The Problem With Semaglutides

Various drugs have long been used to help manage diabetes, including the commonly prescribed Metformin. In 2017, the U.S. Food and Drug Administration approved a semaglutide drug — part of a class of medications known as glucagon-like peptide 1 receptor agonists — with the brand name Ozempic for the treatment of type 2 diabetes.

Since then, semaglutide has also been approved for weight management under the brand name Wegovy. These injectable medications lower blood-sugar levels, increase feelings of fullness, and delay the emptying of the stomach after eating.

“The major reason these drugs work is that they cause you to lose your appetite,” explains nephrologist Jason Fung, MD. “But if you don’t pair that with proper dietary habits, then it’s just a temporary fix because as soon as you stop taking the drug, all the changes reverse.”

“The major reason these drugs work is that they cause you to lose your appetite,” explains nephrologist Jason Fung, MD. “But if you don’t pair that with proper dietary habits, then it’s just a temporary fix because as soon as you stop taking the drug, all the changes reverse.”

A 2023 analysis of pharmacy claims found that two-thirds of people who were prescribed weight-loss drugs like Wegovy stopped taking them within one year. Cost may be a factor, especially for people paying out of pocket. Side effects are another. These can include nausea, vomiting, diarrhea, and, more rarely, stomach paralysis, bowel obstruction, and pancreatitis.

Fung notes that curbing your appetite may be a blessing in the short term, but it loses its appeal. “These drugs take away hunger, but they also take away the pleasure of eating. If you take that away for six months, people are happy because they’re losing weight and getting healthier. But take that enjoyment away for two, three years, and it leads to poor compliance. And when you stop taking it, the problems multiply.”

“The biggest concern with these medications is that we’re seeing too much loss of lean muscle mass,” explains functional-medicine physician Elizabeth Boham, MD, MS, RD. “Whenever you lose lean muscle mass, your metabolism decreases.” Studies show that lost muscle mass also contributes to frailty in older adults.

Furthermore, the weight people regain after stopping the medication generally comes back as fat instead of muscle.

A personalized risk–benefit analysis may come out in favor of semaglutide for some people facing certain or extreme health challenges. “If it helps someone not have gastric bypass surgery, there may be a net benefit,” Boham says. Regardless, anyone who opts to take semaglutide will benefit from working with a personal trainer to minimize loss of lean muscle mass.