Wondering about Weight Loss Drugs?

Are drugs like Ozempic and Wegovy a good option if you're trying to drop a few pounds quick? Well...

I’m interested in your thoughts on using miracle weight loss drugs like Ozempic or Wegovy to slim down so I can go faster and improve athletically. Thoughts?

-Ten Pounds from a PR in Pomona

Thanks for the question, Ten Pounds. At first glance, the recent trend of weight loss drugs seems like a pretty hot deal. Inject a little somethin’ into your gut, stop wanting to eat, loss weight! What could possibly go wrong?

Given the effect they have on blood sugar levels, these drugs were initially designed to help people with diabetes. I’m going to leave that aspect completely alone. That’s 100 percent between you and your medical professional.

But since these drugs suppress appetite, people have now started using them for weight loss. In a way, Ozempic, Wegovy, and the others are just injectable willpower. If you have obesity and you’re under medical supervision, I’ll keep my opinion minimal. In these situations, there’s plenty of science showing you’re up against something akin to an addiction—and your health situation could be so dire that the risks are worth it.

However, what if you’re relatively healthy and just want to lose a little weight to look or perform better? Are they a sound strategy?

Personally, I don’t think so.

Thanks for your two cents. Now, about those drugs…

There are a bunch of them. Ozempic and Wegovy are popular brand names for a drug called semaglutide. Saxenda is the brand name for the drug liraglutide. Mounjaro is the brand name for the drug tirezepatide. Semaglutide, liraglutide, and tirezepatide are part of a class of medications known as glucagon-like peptide-1 receptor agonists—GLP-1 RAs for short.

GLP-1 RAs are having a little moment in the sun. They’re like the Beanie Babies of 2023, except that they might cause cancer. (More on that later.) They’re all the rage on TikTok and folks like Elon Musk and Amy Schumer admit to using them. (Celebrities make all the best life choices!) And earlier this year, Weight Watchers bought Sequence, a company that sells GLP-1 RAs online.

Speaking of online, trying to learn more about GLP-1 RAs via the internet makes for a wild ride. On one side, you have liars like Nao*Medical claiming semaglutide increases athletic performance. (Sorry, I’m not giving these a-holes the benefit of a link. Google it.)

On the other side, you have hyperbolists like Dr. Peter Attia exaggerating that Ozempic or Wegovy are making people “lighter but fatter” and that two-thirds of the weight people lost in studies on these drugs was muscle mass.

Neither is true. Mind you, I’m more in the Attia camp—but I’ll try to state my case without making stuff up.

How GLP-1 RAs work.

GLP-1 is a hormone in your body that regulates appetite and blood sugar levels. GLP-1 RAs promote GLP-1 by stimulating receptors that grab these hormones and put them to work. Taking GLP-1 RAs helps your blood sugar stay steady. It also curbs your appetite. They were created to treat type 2 diabetes, but their appetite-suppressing qualities has made them popular for weight loss.

For what it’s worth, exercise has also been shown to stimulate GLP-1—and it doesn’t require needles.

Are you losing fat… or muscle?

Normally, in people with overweight or obesity, 20 percent to 30 percent of weight loss can come from lean mass. In other words, most of the weight they lose is fat, but one-fifth to one-third of it can come from muscle and other lean tissue. This is completely normal. If you lose weight slower, you’re less prone to break down muscle. Also, if you eat plenty of protein when losing weight, you’re also more likely to hold onto muscle.

Novo Nordisk, the manufacturer of Ozempic and Wegovy, sponsored a clinical trial featured in the New England Journal of Medicine in which subjects with obesity found 39 percent of weight loss coming from lean mass (muscle) when they used semaglutide.

I believe this is the study Peter Attia referred to—and got wrong—in the little rant linked to above. If you’re taking Pete’s word over mine, here’s a blog post backing my correct numbers up—written by Peter Attia.

Still, the concern that losing weight with GLP-1 RAs may eat up muscle mass is worth considering, as a 2021 meta-analysis of 18 different trials suggests.

Keep in mind that, to my knowledge, the people in this research largely have obesity. But the physiology of weight loss shifts when you have less weight to lose, so the muscle/fat ratio might be different. It’s hard to say. Still, muscle matters for athletes. If there’s a chance that the weight you lose decreases your strength, it’s all for naught.

The research shows that’s a risk.

What are the side effects of GLP-1 RAs?

Common side effects can include nausea, vomiting, and diarrhea. In a 2021 clinical trial of semaglutide for weight loss, over 44 percent of participants taking semaglutide (as opposed to a placebo) reported nausea. Over 31 percent reported diarrhea. Over 24 percent reported vomiting. Other, less reported “adverse events” included constipation, headache, and upper respiratory tract infections.

Then there’s the cancer thing.

While the drugs are approved by the FDA,  the government agency still issued a bonanza of warnings for semaglutide, liraglutide, and tirzepatide (including Wegovy, Ozempic, and Mounjaro) that point to risk of pancreatitis, acute kidney injury, suicidal behavior and ideation, and thyroid c-cell tumors—which can lead to thyroid cancer.

That last one is an FDA “boxed warning,” defined as “the highest safety-related warning that medications can have assigned by the Food and Drug Administration.”

Wegovy responded on their FAQ with this, “In studies with rodents, Wegovy and medicines that work like Wegovy caused thyroid tumors, including thyroid cancer. It is not known if Wegovy will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.”

Do you really want to be a cancer lab rat so that you can ride your bike 3mph faster up a hill?

What happens when you stop taking GLP-1 RAs?

When you stop taking GLP-1 RAs, the receptors stop being stimulated and your appetite returns. A 2022 study on semaglutide withdrawal showed that one year after discontinuing the drug, participants had gained, on average, two-thirds of their weight back. (This study was also funded by Novo Nordisk.)

Again, if you have a serious, immediate condition, GLP-1 RAs combined with exercise and nutritional support might be a good course of action. Otherwise, I just don’t see the point of spending hundreds of dollars a month—since your insurance probably won’t cover the injections—for risky solution that’s unlikely to pay off in the long run.

Willpower can be a dirty word these days. And there’s reasonable evidence that people with obesity are up against obstacles that transcend just toughening up.  But if you’re a committed athlete, if you spend hours training and suffering every week, I have bad news: you don’t lack willpower.

In these instances, GLP-1 RAs are just a potentially dangerous shortcut—and shortcuts rarely pay off in the wide, wide world of sports.