Ozempic - Weight loss pill

Ozempic (semaglutide) is a popular, high-strength, weekly injection used in the UK primarily for Type 2 diabetes, often used "off-label" for weight loss. While effective, it has significant downsides, particularly gastrointestinal side effects and high costs, and which include:

- with weight regain often emerging during the second year

- patient attitudes toward Ozempic become increasingly negative as weight loss plateaus or reverses over the longer term

- Patients reported, "I have had all 5 of the main side effects, nausea, stomach pain, vomiting, diarrhea, and constipation."

- hospitalization due to complications such as severe dehydration or gallbladder removal.

Key Downsides of Ozempic in the UK:

Common Gastrointestinal Side Effects: Very common side effects include nausea (often severe initially), vomiting, diarrhoea, constipation, stomach pain, and bloating.
"Ozempic Face" & Rapid Weight Loss: Rapid weight loss can cause a "gaunt" or saggy facial appearance due to loss of fat, sometimes called "Ozempic face".
High Costs: In the UK, Ozempic can be expensive, often costing around £150–£200+ per month.
Shortages for Diabetics: High demand has caused shortages, making it hard for patients with Type 2 diabetes to obtain the medication.

Pancreatitis & Gallbladder Issues: Rare but serious potential risks include pancreatitis (inflamed pancreas) and gallbladder issues.
Other Potential Side Effects: These include fatigue, dizziness, headaches, acid reflux, heartburn, and a potential increased risk of thyroid tumors.

Research also links early-life stress to adult gut issues and reveals that nurturing relationships in older age hinges on shared positive experiences.

Discussion

Principal Findings and Comparison to Prior Work

This study provides new insight into how individuals perceive and evaluate the off-label use of Ozempic for weight loss, based on unsolicited, real-world data from an online medication review platform.

Using a mixed methods approach, we found that user satisfaction was driven primarily by perceived effectiveness in promoting weight loss and appetite suppression, whereas gastrointestinal side effects were common but exerted limited influence on overall evaluations or decisions to continue treatment. Rather, discontinuation was most strongly associated with no/minimal weight loss or the occurrence of other, nongastrointestinal side effects. These findings highlight that, for many users, perceived efficacy outweighed tolerability concerns—a perspective that may be underrepresented in traditional clinical trials—and demonstrate the potential of infoveillance methods to capture patient-centered attitudes that shape treatment adherence.Of the 60 respondents, 40 (67%) reported reduced weight, appetite, or cravings as a result of Ozempic treatment. This finding aligns with clinical trial data demonstrating the broad efficacy of semaglutide in promoting weight loss, with reductions of up to 17.3% observed after approximately 1 year of treatment, depending on dose and patient population [12,14,15]. Across these studies, approximately 13.5% of participants failed to achieve ≥5% weight loss with semaglutide 2.4 mg, comparable to the 18% (11/60) of participants in our sample who reported minimal or no overall weight loss.

Consistent with these findings, subthemes related to weight outcomes were major contributors to respondents’ overall quantitative ratings of Ozempic: subthemes 1a and 1b (“weight loss and related outcomes” and “appetite suppression”) were associated with higher overall ratings, whereas subtheme 1d (no/minimal weight loss or weight rebound) occurred more frequently among lower ratings. Moreover, reductions in weight, appetite, and cravings (subthemes 1a, 1b, and 1c) were strongly associated with respondents’ intention to continue versus discontinue treatment, underscoring these outcomes as being closely associated with long-term medication adherence. Notably, a retrospective study of electronic health records in the United States reported that semaglutide treatment was associated with higher persistence rates at 1 year (40%) compared with other weight loss medications, including liraglutide (17%), phentermine-topiramate (13%), and naltrexone-bupropion (10%) [31], likely reflecting its superior efficacy in promoting weight loss.Several respondents indicated that although Ozempic treatment initially led to weight loss, this effect had plateaued or even reversed with continued use.

This observation aligns with evidence from clinical studies showing that weight loss tends to plateau after approximately 1 year of semaglutide treatment, with weight regain often emerging during the second year in trial extension cohorts [32]. Such plateaus are consistent with those observed following other weight loss interventions and are thought to reflect metabolic adaptations, including reductions in resting and nonresting energy expenditure, accompanied by compensatory changes in appetite-regulating hormones [2,33-35]. In our dataset, very few respondents reported their treatment duration; therefore, we were unable to determine whether this variable mediated positive versus negative appraisals of Ozempic’s efficacy. This should be a focus of future research, as it is conceivable that patient attitudes toward Ozempic become increasingly negative as weight loss plateaus or reverses over the longer term. Such dynamics likely have important implications for long-term medication adherence, including for semaglutide formulations specifically approved for obesity and overweight [36].A high proportion of respondents reported experiencing gastrointestinal complaints, including nausea, diarrhea, and vomiting. This aligns with clinical trial data identifying these as the most common adverse events associated with semaglutide treatment, with prevalence ranging from 41.9% to 82.8% across studies [12-16], as well as with preclinical evidence that GLP-1R agonists act on hindbrain regions involved in emesis control [37]. In our sample, these adverse events occurred with similar frequency among respondents who provided higher versus lower quantitative ratings, suggesting that gastrointestinal symptoms did not substantially influence overall attitudes toward Ozempic as a weight loss medication. This aligns with data from a previous study showing that 99.5% of gastrointestinal adverse events were nonserious, transient, and occurred most frequently during or shortly after dose escalation [38]. Moreover, across several clinical trials, treatment discontinuation due to gastrointestinal complaints was relatively uncommon, affecting only 3.4%-4.2% of participants [14,16].

Together, these findings indicate that gastrointestinal side effects are generally well tolerated and often regarded as “acceptable,” particularly among individuals who experience meaningful weight loss (as described by 1 respondent: “I have had all 5 of the main side effects, nausea, stomach pain, vomiting, diarrhea, and constipation. I am happy with the weight loss, so am learning to manage these”). By contrast, users who reported other physiological (nongastrointestinal) symptoms tended to give lower quantitative ratings. This may reflect the greater severity of some of these adverse events, with several users indicating hospitalization due to complications such as severe dehydration or gallbladder removal. Although we cannot confirm that these outcomes were directly attributable to Ozempic treatment, serious treatment-associated adverse events have been reported in approximately 10% of participants in large-scale studies [15,16], including gallbladder disorders such as cholelithiasis and cholecystitis, which have led to treatment discontinuation in some cases [12].Our data also included 2 instances in which respondents reported experiencing depression symptoms that they attributed to Ozempic treatment. Recent discussions have raised concerns about a possible association between semaglutide use and adverse mental health outcomes, particularly suicidal ideation [39]. This aligns with a recent FDA submission noting a disproportionate number of reports of “depression/suicidal” and suicidal ideation among individuals treated with semaglutide, although no causal relationship was established [39]. However, other studies, including a recent meta-analysis of 25 clinical trials, have found no association between GLP-1R agonists and suicidal or self-injurious behaviors [40,41], and some evidence even suggests a lower risk of these outcomes compared with other medications for obesity and T2D [42].

These mixed findings mirror patterns observed among bariatric surgery patients, where treatment has been associated not only with improvements in depression and anxiety but also with an increased risk of suicidality and self-injurious behavior [43]. Collectively, these data highlight the need for further research, including prospective studies and controlled clinical trials, to clarify the potential mental health risks associated with semaglutide use. Complementary preclinical investigations may also be necessary to identify shared neurobiological pathways underlying the regulation of appetite and mood.

Patient Perceptions of Ozempic (Semaglutide) for Weight Loss: Mixed Methods Analysis of Online Medication Reviews

Authors of this article:Abanoub J Armanious^{1, 2} ; Rachel-Mae Hunter^{1, 2} ; Kristi R Griffiths³ ; Hannah E Bowrey^{4, 5} ; Robyn M Brown⁶ ; Morgan H James^{1, 2, 4, 5}