tempeh are all on the menu) to support a good gut-bacteria balance.
And of course, don’t skip your sleep. Key to body weight regulation, a good night of sleep helps your body recover and maintains healthy cortisol and growth hormone levels, keeping you strong and healthy.
Taking Ozempic is not a shortcut to good health
To sum up: thinness does not equate to good health. If you’re taking a GLP-1 medication and don’t have diabetes, obesity, or excess weight linked to specific health concerns, you’re putting unnecessary strain on your body. (Compounding pharmacies, which supply compounded drugs for off-label use, also do not have FDA approval, further complicating safety.)
Remember, these medications are meant to aid healthy habits like balanced eating and working out. They aren’t designed to replace those things. There is no magic cure-all pill you can take to be effortlessly healthy, even if one may change your outward appearance favorably. Working out consistently and eating well are some of the most potent forms of medicine we know—use them to your advantage.
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