#Science | Explainer

[xtruss]

Since gaining popularity online, the diabetes medication Ozempic (semaglutide) has been increasingly requested to manage weight. Now, there’s a shortage that’s affecting people who use the medication. Photograph By Imyskin, Getty Images

Ozempic is a Serious Drug with Serious Risks. Here’s What to Know.

The diabetes medication semaglutide has recently become a trendy weight loss treatment. But like every drug, there are downsides—and potentially serious side effects.

— By Allie Yang | August 1, 2023

Billionaire Elon Musk credited it for his dramatic weight loss. Celebrity sites allege that many more A-listers are using it to stay trim. And TikTok is full of influencers showing off their startling before-and-after shots showing off their weight loss after using it.

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

The buzz about these drugs has created a shortage of both, according to the U.S. Food and Drug Administration, which is expected to last for several months—causing alarm among patients with diabetes who rely on Ozempic to help control their blood sugar. Experts caution that it’s important to understand these are not miracle drugs—and that there are risks to taking them outside of their intended use.

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

What’s The Science Behind The Drug?

Semaglutide helps lower blood sugar by mimicking a hormone that’s naturally secreted when food is consumed, says Ariana Chao, assistant professor at the University of Pennsylvania School of Nursing and medical director at the school’s Center for Weight and Eating Disorders. This medication, administered through injection, helps people feel full for longer, helps regulate appetite, and reduces hunger and cravings.

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

Patients with type 2 diabetes often have impairments in insulin, a hormone that helps break down food and convert it into fuel the body can use, Chao says. Semaglutide signals the pancreas to create more insulin and also lowers glucagon, which helps control blood sugar levels. This can result in weight loss but experts point out that Ozempic has not been approved for that purpose, though semaglutide at a higher dose (Wegovy) has been.

Wegovy is the first drug since 2014 to be approved for chronic weight management. The difference between the two drugs is that Wegovy is administered at a higher dose of semaglutide than Ozempic. Wegovy’s clinical trials showed more weight loss but only slightly greater improvements in glycemic control compared to Ozempic, Chao says.

The FDA sees Ozempic and Wegovy as two different medications for different uses. Chao says 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 medical providers use the two doses somewhat interchangeably, as obesity and type 2 diabetes are inextricably linked–obesity is the leading risk factor for developing type 2 diabetes.

What Are The Risks?

Like every medication, there can be downsides.

The most common side effects are gastrointestinal issues, such as nausea, constipation, and diarrhea, Chao says—and more rarely, pancreatitis, gallbladder disease, and diabetic retinopathy.

Angela Godwin, nurse practitioner and clinical assistant professor at the NYU Rory Meyers College of Nursing, explains that recent reports of extreme vomiting and gastroparesis (delayed emptying of the stomach) are to be expected.

Gastroparesis “just means the food’s in your stomach longer, which then makes you feel fuller longer,” she explains.

Nausea is one of the biggest side effects of medications like Ozempic and Wegovy, and that can always lead to vomiting, Godwin says. In June, the American Society of Anesthesiologists recommended patients stop taking these medications before surgery to avoid aspiration and vomiting.

“Normally, in my experience, it's tolerable,” she says. “But then there are times when I ask [patients], ‘Well, what happened?’ And they [say] they ate too much and ate too quickly. And then yes, the body will vomit it up, because it just can't tolerate that much food anymore.”

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

Continuing research is helping us understand more about what happens when people stop taking these medications—which many may be forced to do amid current shortages. Research does suggest that stopping use of this medication could cause patients to regain weight, especially if they didn’t make any lifestyle changes.

“In almost all weight-loss studies, it really depends on your foundation,” says Stanford endocrinologist Sun Kim. “Your efforts at lifestyle will determine how much weight you lose. If you have your foundations like food, exercise, and sleep, you’re gonna do well.” If not, you might regain as much as 20 percent of the weight lost per year.

These medications can also be incredibly expensive, especially without insurance. Kim says an injection pen can run more than $1,000.

What Does It Mean To Use This Drug Off-label?

Using a drug off-label means using it in a way other than its intended and its FDA-approved purpose, which may not be safe or effective. Ozempic has been approved only for type 2 diabetics, and Wegovy has been approved only for patients with a BMI above 30, or 27 if they have a weight-related comorbidity like high blood pressure.

“There is no scientific evidence to show whether this medication will be effective or of benefit to those who do not fit the criteria from the FDA-approved label indications, such as people with a BMI lower than 27,” Chao says. “We also do not know the side effects or risks in these populations—there could be unknown drug reactions. These medications are not meant to be a quick fix.”

Even if you meet the criteria, experts warn against trying to obtain the medication without a prescription by traveling to countries that don't require them.

“When the medication’s not used under supervision of a health-care provider, then they can come into misuse,” Chao says. “There could be more serious adverse events that can happen.”

Godwin says recent reports of extreme vomiting and gastroparesis are a reminder that patients should schedule regular checkups with their doctor when taking these medications.

“I think it's so popular now that practitioners might be tempted to just prescribe more freely, and then maybe not monitor patients as frequently,” she says.

Patients should not increase their Ozempic dose without doctor approval—which is possible because there are multiple doses in one pen. “They could definitely have a lot of poor side effects, because they didn't titrate up to that level yet,” Godwin says. The same could be said for Wegovy, which comes in a pack of four one-dose pens.

Robert Gabbay, the American Diabetes Association’s chief scientific and medical officer, said the organization is “very much concerned” about the Ozempic shortage.

“The medication has been an important tool for people with diabetes,” he says. “Not only does it lower blood glucose and weight but it has been shown to decrease cardiovascular events—heart attacks—one of the leading causes of death for those living with diabetes.”

A Last Resort?

Still, Kim says that prescribing drugs like Ozempic and Wegovy to patients who are desperate for a new approach to weight loss can make her feel “like a superhero.” By the time patients come to her, they’ve often tried methods like Weight Watchers and following the advice of dieticians. In that case, she says, medications like Ozempic and Wegovy can be a great option.

“What I find is sometimes as they're becoming successful at losing weight, it really does feed into their lifestyle too, and then they're able to be more active,” Kim says. “It’s hard to lose weight. Seventy-five percent of the U.S. population is overweight or obese. I feel that we shouldn't be holding this back if this can help.”

Chao agrees that these medications are a good alternative for those who are unable to lose 5 percent of their body weight within about three months of making lifestyle changes. Still, she recommends trying those approaches before turning to medication.

Patients should “make sure that they're focusing on a healthy dietary pattern, reducing calories, as well as increasing physical activity,” she says. “It’s important they know that even if they are taking the medication, it's not an easy way out: They're still going to have to make lifestyle changes.”

[hellsitegenetics]

I’m a biology teacher, and we just finished our genetics chapter. I mentioned your blog to some of my students, and they asked if they could submit their own questions to your blog to see what animal they got. I’m so sorry if you have a random influx of 15 y/os in your inbox.

String identified: ’ a g tac, a t gtc cat. t g t tt, a t a t c t t t t g t at aa t gt. ’ a a a / .

Closest match: Patella vulgata genome assembly, chromosome: 1 Common name: Common European Limpet

(image source)

[starry-bi-sky]

bruce and danny being fuckign nerds together,,,, they are being the BIGGEST nerds. geeks. if you will

these losers are color-coding the most inane bullshit. they are making diagrams for things you've never even thought of. they are having the time of their lives

"what are you two doing?"

Danny, sitting criss-cross on a table, hunched over a spread of papers and a bunch of different jello cups, his back is gonna hurt SO much: color-coding jello

Bruce, sitting in a nearby chair, also criss-cross, scribbling on a graph paper: hm [agreeing]

Alfred, already exasperated and SO fond: may i ask why? and on what parameters?

Danny: we're basing it off which flavors are the most mentally stimulating and for which subjects :}

Alfred, SO fond: ah. i see.

Danny, snapping his head over to Bruce and leaning over: wh- no-- no. Buzz, I told you: lemon-flavored jello stays strictly in the 'smelling salts' category--

Bruce, still writing on the graph paper: mn. no.

Danny, nearly sprawled across his back, faux-outraged: strawberry is NOT good for math-- you fucken HEATHEN--! Give me that pen!

Bruce, did that solely to rile up Danny, now trying not to smile: hnm.

[the-faultofdaedalus]

my personal favourite interpretation of those sorcerer supreme tony versions is that he has simply always been doing magic and just never really realized because, of course he has. transistors don’t work like that. magnets don’t work like that. no one else on the planet can make technology work the way he makes it work. to be clear. transistors do not and cannot do the shit he makes them do. sorry buddy i know you wanted to do science but unfortunately you’ve always been doing mage fuckery. rip.

[the-untalented-photographer]

[sengenism]

gen is next to senku like, 90% of the time just to stand there and look pretty while going "ohhhh?" when senku explains science stuff

[nando161mando]

In just 40 seconds, Greta Thunberg explains why it is totally coherent to protest both genocide and climate collapse.

[orengejoshi]

Paperhatober Day 17: Mouth

Flug is gonna get his fingers chomped off... for science!🧪

[mechncheese]

You have draw Bluestreak a total of two (2) times which for me is enough to ask: Do you have any hcs for him? Is he going to be in your au?

Funnily enough, Bluestreak is one of my more niche favs but mostly because of the HCs I've made up for him in my head BAHAHA What can I say? I love background characters and expanding upon them !

He's around in my AU as well ! This ask has been sitting in my inbox for a while and I wanted to get out my list of Autobots sorted before I answered it, so sorray !

As for what he's like in the AU I kept his Yapper Personality, him being a talker to cope with the pain of it all </3 He's a little tragic to me

I won't get too into it but here are some other HCs from my AU

Ik this is a common one and one that might be mildly annoying but he gets mistaken for Prowl sometimes and he has debated on changing some of his frame to differentiate himself more but ultimately decided against it.

He's so homesick, he misses everything all of the time and the only thing he can do is talk to distract himself from the fact that if he lets his mind wander too much he will get sad </3 he has a fear of being left alone.

Bluestreak does this thing where he smiles or laughs out of a nervous habit during inappropriate times and sometimes it unnerves others because how could you be laughing during a time like this but he can't help it.

Bluestreak doesn't take himself seriously and often brushes off his problems with humor. First Aid tells him that maybe he should consider coming to him for therapy.

This has nothing to do with my HCs but anon I hope you know I am in the top 0.1% of Bluestreak fans and my goal is to spread my love for niche characters

[mcnyoom]

What compels me so about Oscar is that he truly is just some guy, if I saw him in the grocery store I would not look twice, but stick him next to a camera and some Belgian twink and I literally Cannot stop looking

[thejakeformerlyknownasprince]

I really want you to get started on Jurassic Park now after reading your tags.

All right, you asked for it! This post is going to be long because I've been rereading Jurassic Park since I was about 10 years old. But. My thoughts:

Jurassic Park is the oldest story in the world: one about hubris, and the price men pay for their ignorance of nature. From the first moment the protagonists step foot on the island, they can see it. There are poisonous plants next to the pool because they "look pretty." The harbor has no retaining wall because tropical storms aren't considered important. And there's a steep price for that hubris. Wu doesn't bother to learn the dinosaurs' names before breeding them, Nedry ignores them as unprogrammable, Malcolm mansplains them to their own creators, Regis laughs at the idea of them escaping, Hammond relentlessly monetizes them, Arnold insists he can control them... And they all get eaten by dinosaurs. It's the characters with the good sense to be overawed and scared (Muldoon, Gennaro, the paleontologists, the kids) who make it out alive. Almost paradigm.

More specifically, it's a book about the most fundamental principle of engineering: be scared, be confused, and then do something anyway. Then do something else, then something else, until something works. Timmy isn't a master hacker in the book; he's just (unlike Grant) willing to push buttons on the computer until he finds the power grid. Gennaro's still a scaredy cat in the book, but he clenches his teeth and goes into the velociraptor nest anyway. The heroic characters are the ones who conclude someone has to do something, despite not knowing what that something is. The villainous ones are the ones who refuse responsibility.

Speaking of which, can we talk about Ian Malcolm? I'm a sucker for a good Cassandra character, especially one that manages to get even the genre-savvy reader rolling their eyes and going "will you shut up?" And Malcolm is one of the best, every off-putting academic habit rolled into one: He thinks he's better than other people for not liking sports. He brags about not caring about appearances and then comments on Sattler's legs. He assumes Hammond has read his monograph and — when Hammond reveals he hasn't — pulls out a copy that he keeps on his person at all times to have Hammond read on the plane. He smugly explains that other characters should've foreseen they'd be killed by dinosaurs, only to be killed by dinosaurs. He calls his theory the Malcolm Effect. I do love Jeff Goldblum's gentler, more charming take on the character ("See, here, now I'm sitting by myself, talking to myself, that's chaos theory" I say literally every time I ask a question of someone who just left the room). But I prefer the way original Malcolm gets away with being right about everything because we so so badly want him to be wrong.

Speaking of that comment about the legs: by the low low bar of 80s/90s thriller writers, Crichton is surprisingly progressive. Jurassic Park invites us to laugh with (and roll our eyes with) Sattler, every time someone expresses shock the world's top paleobotanist is a woman. The Lost World perfectly captures the "women in STEM have to be twice as competent to get half the respect" dynamic, and it's a story about the male characters over-estimating their own competence as the female ones go about saving the day. Race isn't handled perfectly, but it is discussed in both books. Malcolm's chauvinism is designed to make everything else he says a bitter pill, to poison us against him. Crichton's no feminist. But Sattler's hardiness — later Harding's and Kelly's as well — are shown as hard-won in a world that batters nerdy girls so hard that only the toughest survive.

And Malcolm is just one of the many ways Jurassic Park masterfully lampoons scientific bullshit. After little Tina is bitten by a "strange lizard" and nearly dies from the swelling, Dr. Cruz assures her parents that lizards bite zookeepers all the time, that some people are allergic to lizard venom, and that the lizard Tina drew resembles a basilisk — and then we cut to him talking to his fellow MD. Where we find out that lizards don't attack humans in the wild, no human they know of has ever been hospitalized for a lizard bite, basilisks aren't venomous, and Tina's condition doesn't resemble an allergic reaction. They have no idea what this "lizard" (a Procompsognathus) could be or how it poisoned this kid, but they've been taught to obfuscate rather than admit that. Scientists are arrogant, and ignorant of their ignorance.

But the book is every bit as positive about empiricism as it is negative about individual scientists. The seamless way Crichton blends science fiction with science fact gets me every time. His preface connects Watson & Crick to Swanson & Boyer to Malcolm & Levine, explaining each step of the research process as he goes. He goes on to explain how Genetech developed its ideas from IBM, and that IBM and Genetech both contributed to InGen, which in turn influenced Biosyn, funded by Hamaguri... and only two of those names are fictional, but don't worry about which. Crichton does his homework, and then he presents his homework in the most compelling way of any writer I've ever encountered.

You need no further proof than the technologies — satellite phones, electric cars, touchscreens, gene editing — that were sci fi in 1990, commonplace today. Crichton did the reading. And he rolls that science out ever-so-slowly: dribbling first the mystery of the worker with a 3-foot gash in his torso who claims a bird of prey did it, then the mystery of the resort that needs the world's most powerful data storage, then the mystery of the billionaire who calls in the middle of the night with "urgent" questions about what baby dinosaurs eat... Until even 10-year-old me could look at that picture of a fractal and go "ohhh, I see how the unstable phase shifts of chaos theory explain the fact that a thunderstorm caused that guy to get eaten by a T. rex." Almost paradigm.

And all Jurassic Park's banging on about chaos theory belies a deep understanding of how interconnected ecosystems are. Animals, like plants, like subatomic particles, must be understood holistically. Pretending that the best way to learn the truth of any system is through breaking it down "is like saying scrambled eggs and bacon for breakfast is human nature. It's nothing of the sort. It's uniquely Western training." Crichton clearly loves biology: "a single fertilized egg has a 100,000 genes, which act in a coordinated way, switching on and off at specific times, to transform that single cell... A house is simple in comparison. But even so, workmen build the stairs wrong, they put the sink in backward, the tile man doesn't show up when he's supposed to. All kinds of things go wrong. And yet the fly that lands on the workman's lunch is perfect." And he clearly hates what capitalism has done to biotechnology.

Hammond the venture capitalist is a perfectly despicable villain: No dinosaurs have escaped, because I said so. If there are problems, no there aren't. Put on a good show for investors, no matter how many contractors die in the process. Talk about all the "good" the park will do by making tons of money. The kids are stranded and the tech expert's dead? No they're not, because I said so, now pass the ice cream. It's truly a delight watching him get eaten by dinosaurs.

For that matter, Jurassic Park is bursting with details of style over substance. There are cutesy Apatosaurus cutouts in the hotel rooms and bars on the widows, a half-finished restaurant covered in Pterosaur poop, and a celebrity-narrated tour track that can't synchronize with the dinosaurs. It's trying to be Disney World, and it's actually a roadside zoo. The signage — "When Dinosaurs Ruled the Earth," the hand-lettered "Welcome to Jurassic Park", the room (and department) called "Control" — isn't subtle in its irony. But it is fun.

Which is yet another great sci fi trick. "Our funding is infinite but our peer review sucks" perfectly sets up the blend of the accurate with the plot-fueling (likely why Crichton reuses it several times). Why are there Pterosaurs in a dinosaur park? Our funding is infinite but our peer review sucks. Why are so many Cretaceous dinosaurs in Jurassic Park? Our funding is infinite but our peer review sucks. You didn't know Dilophosaurus is venomous? Our funding is infinite... It's perfect, because it's the opposite of how the scientific process usually works. Again: Crichton knows his shit, and he knows how to communicate it.

Like, even when I'm reading Sphere or Terminal Man — books where I'm perfectly aware I know more than Crichton on the subject, not in the least because their science inevitably became outdated — I still find myself believing, at least for the length of the story. You don't have to suspend disbelief when reading Crichton's work; he hoists it into the stratosphere for you. Half the time he won't give it back even after you're done. Almost paradigm.

But despite all that nerdery, Jurassic Park is still a rocking adventure story that builds momentum until it smashes to its conclusion at 70 miles an hour, ending the millisecond it can do so with not a word of denouement. You can practically hear that last deep piano note on the final words. It's cinematic as hell. This is Crichton post-Westworld, pre-Twister, the ultimate adventure writer. He reads, clearly, avoiding the errors of sci fi amateurs who watch too many movies (the T. rex has a distinctive smell, the island is relentlessly humid, so on) but he knows how to make a tight fast-moving story that you can consume in under three hours. His imagery is powerful, his pacing is on point, and his plot sucks you in and shoots you out like a water slide.

Jurassic Park is fun. It's informative. It makes you laugh, and gasp, and sigh, and think. It has its flaws (Harding Sr. fades out in the 3rd act, Grant's Maiasaura expertise never pays off) but those are minor in a book that stands up so well to rerereading. Almost paradigm.

[rororonyan]

I'm french canadian, i thought i'd put that out whilst i drop a french canadian oc

I like to think he has a human or a vampire darling

In franco-canadian folklore, Loup-Garous are a type of werewolf, in Quebec, they are especially prominent and are specifically sourced from religious curses, such as not going to mass or confessions. They're often men, and are cursed to transform into an animal (wolf, cat, dog, owl, cow..) every night for 101 days

Cédric's family is amidst the few who are able to inherit the curse, Cédric is a little shit who makes sure to 'renew' it after the 101 days stop. In truth this is caused by a very rare gene, his whole family has it, but because his family is highly religious and makes sure to go to mass, they also happen to drink wine. Ethanol subdues the gene and thus the 'curse'. Because Cédric dislikes alcohol, his gene is always active.

[sabrebash]

So my aunt seems to have witnessed BALL LIGHTNING and i can't get her to understand how potentially important that is

She's not a fantasist type, just a fun country gal in her 70s. So last night on the phone she casually drops that during a very intense thunderstorm a couple of nights ago, she sees lightning congeal into an orb and hover above the ground for a couple seconds before fizzling out, and she was scared of fire and for her neighbor's cows. She's just like 'Yeah it was scary :(, but anyway i saw your cousins :)' and i'm like AUNTIE, YOU ARE MORE LIKELY TO GET BIGFOOT'S AUTOGRAPH THAN SEE BA--

'Yeah i wish i had gotten it on video, haha but it was very scary' AUNTIE, IF YOU HAD GOTTEN IT ON VIDEO YOUR NAME WOULD BE IN HISTORY BOOKS

[genericpuff]

I find something that annoys me is how people misunderstand why Persephone is considered the goddess of spring.

It’s because Demeter makes it spring when she returns. Not because Persephone has some awesome sick flower powers and she makes it all pretty before returning to her 10000/10 husband.

Agreed! But also, if I can offer up my own food for thought / interpretation: Demeter didn't necessarily create 'winter' as we traditionally perceive it, rather she created famine.

In that same sense, Demeter isn't even necessarily "making it Spring" when Persephone returns - she makes the land fertile again, allowing mortals to harvest their crops and thrive. Thus creating the "seasons" of harvest and drought.

Like many of the myths we've preserved and still read today, The Hymn to Demeter was a story created to explain natural phenomena that we didn't yet know how to explain. In Demeter's case, the story of her separation from her daughter explained the cycle of nature - why the clouds would no longer rain, why the ground would dry and crack, why the soil would become brittle, and why the crops would lose their will to live. It wasn't necessarily because she brought about 'winter', it was simply that she stopped performing her own duties, which were specifically dedicated to the harvest, especially that of wheat and grains (both of which are INCREDIBLY important foods that played their own massive role in the evolution of the human race - they weren't only essential to keeping both humans and livestock fed with their carb-heavy components, but could also be used to make fabrics and tools.)

Just as people prayed to Poseidon for safe travels across still waters, so too would people pray to Demeter for a bountiful harvest. Whenever there were droughts, you could understand it as the period when Persephone would return to the Underworld; or you could even blame it on yourself, or even your own fellow mortals, if you felt that perhaps Demeter had been disrespected in some way so as to bring about a drought as punishment.

This is why The Hymn to Demeter also functions as a foundational story for the founding of The Eleusinian Mysteries - a cult that worshipped Demeter, and other deities attributed to the harvest (ex. Dionysus) whose initiates were sworn to secrecy, never to speak aloud what practices were happening within the cult. And they did a damn good job of it too, because to this day we still don't fully know what went down in those cults. They're mysteries, after all :')

Demeter wasn't the only god who was attributed to the harvest and the weather patterns that would cause drought, but she's certainly one of the most popularly discussed, undoubtedly due to the fact that her story is one of the oldest and most well-preserved, and she was attributed to some of the most essential crops of that era.

But as it would happen to many myths over the centuries, the exact cultural contexts and intentions behind her original story have become either lost, or re-interpreted so many times that we can't even fully trust that Homer's version is "accurate", at least not without any way to retrieve those original oral stories that predated both him and other famous poets whose work we still study and analyze today.

But hey, that's just my own interpretation! One out of the thousands that have existed and the thousands that will undoubtedly go on to exist. I'm sure my own interpretation of it isn't perfect or foolproof, but I hope it offers up some fun food for thought!