Addressing the Ozempic Craze in Clinical Practice

Semaglutide, tradename Ozempic, is an injectable drug that people with type 2 diabetes take weekly to control their blood sugar levels. It also causes weight loss, a key advantage for some people with diabetes. 

“Uncontrolled type 2 diabetes and the relentless damage that unhealthy blood sugar levels can have on the body results in serious consequences,” explained diabetes expert Beverly Yates, ND, the creator of the Yates Protocol to help people thrive with diabetes and the author of the book Heart Health for Black Women. “For these individuals with uncontrolled type 2 diabetes, pharmaceutical interventions such as semaglutide can be a game changer.”

There is no question that semaglutide does in fact lead to weight loss. In a 2022 study that followed more than 300 overweight or obese adults with at least one weight-related comorbidity for two years, semaglutude resulted in 15.3 percent weight loss compared to 2.6 percent in the placebo group. Another 2022 study resulted in a nearly six percent weight loss at three months and nearly 11 percent at six months.

In 2021, the Food and Drug Administration (FDA) approved semaglutide for chronic weight management in adults with obesity who have at least one obesity-related condition, such as high blood pressure or high cholesterol. Semaglutide does not have FDA approval for weight loss in the general public who do not have comorbidities; however, because of all the media attention, it is being prescribed off-label.

“This drug is not meant for the general public looking to lose a small to moderate amount of weight,” said Yates. Her concern among the general population who are using the drug is with both the known side effects and the unknown long-term effects.

Adverse Events

While semaglutide is effective at reducing obesity, the question remains, at what cost?

According to a 2022 literature review of clinical trials, most of the trials had more than 70 percent of the participants experience at least one adverse event, which included nausea and vomiting but also more serious side effects such as retinopathy complications, pancreatitis or pancreatic cancer, gall bladder issues, cardiovascular events, impaired renal function, and medullary thyroid cancer. 

In addition to thyroid cancer, cardiovascular issues, and kidney and pancreatic problems, the NIH has identified the following side effects:

• Nausea and vomiting
• Constipation or diarrhea
• Abdominal pain
• Heartburn and burping
• Rash, itching, swelling of the eyes, face, mouth, tongue, or throat
• Difficulty breathing or swallowing
• Decreased urination 
• Swelling of the legs, ankles, or feet
• Vision changes
• Fainting or dizziness
• Rapid heartbeat
• Yellowing of the skin or eyes
• Clay-colored stools
• Fever

What’s more, a 2022 clinical trial demonstrated that discontinuation of semaglutide resulted in weight regain and any cardiometabolic benefits reverted to baseline.

In addition, there is also a side effect called “Ozempic face,” where the patient develops sagging, aging facial skin that is treated with facial fillers or a facelift. This effect is caused by the rapid weight loss in the face where the skin cannot retract due to reduced levels of collagen and elastin.

Natural, Safe Appetite Suppressants

Presently there are nine anti-obesity drugs available, with eight of them, including semaglutide, using appetite suppression as their key mechanism of action. Integrative practitioners utilize a wide range of tools to help patients with appetite control. These strategies are far safer than pharmaceutical interventions, especially semaglutide. 

In her clinical practice, Yates has found one or more of the following interventions to be effective in most cases:

Focus on sleep. “Sleep disorders, especially sleep apnea, can cause an increase in appetite the day after a bad night’s sleep due to changes in the hormones leptin and ghrelin,” Yates explains.

• Green tea. “Drinking green tea offers a number of health benefits and provides some caffeine for appetite suppression but not so much caffeine that it disrupts sleep,” she said.
• Diet. Yates has her patients focus on leafy greens, healthy proteins and fats, and complex carbohydrates to suppress appetite and slow gastric emptying. “I also have my patients add ¼ cup of slow-burning, resistant starch complex carbs like beans and legumes to each meal,” she said.
• High fiber. Foods high in fiber provide bulk and instill a feeling of fullness and satiety. 
• Hydration. Drinking eight to 10 glasses of water throughout the day is important for appetite control.

“I also counsel my patients on how to pay attention to how the foods they eat make them feel,” Yates explained. “If they don’t feel satisfied and full after eating a food, then I teach them how to replace that food with something that gives them the satiety they need. Making these types of swaps can make a big difference when it comes to appetite control.”

Supplements to Consider

There are several nutritional supplements to consider when it comes to appetite control including, fenugreek glucomannan, garcinia cambogia, and green tea extract.

In addition to drinking green tea as Yates suggests, taking green tea extract as a dietary supplement may also be a solid weight loss strategy. A 2020 meta-analysis showed that taking green tea extract resulted in significant decreases in body weight, body mass index (BMI), and waist circumference. 

A 2005 clinical trial found that a supplement derived from garcinia cambogia not only suppressed appetite, it also led to reduced body weight and BMI while improving blood lipid profiles and increasing fat oxidation compared to placebo.

Research also demonstrates that glucomannan inhibits appetite, slows intestinal absorption, and can reduce total and LDL cholesterol.

A 2015 study involving overweight females showed that drinking a tea containing fennel and fenugreek decreased hunger and increased feelings of fullness. 

Clinical Considerations

The media frenzy following Ozempic may cause your patients to inquire about it. In addition to counseling them on diet and lifestyle factors that can positively influence weight loss, a conversation about all-natural, safer ways to suppress appetite may be in order.