Who should really be taking 'miracle weight-loss' drug Ozempic – a ...

There is nothing that sends the world into a frenzy like the talk of a new weight-loss drug. How can I get it? Should you be allowed to take it? Shouldn’t you just lose weight the old-fashioned way? How much is it? Can I use it to get into my dress for the weekend? And so on.

These are just some of the questions that arise with any mention of losing a few kilos with the help of a pill. The reality is that when it comes to weight loss and pharmaceuticals, things are a lot more complicated.

Specifically, when it comes to the growing range of semaglutide drugs, which include Ozempic and Wegovy, our food intake is actually more important than ever when it comes to losing weight and keeping it off.

For anyone who has tried, or is trying to lose weight, you will know all too well that it is not easy, especially as we get older. We are physiologically programmed to store extra calories, and with plenty of extra calories within easy reach, it is far easier to overeat than under-eat.

Then we have the added variable of an extremely sedentary lifestyle here in Australia, thanks to open roads that require a lot of driving, long work days to pay increasing mortgages and a tech-dominated lifestyle. This means that even if you eat a “healthy” diet, weight control is tricky with multiple variables working against us.

There is a commonly held belief that weight loss is based on a simple equation – energy in versus energy out. You can drop a few kilograms by eating less and moving more. For some people, with normal metabolic function, weight loss can indeed be this simple – but not for everyone.

What we have come to understand is that genetics and weight gain over time affect metabolic function, or how efficient the body is in metabolising fat.

Specifically for those individuals with a genetic predisposition to glucose regulation issues, which will ultimately lead to type 2 diabetes, it is not as simple as calories in versus calories out.

Rather, the ability to efficiently metabolise body fat is largely influenced by the hormone insulin, the primary regulator of both glucose (carbohydrate) and fat metabolism in the body.

For these individuals, weight gain over time can affect insulin function, and as one of the key actions of insulin is to store fat, high insulin levels ultimately block fat loss.

High insulin levels also drive sweet cravings and appetite, and cause fatigue. Ultimately, that means that simply because you eat less, it does not mean you will lose weight.

The latest “weight loss” drugs including Ozempic are the first drugs of their kind to specifically target insulin action and appetite simultaneously. Not only do they actively stimulate insulin production in the pancreas, but they also target a receptor in the body called GLP-1, which reduces blood glucose levels and has a significant impact on appetite.

What this means is that individuals with insulin and glucose dysfunction have their hormone levels normalised, so they are no longer blocking fat loss, plus they do not feel so hungry all the time, so they eat less and lose weight. These drugs are not weight-loss medications, but they do help those with glucose regulation issues to be diet compliant and lose weight.

Whilst semaglutide medications are linked to weight loss, for just as many clients I have seen using them, just as many are not getting the desired weight loss results, simply as they have not adjusted their dietary intake.

Taking these medications will not miraculously see the kilos drop, rather it is the link between these medications and a significantly reduced appetite, and calorie intake as a result, that leads to weight loss over time.

If you continue to eat past this reduced appetite, or over time do not increase your exercise, these medications will do very little. Ultimately, they are a tool to improve insulin action and enhance diet and exercise, not override it.

Ozempic and other semaglutides including Wegovy are not specifically weight-loss drugs. Rather they are drugs that target glucose dysfunction and as such should be prescribed by a GP or endocrinologist. They are medications that need to be rightly prescribed by a doctor who is experienced in the management of insulin resistance and type 2 diabetes.

If you have difficulty losing weight, suspect you may have glucose or insulin issues, have had gestational diabetes or have a family history of type 2 diabetes, it is worth discussing the pharmaceutical options that are available with your GP or endocrinologist.

Indeed, these drugs are powerful and for the right person they will ultimately prevent the development of type 2 diabetes. But they will only work if you also change your diet accordingly.

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