The semaglutide story starts in 2017. That’s when the U.S. Food and Drug Administration (FDA) approved this synthetic hormone-like drug—sold as Ozempic—to treat people with type 2 diabetes.

Four years later, in 2021, the FDA approved a more concentrated form of semaglutide—this one called Wegovy—to treat obesity. To meet the qualification for a Wegovy prescription, you either have to be obese with a body mass index (BMI) of 30 or above, or be overweight with a BMI of 27 or above and have at least one weight-related clinical condition. This may be high blood pressure, high cholesterol, or type 2 diabetes, among others.

In the years that Ozempic and Wegovy have been on the market as prescription drugs—and both remain prescription-only—they’ve helped a lot of people. In many cases, type 2 diabetes and weight loss results have been dramatic.

But as so often happens with blockbuster drugs that get big buzz and startling early results, there are also significant drawbacks to consider. Semaglutide comes with potentially serious side effects and an increase in eating disorder risk.

Clearing up a misconception

Amid the media hype about semaglutide, many reports breathlessly and conspiratorially assert that “people are taking a type 2 diabetes drug for weight loss in a dangerous, off-label manner!”

That’s simply not true in the case of the Wegovy form of semaglutide. Remember, the FDA approved Wegovy in 2021 specifically for weight loss, so it’s a weight-loss medication, not a type 2 diabetes medication.

Ozempic, on the other hand, is the less-concentrated form of semaglutide approved in 2017 for type 2 diabetes. When people take Ozempic for weight loss, that is considered off-label, and therefore more controversial.

How semaglutide works—and some notable successes

On the diabetes side of things, Ozempic/semaglutide mimics a naturally occurring hormone called glucagon-like peptide-1, or GLP-1. In so doing, it increases the production of insulin, which helps control blood sugar. This is vital for people with diabetes.

Regarding weight loss, Wegovy/semaglutide’s GLP-1 mimicry helps slow down stomach digestion. This makes you feel fuller faster and for longer. The drug also targets brain receptors that reduce appetite.

When taking Wegovy, many patients have been able to lose up to 20 percent of their body weight. That’s a lot more than usually occurs with standard anti-obesity drugs. Many weight-loss researchers see Wegovy’s effectiveness as a significant scientific breakthrough.

Risks and side effects of semaglutide

Possible side effects of the drug include fatigue, malaise, nausea, diarrhea, and severe constipation. In rare cases, semaglutide can cause pancreatitis and gallstones. To sidestep these risks, doctors normally have their patients start on lower doses, and gradually increase the amount.

The bigger, more widespread health risk is when people take Ozempic or Wegovy who don’t have a medical need for it. Many are just trying to drop pounds to reach their so-called “ideal” weight. People are often able to get the drug online from telehealth startups that are marketing and distributing the drug with little medical oversite and who are simply in it for profit. That’s a dangerous environment.

In some cases, celebrities and other influencers are touting the drug as a miracle weight loss drug—the proverbial magic bullet. That’s not how weight-loss works, and, again, it’s dangerous thinking.

Final thoughts and recommendations

The awareness and allure of Ozempic and Wegovy have made their way into the addiction treatment center where I work. We sometimes see patients (usually women, but men as well) who have stopped using drugs or alcohol, and who occasionally gain weight. Many are now asking for these new medications, but we don’t allow that.

The key, for me, is that semaglutide in both forms must only be prescribed and taken for actual health reasons, not merely to lose weight, especially if you’re not obese or overweight. There must be a true medical need, not merely a cosmetic one.

We in the medical community need to be on the same page about risks and proper use so semaglutide in all forms is used safely. This drug should only ever be part of an overall diabetes-control plan or weight-loss plan that includes proper nutrition, regular exercise, adequate sleep, stress-lowering practices, and all other lifestyle considerations.

Also—and this is vital—before anyone receives a prescription for semaglutide, they should be screened for eating disorder risk. It’s a bad situation if someone thinks this drug is their ticket to some ideal weight that in the end may be unattainable or unsustainable. That could put them on an unhealthy roller coaster for years.