A Weight Loss Specialist Explains the Ozempic Craze

“When I look around this room, I can’t help but wonder, Is Ozempic right for me?” Jimmy Kimmel’s joke during the Oscars cemented it: Little known until recently, this medication has gone so mainstream it’s become a predictable punchline, entering the rarified air of names like Viagra and Adderall before it. But does everyone even get it? 

Ozempic is a brand of the generic drug semaglutide that is currently FDA-approved to treat patients with Type-2 Diabetes by controlling their blood sugar levels. It also curbs appetite, making it an effective weight-loss drug for people with obesity-related illnesses—and, more controversially, a tool for people looking to lose a little weight for cosmetic reasons. 

With viral TikToks and new stories of drug shortages and celebrities admitting (or denying) taking it, the whole thing might feel like a callback to the diet pills of the 1990s, when pharmaceutical companies marketed powerful amphetamines as weight loss supplements before we understood the severity of Fen-Phen’s side effects: anxiety, dependence, psychosis, and in extreme cases, heart failure or death. 

So for any hot new “miracle drug,” it’s doubly worth considering the risks—whether that’s “Ozempic face,” the term for someone becoming especially gaunt, or the fact that one recent study of semaglutide found that a third of weight loss came from muscle, bone mass, and lean tissue. And as is often the case for drugs that cause weight loss, the effects regulating diet and portion control are generally understood to last only as long as people actively take it.

There’s a lot to wrap your head around, so VICE spoke to Jeff Toll, an internal medicine and primary care provider based in Los Angeles. Dr. Toll has prescribed Ozempic to patients as part of what he calls a holistic plan for wellness and weight loss. He gave us his take on safety concerns, supply issues, and alternative care plans in the age of Ozempic.

VICE: When did you first encounter Ozempic?
Jeff Toll: We had been using these drugs for years with diabetic patients and having a lot of success with not only improving their diabetes but, in many cases, helping them lose a lot of weight. Drug companies did large independent studies just on the weight loss effect, regardless of whether someone was a diabetic or not. I think many of the doctors expected a result like this just because of how profound the weight loss was with these drugs in diabetics. But it was nice for us to see the independent studies for weight loss without seeing any new negative major side effects coming up to realize that they were safe to use for weight loss in non-diabetic patients. There’s a lot of weight-related comorbidities other than diabetes: hypertension, high cholesterol, gout, osteoarthritis. Things like back pain, or knee pain, or hip pain are worse from just being overweight. For a lot of people, getting on these medications to lose weight actually helps several other medical conditions that are not just sugar-related conditions.

Since Ozempic catapulted into the zeitgeist, has it come up more often in your practice?
We take care of a lot of celebrities, musicians, and athletes, and I think a lot of people are wanting to take advantage of these drugs to try to lose weight when possible, and I think it puts the doctors in a difficult position. In my practice, we do a lot of help with people’s diet, exercise, and other means of losing weight. But the nice thing is that, for the most part, there is a benefit without a whole lot of risk involved with these medications, especially when we’re watching them closely to check labs, and check people’s sugars frequently.

What happens after you stop taking Ozempic?
In general, having a healthy diet and exercising consistently is going to be the way to be healthier in the long run, no matter what. Typically, whenever I start anyone on Ozempic, we’re also obviously talking about their diet, exercise, and putting into place these good habits whether they’re on the drug or not. Those habits will augment the effect of the drug, and they will also help people lose weight if they’re not on the drug. One of the concerns about these medications is that people are reporting gaining a lot of the weight back. But I’ve found that in our practice, when you incorporate a change in habits and slowly wean the dose off, that’ll work. With those habits in place, typically people will actually be able to keep the weight off. One effect of Ozempic is that it tends to make people control their portion size and what they’re eating. And that’s one of the ways it makes people lose weight. So I always have people self-monitoring what the drug is teaching them about their portion sizes. 

Are people seemingly making medical decisions based on celebrity endorsements?
Whether we’re talking about plastic surgery or, you know, cosmetic injections, there’s always going to be celebrity trends that people are following. I think the reason why, to me, this trend is actually less harmful than some of those plastic surgery trends is: It’s almost never a bad idea to get someone to a more healthy weight. For the most part, doctors are not recklessly giving this medication to people who don’t need the weight loss. If people don’t need weight loss and go on Ozempic, they often get low blood sugar and don’t feel very well. So they don’t really want to be on it anyway.

Have you encountered any difficulties in supplying the drug?
Definitely, it’s really hard to get them. And sometimes, some of the drugs in the class are harder to get for some time, then the manufacturer makes more, and the other ones are harder to get. In our practice, we have a bunch of care coordinators who are on top of all aspects of people’s care, including how they can get their medications. They’ve been able to sort of navigate that, but I imagine a lot of practices are having difficulty right now. And I imagine there are people having trouble finding it independently.

Are you more optimistic about Ozempic and generic semaglutide over previous “miracle” drugs?
Yeah, I think so. Anything that is an amphetamine or amphetamine-like drug will have inherent risk of harm to it; it can lower your appetite but potentially have all sorts of side effects, including anxiety and insomnia. The nice thing about Ozempic is that it’s a drug that’s metabolically beneficial. So it’s not causing weight loss through some bad side effect; it’s actually improving our metabolism, helping us lose weight, and lowering our appetite. Hopefully, the FDA is tracking all this over a period of at least 10 years, similarly to how they tracked its impact on diabetics. Hopefully, we make sure that the track record continues to be safe, but this one appears to be much safer and more beneficial than other drugs like Fen-Phen were in the 90s.