The weight loss drug Ozempic rocketed into public consciousness last year, and a social media–fueled desire for the medication has led to shortages for patients with type 2 diabetes.
Now, people are increasingly recognizing the medication’s side effects, which can include loose skin, which has become known as “Ozempic face.”
“Any rapid weight loss will decrease fat volume in many parts of the body, especially in the face, resulting in sagging tissue and skin,” said Dr. Lyle Leipziger, chief of plastic surgery at North Shore University Hospital and Long Island Jewish Medical Center. “Slow progressive weight loss may allow skin retraction of the face to occur, so it’s not as acutely damaging as rapid weight loss.”
“The goal of weight loss is to improve health,” said Dr. Vadim Sherman, medical director of bariatric and metabolic surgery at Houston Methodist Hospital. “You can reduce fat and weight, but the consequence is that the skin is already stretched.”
This may be the most visible effect, but it’s not the only one, and it’s certainly not the most serious potential consequence. People who are taking the drug can have issues including vomiting and pancreatitis, although side effects are generally rare.
Most of the side effects were documented in clinical trials of people taking the drug for an approved purpose, said Dr. Latasha Seliby Perkins, a family physician in Washington, DC, and member of the American Academy of Family Physicians. We don’t necessarily know what happens in those who are taking these drugs because they want to lose a small amount of weight, which is not one of its FDA-approved uses.
Ozempic (a brand name for semaglutide) was originally approved in 2017 to lower blood sugar in people with type 2 diabetes. But clinical trials soon revealed a helpful side effect: weight loss. This is especially important for people with type 2 diabetes, many of whom are medically considered overweight or obese.
So in 2021, the Food and Drug Administration granted another approval, this time for weight loss but only in people with a body mass index of 27 or higher with at least one related health condition and those with a BMI of 30 or greater. The trade name of the drug was changed to Wegovy and higher maximum doses were approved.
Both Wegovy and Ozempic belong to a class of medications known as GLP-1 agonists, which work in several ways, including suppressing the GLP-1 receptors in your brain to pull back your appetite. GLP stands for glucagon-like peptide-1, which is a hormone involved in blood sugar control. Other GLP-1 agonists include Rybelsus (semaglutide), Saxenda (liraglutide), and Mounjaro (tirzepatide).
Drug shortages for people who really need it
The weight loss associated with Ozempic and related drugs has made them appealing to people who don’t have type 2 diabetes or meet other FDA criteria for using the drug. This has created a shortage for the people who need it most and who should be taking it: those with type 2 diabetes.
“When there’s a weight loss component to a drug, it’s beneficial for people who have type 2 diabetes,” Perkins said. Not necessarily for other folks.
In the longer term, not having this medication could lead to kidney, heart, and eye disease and even death for those with type 2 diabetes, although there are other medications on the market that can be used to help lower blood sugar. “Diabetes can really affect people’s lives,” Perkins said.
This brings up an important point: You should know which drugs you are taking and read their package inserts, said Dr. Kelly Johnson-Arbor, a medical toxicologist and interim executive director of the National Capital Poison Center.
For those who find the multiple folds and fine print intimidating, take heart. You only really need to scan the beginning, Johnson-Arbor said.
“The first page is usually a good place for a general overview,” she said. At the very top is a box with any important health warnings (like cancer), then further on warnings and adverse reactions.
Here are some of the side effects of Ozempic and drugs in the same class.
Nausea, vomiting, diarrhea, abdominal pain
Gastrointestinal symptoms are among the most common side effects of the GLP-1 agonists, Johnson-Arbor said. This isn’t surprising given that Ozempic, Wegovy, and other similar drugs act on various aspects of the digestive system. “Your GI tract is a bit more sensitive on this medication,” Perkins said.
In clinical trials, nausea occurred in 20% of people taking a 1 mg dose of Ozempic, 16% of people on a 0.5 mg dose, and 6% of people taking a placebo. Vomiting and diarrhea were less common but still occurred in about 9% of people on the 1 mg dose compared with 2% taking a placebo.
Diarrhea and vomiting can lead to another unwanted effect: dehydration. “When you’re vomiting, your body has to use some of its water source to get the food out,” Perkins explained. “The same thing with diarrhea.”
Often these effects are mild, but they can cause people to discontinue the drug, Sherman said. The best gauge of how hydrated you are is your urine output — you should be going to the bathroom once every hour or two. If that slows to every third or fourth hour, call your doctor’s office for advice. Any less frequent than that, visit urgent care or an emergency room, Perkins said. And always hydrate.
For people on the 1 mg dose, 6% reported abdominal pain and 3% reported constipation.
Sometimes dehydration from vomiting and nausea is so bad it can lead to kidney injury, Johnson-Arbor said. One patient taking Ozempic needed temporary dialysis after increasing his medication dose. Kidney function declined in two additional individuals taking Ozempic, although both had underlying kidney disease from long-standing diabetes, as did two others who were taking GLP-1 agonists.
“Kidneys do the job of filtering urine and taking things you need for [the] body,” Perkins explained. “You need water to flush through the kidneys. If you don’t have enough water, it starts causing damage.”
Experts recommend that people with existing kidney disease be cautious when using GLP-1 agonists. If you are taking one of these medications and have severe and persistent nausea, vomiting, and other GI side effects, see a doctor. “It’s a good idea to have some labs done to see if something else is going on,” Johnson-Arbor said.
A racing heartbeat can be another consequence of dehydration, Perkins said.
Several cases of acute pancreatitis have been reported in people taking GLP-1 agonists. Pancreatitis is an inflammation of the pancreas — the primary gland involved in insulin production. Symptoms include nausea and vomiting, fever, rapid heart rate, and a distended and painful belly, as well as yellow skin and eyes.
“If you have a history of pancreatitis, you might want to use caution when considering Ozempic, although it also has happened in people without a history,” Johnson-Arbor said.
Possible risk of thyroid cancer
Researchers have also seen a type of thyroid cancer called medullary thyroid carcinoma, but only in rodents given the drug. While it could be a risk in humans. The first GLP-1 agonist was only approved 20 years ago, so we don’t have a lot of data on long-term side effects, Johnson-Arbor said.
“People should be aware, this is a rare cancer that could take years to develop,” she continued. “Don’t take these drugs if you have a history of thyroid disease.” It’s also possible that this cancer is unique to rodents, which have a large number of GLP-1 agonists in their thyroids, she added.
Signs of thyroid tumors can be a lump in your throat, trouble swallowing, hoarse voice, or shortness of breath.
According to Johnson-Arbor, gastroparesis “is also called delayed gastric emptying.” She explained it’s a disorder that slows or stops the movement of food from your stomach to your small intestine even though there is no blockage in the stomach or intestines.
While this can also make you feel full, it’s more likely to cause nausea and vomiting, Sherman said, adding that it does appear that gastroparesis and other GI effects go away after you stop taking the medication.