An Extreme Risk of Taking Ozempic: Malnutrition
The diabetes medication has gained attention for its dramatic weight loss effects — but doctors worry that it can go too far.
April 21, 2023, 11:04 a.m. ET
Almost immediately after starting Ozempic, a diabetes medication known for inducing weight loss, Renata Lavach-Savy, 37, a medical writer in North Bergen, N.J., was left without any semblance of appetite. She started setting alarms to remind herself to eat. She was so exhausted that even after 10 hours of sleep, she would collapse onto her couch after work, unable to move.
She left purses and clothes strewn across her bedroom floor, because she was so queasy all the time and worried that bending down to pick them up would make her vomit. Four months later, Ms. Lavach-Savy’s dietitian told her that she might be malnourished.
Ms. Lavach-Savy was shocked. “How can I be malnourished? I’m over 200 pounds,” she recalled thinking. She stopped taking Ozempic last fall.
Her doctor originally recommended Ozempic because Ms. Lavach-Savy had polycystic ovary syndrome, a hormonal condition that often occurs alongside insulin resistance. The weekly injections led to constant, low-level nausea, a squiggle of sickness in her stomach. She lost all desire to eat.
Severe cases like Ms. Lavach-Savy’s are rare, experts say. But some people taking Ozempic can experience such intense lack of appetite that they do become malnourished, said Dr. Andrew Kraftson, a clinical associate professor in the division of metabolism, endocrinology and diabetes at Michigan Medicine. Doctors say it is important that people are given clear guidance on proper diet and nutrition while on the medication. People who experience extreme outcomes from the medication may need to stop taking it altogether.
“You can’t eat what you feel like or what you want,” Ms. Lavach-Savy said in describing what it was like to be on the medication. “You have to eat what your body will accept.”
Ozempic works, in part, by blocking the brain’s hunger signals, suppressing appetite; it also causes the stomach to empty more slowly, leading people to feel full for longer.
When people are on a drug like Ozempic, doctors need to monitor them closely with regular check-ins, Dr. Kraftson said. He recommends a daily caloric intake — typically between 1,000 and 1,500 calories, individualized based on a person’s starting weight and estimated metabolism — for his patients and counsels them on their diets to ensure they’re getting enough nutrients.
“We’re not trying to make you vanish into nothingness,” he said. If people are unable to eat enough while on the drug, he decreases the dose or tells them to stop taking the medication altogether.
No standard nutritional guidelines have yet been established for patients taking Ozempic or other medications that work similarly, like Wegovy and Mounjaro. Doctors usually give similar dietary recommendations to people taking drugs like Ozempic and other patients who are trying to lose weight or who have diabetes, said Dr. Robert Gabbay, the chief scientific and medical officer of the American Diabetes Association. That means following a diet that is high in fruits, vegetables and fiber, like the Mediterranean diet, said Dr. Janice Jin Hwang, the division chief of endocrinology and metabolism at the University of North Carolina School of Medicine.
Avoiding high-fat foods is also critical, because they can make people taking Ozempic feel uncomfortably, even painfully full, Dr. Gabbay said. He urges people to eat slowly and pause halfway through a meal, assessing how full they actually are. “You could power through a cheeseburger and fries in five minutes,” he said. “But wow, are you going to feel like you way overate.”
People taking Ozempic tend to lose weight because they consume fewer calories, not because the drug itself magically burns fat, Dr. Gabbay said. If patients don’t regularly meet with their doctors to ensure they are getting adequate nutrition, these medications could lead to, or exacerbate, disordered eating, Dr. Kraftson said.
While scientists are still trying to understand how Ozempic affects the brain, a known side effect is that people’s cravings can change. Ozempic contains semaglutide, which mimics a hormone called glucagon-like peptide-1; when people take the drug, higher levels of that hormone flood the receptors in our brain that regulate our eating behaviors, Dr. Hwang said, changing how our neurons transmit signals to the rest of our body. Just as some people lose interest in once-beloved foods after bariatric surgery, those taking Ozempic often find that they no longer crave foods that are high in fat and sugar — both because their appetite decreases overall and potentially because of those neural changes, Dr. Hwang said.
“When you’re given a choice of a salad versus fried chicken, it just becomes a little easier to make those healthy choices,” she said.
However, people taking these medications need to be aware of the complications that can arise from having little to no appetite. “It’s never healthy to not eat,” Dr. Hwang said.
