Newspaper headlines, magazine articles, subway posters, highway billboards, and more are all talking about Ozempic. Why?
Ozempic (semaglutide) is approved for people with type 2 diabetes. It is gathering attention as an effective weight loss drug, with some touting it as a miracle drug. Certainly, the medical benefits of Ozempic have the potential to improve the health and well-being of untold numbers of people. But as with any medication or medical innovation, it inevitably comes with some downsides and potential risks. So then, how do we weigh the risks and benefits of Ozempic, Wegovy, and the rapidly expanding class of similar medications, from a mental health perspective?
1. Brief Background. Ozempic (semaglutide) was approved in 2017 for the treatment of adults with type 2 diabetes mellitus, and a higher dose form of semaglutide known as Wegovy received FDA approval for weight loss in 2021. It operates as an appetite suppressant and is designed to lower Hemoglobin A1c, a measure of blood sugar control. It is self-administered weekly via a pre-filled pen that is injected under the skin of the abdomen, thigh, or upper arm.
2. Health Benefits. According to the CDC, nearly 1 in 10 Americans have diabetes, and an overwhelming majority, about 90-95%, have type 2 diabetes. Many of these people stand to benefit immensely from these medications. Based on clinical trials conducted at 536 sites in 33 countries involving 4087 patients, Ozempic has proven to be effective for treating type 2 diabetes mellitus. According to safety studies, adverse events are not widespread, but not an insignificant number of people taking Ozempic report gastrointestinal issues, including nausea, vomiting, diarrhea, abdominal pain, and constipation. For those who tolerate Ozempic well, it offers the promise to gain control over their diabetes, which has the potential to reduce stress and enhance overall mental health and well-being as well.
3. Mental Health Risk Related to Eating Disorders. Ozempic’s effects depend on continuous treatment, but the long-term risks of taking Ozempic are unknown. What we do know is that the immediate outsize attention being given to the medication’s weight-loss-inducing properties is undoubtedly – and understandably – triggering for people currently struggling with an eating disorder, those prone to developing one, and people in recovery from one. This emphasis on weight loss reaffirms mainstream society’s staunchly embedded thin ideal and rampant glamorization of thinness. While Ozempic may indeed assist some individuals in important ways, we should consider the potential inadvertent impacts. In fact, many people who develop eating disorders identify dieting (driven by weight dissatisfaction) as a primary risk factor that preceded the onset of their eating disorder If Ozempic and similar drugs are being taken by individuals who are not overweight or diabetic, and driven by a cosmetic desire to lose weight, we could very quickly see a surge in the number of people engaging in dangerous dieting behaviors and prescription medication abuse that could increase risk for eating disorders.
4. Mental Health Risk Related to the Enduring Stigma of Obesity. How we view obesity as a society is highly problematic. Despite all the talk around body acceptance, on a deep level, many of us have internalized a viewpoint of obesity as a personal or lifestyle choice and, thus, representative of a personal failing rather than a medical condition akin to diabetes. Weight stigma is associated with mental health risks such as depression, impaired emotion regulation, and maladaptive coping. Research shows that increasing body mass index (BMI) is strongly associated with weight stigma and diminished mental health. If public figures like celebrities and social media influencers are (ab)using Ozempic to shed unwanted pounds and receive praise or elicit envy for their weight-driven body transformations, we are inadvertently helping to perpetuate society’s stigmatization of obesity and unhealthy relationship with body weight.
5. Off-label Use of Prescription Medications. Off-label prescribing refers to the practice of prescribing a medication to a different population or for a different purpose from what it was approved for by the FDA. It is both common and legal. In fact, one in five prescriptions written in the US today is for off-label use. In some cases, off-label prescribing can be highly effective and appropriate, but it can also be a slippery slope. Consider, for example, medications such as the stimulants Adderall and Ritalin that are approved for the treatment of another mental health condition, attention deficit hyperactivity disorder (ADHD). These prescription medications are widely abused on college campuses and increasingly among middle schoolers and high schoolers, who take them to support marathon study sessions and cramming for exams. Promoting health, including mental health, requires that we get clear on the difference between off-label prescribing and prescription abuse.
Occasionally, a new medication becomes big news. Ozempic is doing just that and more. Weighing its benefits and risks is complicated. Ozempic is likely to have significant health, including mental health, benefits for some individuals and significant risks for others. These benefits and risks are part of a larger landscape of big issues related to population weight. It is time to think more critically about the drivers of obesity and weight problems in the world today and address social determinants at a public health level. The result will be better health, including mental health, for all.