What do I need to know about Ozempic, TikTok's favorite weight loss product?

Billionaire Elon Musk takes credit for his dramatic weight loss. Celebrity websites claim that many other stars use it to stay slim. And TikTok is full of influencers showing off their striking before-and-after photos showing how they lost weight after using the drug.

What is it? A drug called semaglutide, which is sold under different brand names, including Ozempic, approved in 2017 to treat type 2 diabetes, and Wegovy, approved just last year for weight loss.

The hype surrounding these drugs has caused a shortage of both, according to the U.S. Food and Drug Administration, which is expected to last several months, causing anxiety among diabetic patients who rely on Ozempic to control their blood sugar levels. Experts warn that it is important to understand that these are not miracle drugs and that there is a risk of taking them improperly.

Here's what you need to know about semaglutide, including how it works and the risks.

What is the scientific basis for this drug?

Semaglutide helps lower blood sugar levels by mimicking a hormone that is naturally released when food is consumed, said Ariana Chao, associate professor at the University of Pennsylvania School of Nursing and medical director of the Center for Weight and Eating Disorders. This drug, administered by injection, helps people feel fuller for longer, regulates appetite, and reduces hunger and food cravings.

There is significant demand for the drug. In 2019, more than 11 percent of the population was diagnosed with diabetes, and in 2020, more than four in 10 adults are classified as obese.

According to Chao, patients with type 2 diabetes often have impaired production of insulin, a hormone that helps break down food and turn it into fuel for the body. Semaglutide signals the pancreas to produce more insulin and also reduces glucagon levels, which help control blood sugar levels. This can lead to weight loss, but experts note that the drug Ozempic has not been approved for this purpose, although a higher dose of semaglutide (Wegovy) has been approved.

Wegovy is the first drug approved for chronic weight control since 2014. The difference between the two drugs is that Wegovy is prescribed at a higher dose of semaglutide than Ozempic. According to Chao, clinical trials of Wegovy showed greater weight loss but only a slight improvement in glycemic control compared with Ozempic.

The FDA views Ozempic and Wegovy as two different drugs for different purposes. Chao says that many insurance companies cover Ozempic for diabetes but don't cover Wegovy for obesity, a prime example of weight bias in health care. That's why some health care providers use the two drugs interchangeably, because obesity and type 2 diabetes are inextricably linked - obesity is a major risk factor for type 2 diabetes.

What are the risks?

Like every medicine, it can have negative sides.

According to Chao, the most common side effects are gastrointestinal problems such as nausea, constipation and diarrhea; less common are pancreatitis, gallbladder disease and diabetic retinopathy.

These drugs have been extensively studied, but their relatively recent approval means that researchers still don't know what the effects of taking them long-term may be.

Ongoing research is helping us better understand what happens when people stop taking these medications, which many may be forced to do when they are deficient. Studies show that stopping these medications can lead to weight gain again, especially if patients have not changed their lifestyle.

"In almost all weight-loss studies, it all depends on your foundation," says Stanford endocrinologist Sun Kim. "Your lifestyle efforts will determine how much weight you lose. If you have a foundation of food, exercise and sleep, you'll get good results." Otherwise, you can gain back up to 20 percent of your lost weight in a year.

These medications can also be incredibly expensive, especially without insurance. Kim says the cost of an injection pen can exceed $1,000.

What does it mean to use this drug off-label?

Off-label use means using the drug off-label and not for its FDA-approved purpose, which can be unsafe or ineffective. Ozempic has been approved only for patients with type 2 diabetes, and Wegovy has been approved only for patients with a BMI greater than 30 or 27 if they have co-morbidities related to weight, such as high blood pressure.

"There is no scientific evidence to support the efficacy or benefit of this drug for those who do not meet the criteria on the FDA-approved label, such as people with a body mass index below 27," Chao says. "We also don't know the side effects or risks in these populations - there may be unknown drug reactions. These drugs are not designed to address the problem quickly."

Even if you meet these criteria, experts caution against trying to get over-the-counter medication by traveling to countries where it is not required.

"When medications are not used under the supervision of a health care provider, then they can be misused," Chao says. "More serious side effects can occur."

Other experts also argue that with Ozempic becoming hard to find, diabetic patients should be first in line.

"What worries me, and I hope it's temporary, is the supply problem," Kim says. "If I had to sort and prioritize, I'd probably prioritize someone who controls their diabetes to get it."

Robert Gabbay, chief scientific and medical officer of the American Diabetes Association, says the organization is "very concerned" about the shortage of Ozempic.

"The drug has become an important tool for people with diabetes," he says. "Not only does it reduce blood glucose levels and weight, but it has also been shown to reduce cardiovascular events -- heart attacks -- one of the leading causes of death for people living with diabetes."

Last resort?

Still, Kim says prescribing drugs like Ozempic and Wegovy to patients desperate for a new approach to weight loss makes her feel like a "superhero." By the time patients come to her, they've already tried methods such as Weight Watchers and following the advice of nutritionists. In this case, she says, drugs like Ozempic and Wegovy can be a great option.

"I've found that sometimes when they successfully lose weight, it affects their lifestyle as well, and then they can be more active," Kim says. "Losing weight is very difficult. Seventy-five percent of the U.S. population is overweight or obese. I don't think we should hold it back if it can help."

Chao agrees that these medications are a good alternative for those who cannot lose 5 percent of their body weight within about three months of a lifestyle change. However, she recommends trying these approaches before resorting to medication.

Patients need to "make sure they focus on healthy eating, reducing calories, and increasing physical activity," she says. "It's important that they know that even if they take medication, it's not an easy way out: They still have to make lifestyle changes."

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