The Ozempic Diet for Weight Loss | A Dietitian's Perspective

How Do Ozempic And Wegovy Work?

Wegovy and Ozempic are glucagon-like peptide-1 agonists (GLP-1 agonists). So, they act similarly to our bodies’ natural hormone GLP-1. This hormone has a multitude of benefits, but in short:

1. It helps slow down food absorption in the stomach, so you feel fuller longer.
2. It regulates insulin and blood sugar by stimulating the pancreas.
3. It helps tell your brain that you are full, suppressing hunger, reducing cravings and helping people feel a lot more in control of their food intake.

This tends to make achieving a calorie deficit a lot easier. In fact, it's been shown to reduce calorie intake by 35%
without changing people’s perceived hunger levels during the day. So basically you can eat less, and not feel hungry.
Now, this is game-changing in the dieting world because, typically, people who have lost weight experience more food cravings and less satisfaction after eating, which in turn can derail long-term efforts. So the takeaway is that these weight loss drugs are not magic; they still require a calorie or energy deficit. But because of the impact on how full or hungry you feel when on these drugs, they make obtaining and sticking to that deficit and diet much easier.

How Are Ozempic and Wegovy Taken?

The medications are administered once a week through an injection. Typically, the treatment starts at a low dose that lasts for about four weeks, followed by an incremental increase in dosage. For instance, you may start with a .25 dose and remain on it for four weeks before advancing to a .5 dose. Gradually, you can increase your dosage to the maximum amount of 2.4 milligrams, depending on your tolerance to side effects and other factors.

Who Can Get Ozempic And Wegovy?

Typically, weight loss medications are prescribed to adults with a body mass index (BMI) of 30 or higher. However, if their BMI is 27kg/m2 or higher and they have other health conditions such as hypertension or type 2 diabetes, they may also be eligible for medication. Other guidelines (NICE Guidelines) suggest even higher BMIs for weight loss medication eligibility.

Do Ozempic And Wegovy Work For Weight Loss?

Yes, they do work - that is why there is so much hype. Most studies on semaglutide suggest it results in about 15% loss of body weight when paired with healthy lifestyle interventions like diet and exercise, which is pretty dramatic! The weight loss drugs we have had in the past only resulted in 5-8% weight loss at best, with awful side effects.

When Should You Consider Weight Loss Drugs?

Weight loss drugs should ONLY be considered after all other weight loss interventions have been trialled and evaluated first.

If you are considering them, having open conversations with your healthcare team is important. I always emphasise that I want my patients to feel like they can chat openly with me. Some people can feel shame if they feel like they have failed at traditional weight loss attempts. If you do decide to take them, I strongly advise having a healthcare team supporting you, including a dietitian. This is because many changes are happening, and losing weight quickly can often result in weight regain later. It really is a multi-dimensional intervention; you need to look at diet, exercise, behaviours and even mental health. This can be a big change for people, and there are often issues with body image, self-worth, and emotional or binge eating that need to be addressed. If you're SERIOUS about making this a lifelong change, you need the appropriate follow-up and support in place.

Considerations That Your Doctor Should Discuss With You Before Starting Ozempic Or Wegovy

1. Risk-benefit analysis: Not unlike a birth control pill, antidepressant, or even an antibiotic, medicine is all about risk and benefit. It’s all about weighing the potential discomforts or risks with the potential benefits, both immediate and long-term.
2. Have all lifestyle interventions been trialled first? Traditional weight loss methods, e.g., diet and exercise, must be explored first.
3. Not every drug works for every patient; individual responses vary widely. We all metabolise drugs a little differently to the next person. I have seen people who these drugs have worked very well for, and for others, they have not worked at all. Some people just continue to eat past all the fullness signals.
4. A plateau is reached when the maximal therapeutic effect is achieved, and weight loss ceases. This does not mean the drug has "stopped" working. It simply means that additional strategies will be required to induce additional weight loss.
5. Finally, when drug therapy is discontinued, weight regain can be expected.

Additional Considerations From A Dietitian's Perspective

MINDSET:

You need to have the correct mindset when beginning a weight loss journey with the support of medication. It's not an easy way out or a magical solution. This is a commitment. What these drugs can ultimately do is really help you in the weight loss phase; they can help you stick to a calorie-reduced diet that you might have really struggled to stick with before. But sustaining it can be tricky, so you need to approach it correctly with a lot of support in different areas. Do not just get a script online. If you are trying to use it as a quick fix to lose weight and ignore all the other factors, you might lose weight in the short term, but it will come back on.

BE SMART WITH WEIGHT LOSS: Fat Loss Vs Muscle Loss.

And this is where a dietitian can help you. You might find that your appetite is low, and you think the drugs are really working. You start skipping meals, and the weight begins to come off slowly. But you might be making things more difficult down the road by doing this, as you will likely start to lose a lot of muscle tissue rather than fat tissue.

You want to try and maintain as much muscle tissue as possible. Muscle is metabolically active tissue, and this will help you in the long run to maintain weight loss. In simple terms, what this means is that muscle burns more calories than fat. So, the more muscle you have, the higher your metabolic rate. Losing weight too quickly can result in losing a huge amount of muscle mass. So you'll lose weight, but you won't become metabolically fit. Then, as soon as you start eating normally again, you'll put the weight back on and possibly additional weight because your metabolism will have adapted in a negative way.

DIET: PRIORITISE PROTEIN

To get the most out of ozempic, you have to commit just as equally to diet and exercise. You need to make sure that you are:

1. Eating adequate protein to maintain your muscle mass.
2. Implementing some resistance exercises to help stimulate the muscles.

But these are habits, lessons and new behaviours that you need to learn and take with you beyond ozempic. Ozempic is not a REPLACEMENT for physical activity and a balanced, nutrient-dense diet.

A NEW NORMAL - Lower Metabolic Rate

This might sound obvious, but when you do lose weight, you are now a smaller human being. This is a new normal that many people might find difficult to grasp at first. Your body now expends less energy than it once did when it was larger. So the amount of calories you burn daily, just in general, goes down.

HORMONAL CHANGES After Weight Loss

Hormones that control appetite change after weight loss. Once you have lost weight (whether it's with the help of a drug or not), the hormones that are involved with regulating your appetite can change, making it harder to keep the weight off. I’ve discussed this in my diet cycle video here. But essentially, when on a diet, our body fights to maintain body weight homeostasis. It does this by increasing hunger hormones and thoughts about food and decreasing our satiety hormones in a desperate effort to make us eat more. It's a survival mechanism from our ancestors when we had to live through famine and food shortages.

This is why some favour using anti-obesity medications longer term for weight loss maintenance if they are well-tolerated. Without a medication like Ozempic, the body is programmed to ramp up your appetite with every extra pound of body weight you lose. Some research even suggests that these hunger adaptations persist for years after the diet ends. So, behaviour changes, regular follow-up, and support are important here as this phase of weight maintenance can be difficult.

What Happens When You Stop Taking Ozempic or Wegovy?

When you stop taking the drug, the effects obviously stop...and for some, this means the weight creeps back on.

Some research shows that one year after discontinuing Ozempic or Wegovy, participants regained an average of ⅔ of their lost weight. This is not surprising since, as I mentioned, these medications help to counteract the increased appetite that is often associated with weight loss. Some patients may be able to gradually taper off the medication while maintaining a healthy diet and exercise routine, but it can still be a challenge. The clients that I have seen come off the drug and maintain the weight loss have been dedicated to sustaining these new habits that they built, like making exercise a part of their daily life, making better food choices day to day and so on.

Is Ozempic Safe?

We don't have long-term use studies at this point to know about the long-term side effects of using these drugs for weight loss, which is very important to be aware of. But at the same time, these GLP-1 receptor agonists, as the drugs are called, have been used for type two diabetes now for quite a while.

What is very important to mention is the people who are taking these medications who don't meet the criteria (a BMI of over 30 Or a BMI of over 27 with at least one pre-existing condition), there is no evidence to support that the drugs are safe for them. So, if you are taking these medications for a five or 10-pound weight loss, but you are already at a healthy enough weight, we really don't know if the drugs are safe for you. There are no studies on this population to figure out what the risk-benefit ratio is.

All of the studies on these drugs are assessing disease risk for people with higher BMIs or pre-existing conditions, so nobody knows what the impact is if you just want to shed a few pounds before a holiday. The goal of weight loss medications is to help reduce the health consequences related to obesity.

SIDE EFFECTS OF OZEMPIC

These vary according to the individual. The most common side effects are nausea, vomiting, constipation, diarrhoea, overall gastrointestinal upset, dizziness and headaches. Thankfully, most report nausea declines pretty steadily over time. But for some people, it’s completely debilitating; this is why the dose is often started lower and then increased if needed.

So you may not be a great candidate for these drugs if you already suffer from slow gastric emptying, acid reflux or if you have any gastrointestinal disease like IBS, crohn's or ulcerative colitis. More serious potential side effects like thyroid cancer have been seen in animal research, so these drugs are contraindicated for people with a personal or family history of thyroid cancer. Other issues that have been observed include pancreatitis, gallstones and acute kidney injury. ALWAYS speak to your doctor about the risks and side effects.

CLOSING THOUGHTS

In an ideal world, I would love it if diet and exercise could be enough for everyone, and that should always be the first approach. However, I have seen so many people really try to lose weight and struggle. I have seen first-hand some beautiful cases where these drugs have really helped change people's lives, improving physical and mental health. I can't emphasise enough, though, that they need to be used with a HUGE amount of support. Diet, lifestyle and even psychological interventions need to be implemented also.

I think the weight maintenance phase can't be overlooked because, at the end of the day, what good is it to lose lots of weight and then put it back on? I'm definitely worried that social media and Hollywood culture are positioning these drugs as an easy solution for fast weight loss.

Using them without proper support is going to do more harm than good long term.

Please let me know in the comments what your thoughts are on these drugs. And if you have any questions, please ask, as I’m here to help you.

This post was all about ozempic and the popular "Ozempic Diet" for weight loss.

More about the author:

Hi there! My name is Maria, and I am a Registered Dietitian practicing in Ireland and Bermuda. I have extensive experience in helping clients lower their cholesterol levels through dietary interventions. I hope you found the article informative and beneficial. If you have any questions or concerns, please do not hesitate to contact me. Additionally, if there are any other topics related to nutrition that you would like me to cover in my upcoming articles, please let me know. I would be more than happy to help.

Stay happy and healthy 💚

Your Registered Dietitian

Maria xox

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