Stephanie, a Hong Kong healthcare worker, has fought for years to lower her weight. In the past 10 months, she has lost 25.4 kilograms (56 pounds).
“I’ve tried every diet under the sun,” the 38-year-old, who does not want to use her full name, says. Nothing worked for her, or nothing worked for long – until now. So what is behind her staggering weight loss?
Stephanie has been using Ozempic, a weekly injection that is taking the world by storm.
Ozempic, the brand name for a drug called semaglutide, is also marketed and sold under the name Wegovy. For more than 15 years, semaglutide has been used primarily for the treatment of Type 2 diabetes.
Nutritionist Diane Tran, from Hong Kong’s Central Health clinic, says the drug mimics a hormone, glucagon-like peptide-1 (GLP-1), which occurs naturally in the body. GLP-1 works in several ways to regulate blood sugar, including by slowing the rise of blood glucose levels after eating.
It also slows down the digestive process by reducing the rate at which food is emptied from the stomach, making you feel fuller for longer. These effects usually result in weight loss.
A typical anecdote from people on semaglutide describes how they ordered a favourite dish at a restaurant – and found they could not finish it.
Anna, a teacher in Hong Kong in her mid-40s who chose not to use her full name, has been on Ozempic for seven months.
“I was obese,” she says. “My insulin and blood sugar levels were terrible. At my heaviest I weighed 119kg.” Since starting Ozempic, she has dropped to 102kg – a “huge feat”.
Her family, she says, have always eaten healthily, rarely indulge in junk food and are active. At one stage, Anna was working out four times a week – “and still the weight didn’t come off”.
Her doctor realised this was because of her thyroid and insulin resistance, which is why she was prescribed Ozempic.
“Often, weight and Type 2 diabetes go hand in hand, so the healthier [the person] and lower the weight, the higher the chance of getting better,” says Anna.
Dr Susan Jamieson, who has almost three decades of medical experience in Hong Kong, says it is well known that people who have a lower BMI – body mass index – have a lower risk of many killer diseases, including heart disease, diabetes, Alzheimer’s and most cancers.
Tran agrees. “Even a modest weight loss of five to 10 per cent of your total body weight is likely to produce health benefits,” she says.
Semaglutide as a prescription absolutely has a place in a world where obesity is a significant health problem. As Tran acknowledges: “If prescribed by a doctor and used under proper medical supervision for the right reasons, in the right person it can be very helpful for those who have really tried but still struggle to lose weight.”
But it is really important that it is a doctor who prescribes this drug. In Hong Kong, these drugs can only be prescribed by a medical doctor – as there are many reasons a person may battle with weight, including undiagnosed health conditions.
Jamieson says it is not going to work in every case of excess weight, which is why a full family and medical history is vital before prescribing it.
There is no question it is effective – in a study conducted by the US Food and Drug Administration (FDA), people who took the drug for 16 months lost an average of 12 per cent of their body weight compared with those who received a placebo. But some doctors remain cautious.
There is an FDA warning about the development of thyroid tumours in rodent studies, and it can be unsafe in patients who have – or have had – pancreatitis or certain types of thyroid cancer.
Some worry it will do little to instil healthy eating habits, and that it will just have a “Band-Aid” effect without addressing the cause of the problem.
Many worry that once you are on it, you may need to be on it for good and nobody knows the long-term effects of being on the drug. The longest trial, Tran notes, was 104 weeks.
One study found that, a year after withdrawing from the drug, patients were inclined to gain back an average of two-thirds of the weight they had shed.
Tran says there is also the worry that, given the attention Ozempic and other drugs have garnered, people who “don’t fit the criteria for which the drug is approved” may seek to use it.
Celebrity endorsements from the likes of Elon Musk – who revealed the “secret” of his weight loss to his 116 million Twitter followers was Wegovy – might raise a drug’s profile but risk diminishing its real and important purpose.
That kind of spotlight has driven the market and has, Trans said, “led to an international shortage, especially for diabetic patients who really do need it”.
Since semaglutide went on the market in 2021 for weight loss, it has been in short supply. It costs about US$1,300 a month for the 2.4mg weight-loss dose, which is higher than the 1mg or 2mg doses used to treat diabetes.
Anna cautions that while Ozempic is making a difference to her, it is not a “wonder drug where the weight automatically falls off you. You still have to watch what you eat and exercise regularly”.
Tran says this is the right approach: studies show that semaglutide works best when combined with a healthy diet and exercise. For those who continue to overeat or who make unhealthy food choices, the impact on weight loss may be minimal.
Neither Anna nor Stephanie have suffered serious side effects. Stephanie had an on-off headache for a couple of weeks but says that was probably because she was eating less.
Anna says she has been spared because she eats little junk food, which often causes a spike in insulin levels which can leave a person feeling ill.
Semaglutide is not a wonder drug where the weight automatically falls off you. You still have to watch what you eat and exercise regularly. Photo: Shutterstock
Semaglutide is not a wonder drug where the weight automatically falls off you. You still have to watch what you eat and exercise regularly. Photo: Shutterstock
Clinical studies found that seven per cent of patients treated stop taking the drug because of adverse reactions, nausea being the most common, possibly caused by the slowing down of the emptying of the stomach.
Usually though, side effects are short-lived. Eating slowly, says Trans, having smaller meals and avoiding fried, fatty foods and those high in sugar can help.
Anna would like to lose another 10kg to 15kg. “I don’t want to be stupidly skinny,” she says. “Just to look healthy, that will make me happy – and help with my thyroid and borderline sugar/insulin issues.”
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It does not work for everyone, says Stephanie. She cautions: “You can’t start the injections and eat loads of bad foods, you need to work on your diet, drink plenty [of water], avoid snacking.”
Anna warns potential users not to get caught up in the hype. “Do your research and make sure you’re doing it for your health and not for any other reason.”
Diane Tran’s five tips for managing your weight naturally
If semaglutide is not suitable for you, lifestyle and nutrition interventions can contribute to achieving weight-loss goals.
1. Get enough protein and fibre. This slows down the passage of food through the stomach, helping to make you feel full for longer. Lean protein sources include plant-based proteins such as legumes – among them lentils, beans and chickpeas. Fibre-rich foods include vegetables, fruit, whole grains and legumes.
Aim to eat five 80g portions of vegetables a day; one portion equates to roughly a handful.
2. Cut down on refined carbohydrates. Switch from white pasta, rice, bread and flour products to wholemeal or wholegrain versions and consider using quinoa and buckwheat instead. These have a higher fibre content and can help slow the rise in blood sugar levels after a meal.
3. Aim to eat lower glycaemic index (GI) foods. The glycaemic index ranks foods on a scale of 0 to 100 depending on how much they raise blood sugar levels after eating.
4. Intermittent fasting may help with weight loss. Check with your doctor first, as intermittent fasting – time-restricted eating or narrowing the window in which you eat – is not for everyone.
5. Work with a supportive professional to support sustainable behaviours. Studies show that continuing interaction with healthcare providers improves weight maintenance and long-term outcomes. (South China Morning Post)
