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Drugs like Ozempic and Wegovy have been billed as “gamechangers” in the fight against obesity and diabetes, and the popularity of these drugs as a weight loss aid is booming: In the U.S., health care providers wrote 9 million prescriptions for drugs like Ozempic in the last three months of 2022 alone, according to a 2023 analysis.
But like any medication, however, Ozempic and similar drugs — which use semaglutide as an active ingredient to mimic a naturally occurring hormone called GLP-1 — come with a range of side effects. Nausea, headaches, vomiting, and diarrhea are common effects and many questions remain about these drugs, including their long-term impacts on the body.
What’s more, emerging connections to rare and severe conditions like gastroparesis, or stomach paralysis, and other serious gastrointestinal illnesses is drawing concern.
One way in which Ozempic affects the body is by slowing the rate at which the stomach empties. By prompting release of insulin and interacting with GLP-1 receptors in the brain and elsewhere in the body, Ozempic affects an individual’s appetite.
“Every gastroenterologist will tell you that clearly Ozempic has an impact on gastric emptying,” says Sameer Khan, a gastroenterologist at John Hopkins Hospital. “There’s a large number of GLP-1 receptors in the stomach and it’s already known that Ozempic and similar drugs slows digestion.”
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Yet amid reports that those using semaglutide drugs like Ozempic for weight loss have suffered from severe side effects, researchers have sought to shed light on the issue. In a 2023 paper published in JAMA, a team at the University of British Columbia found that use of Ozempic and other semaglutide drugs was associated with an increased risk of serious gastrointestinal illnesses, including stomach paralysis.
To arrive at their findings, the researchers analyzed health insurance records for around 16 million U.S. patients, assessing non-diabetics who were prescribed semaglutide or liraglutide between 2006 and 2020. They found that GLP-1 agonists such as Ozempic increased the risks of pancreatitis, bowel obstruction, and gastroparesis, or stomach paralysis, amongst patients.
They also found that incidences of biliary disease, that affects the gall bladder, were higher. Other studies, however, indicate that the risk of pancreatitis may be exaggerated.
“Given the wide use of these drugs, these adverse events, although rare, must be considered by patients thinking about using them for weight loss,” Mohit Sodhi, first author of the paper and a graduate of University of British Columbia’s experimental medicine program, said in a press release. The study marked the first large-scale study investigating the issue and the exact mechanism that increases these risks is unclear.
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A problem in understanding the scale of these effects, says Khan, who was not involved in the study, is that patients who are prescribed Ozempic and present with side effects are often told to stop the treatment as a safety precautions.
In his own clinical experience, Khan says that around 10 to 15 percent of patients had to stop taking the medicine or reduce their dose due to a diverse range of side effects, including gastrointestinal problems. Numbers in a large clinical trial were lower at around 5 percent.
Research indicates that these drugs can relax muscles in the stomach in the first portion of the stomach, leading to food stay there for longer. In addition, it can narrow the passage leaving the stomach, further slowing down food exit, Khan adds.
In addition, those with diabetes are also already at high risk of gastroparesis, regardless of whether or not they’re taking semaglutide drugs.
“Diabetes affects the nerves and that includes the nerves going to the stomach that tell them to squeeze appropriately,” Khan says. “In terms of risk factors, diabetes and diabetic neuropathy affecting the stomach is probably one of the biggest risk factors for having adverse events as it relates to this medicine.”
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Though these incidences of severe side effects are still considered rare, experts say caution must be taken by those considering taking these drugs to help with weight loss. The University of British Colombia team called for warnings of gastroparesis to be added to medications.
“These drugs are becoming increasingly accessible, and it is concerning that, in some cases, people can simply go online and order these kinds of medications when they may not have a full understanding of what could potentially happen. This goes directly against the mantra of informed consent,” Sodhi said in the statement.
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Sean Mowbray is a freelance writer based in Scotland. He covers the environment, archaeology, and general science topics. His work has also appeared in outlets such as Mongabay, New Scientist, Hakai Magazine, Ancient History Magazine, and others.