Updated: Nov 22
Over this past year, Ozempic injections gained vast popularity as a seemingly quick fix weight loss tool. Initially, Ozempic purpose was to help regulate blood sugar for people with diabetes. Weight loss happens to be a side effect of taking the drug therefore driving the drug's popularity amongst non-diabetics. In today’s market, there is an increase in off-label use, creating a high demand and causing a global shortage of Ozempic for diabetes users. People may think that Ozempic could be a quick fix to their weight loss goals, but it should not be a substitute for practicing healthy lifestyle habits such as exercise, activity, healthy food options, sleep and stress management, which in turn creates and helps sustain a healthy body composition over time. If people only use Ozempic for vanity, the potential risks can exceed the weight loss results. Ozempic has side effects that make daily life uncomfortable and difficult to maintain, even for people who struggle with diabetes. Ideally, Ozempic could be a short-term tool if needed and prescribed by a medical doctor while implementing specific lifestyle habit interventions. Nutrition and training can to help regulate blood sugar levels, lose excess body fat, retain autonomy over your health and most importantly, not rely on an expensive pharmaceutical drug to do the “work” for them. We deep dive what Ozempic is, the limitations, and how to prevent diabetes or blood sugar dysregulation through nutrition & training.
What is Ozempic?
Semaglutide is the active ingredient in Ozempic and is a subcutaneous injection given once per week. Ozempic is approved to treat patients with type 2 diabetes mellitus by lowering total blood sugar. The same pharmaceutical company that
produces Ozempic does have another semaglutide medication brand called Wegovy. This medication works the same as Ozempic and is approved for weight management for people who are chronically obese and have a specific body mass index (BMI). The main difference between the medications is that the dosing is higher in Wegovy compared to Ozempic and less frequent injections.
How does Semaglutide Work?
Semaglutide mimics a hormone called GLP-1. This hormone is released in the gastrointestinal tract as we digest food. The hormone signals insulin to be released to store the excess blood sugar from the food ingested. This hormone’s role also influences brain pathways to make someone feel satiety (fullness), consuming less food. In summary, semaglutide causes people to be less hungry and consume less food (creating a calorie deficit), leading to fat/weight loss.
Semaglutide for Diabetics
Semaglutide works for people with diabetes by promoting the re-uptake of excess blood glucose when they are insulin-resistant or have insufficient insulin. When a person with diabetes cannot regulate their sugars alone through diet and exercise, semaglutide can help reduce their blood sugar to healthy levels. Semaglutide for diabetes is injected once per week subcutaneously, starting at a dose of 0.25 mg and can increase to 2 mg once weekly over time.
Diabetes mellitus has different classifications: type 1 and type 2.
Type 1 diabetes: Results when a person’s immune system attacks the cells in their pancreas that produce insulin. One cannot produce adequate insulin to maintain healthy blood sugars. Type 1 diabetes is considered an autoimmune disease.
Type 2 diabetes: Results when you can produce insulin but cannot make enough or when your body is resistant to the insulin you have that can occur based on unhealthy lifestyle habits. Too much sugar in our blood consistently over time can damage our vasculature, tissues and organs.
Type 2 is preventable and reversible with proper adherence to healthy lifestyle habits. Insulin resistance can lead to:
Coronary artery disease/ atherosclerosis
Nephropathy (kidney damage)
Causes of Diabetes
Both controllable and uncontrollable factors can cause diabetes. Controllable lifestyle habits usually cause insulin resistance, which eventually causes acquired type 2 diabetes.
Three causes of insulin resistance are: 1. Lack of physical activity 2. Poor nutrition intake 3. Obesity.
Uncontrollable causes for diabetes can be caused by:
Autoimmune disease (Type 1 diabetes)
Hormonal imbalances (Ex. Pregnancy)
Thyroid disorders (Acromegaly and Cushing syndrome)
Pancreatic damage or removal
Causes of Obesity
Currently, overweight adults make up 39% of the worldwide population at a whopping 1.9 billion people, with obesity touching the lives of 650 million. Obesity has tripled worldwide since 1975, and although genetics has some contribution to obesity, it is not responsible for that rate of increase. Environmental factors around nutrition and lifestyle influence this increase. Directly linked controllable risk factors for obesity can consist of:
Consuming high amounts of calories dense, low-nutrition food
Consuming ultra-processed foods
Consuming food with high sugar content
Lack of physical activity
Coupling overconsumption of poor nutrition with a lack of physical activity results in more fat storage as the calorie consumption outweighs the breakdown of calories. Other factors contributing to obesity can consist of:
Hormone imbalance (Thyroid Dysfunction, Chronic High Cortisol Levels, Insulin Resistance)
Lethargic lifestyle and modern-day online life (screen and work-from-home culture)
To put it simply, obesity results when someone is taking in more energy (food) than they are burning, and they store the excess as fat. That said, many factors can be contributing and need consideration when assessing obesity. Obesity is a gateway to various comorbidities such as:
Type 2 diabetes
Respiratory illness (sleep apnea, asthma)
Musculoskeletal disorders (osteoarthritis)
Semaglutide for Obesity
Semaglutide for obesity affects someone's perception that they are fuller faster, resulting in them eating less from the effects of the GLP-1 hormone on specific brain pathways. Semaglutide for obesity is injected once per week subcutaneously, starting at 0.25mg and increased to a target dose of 2.4mg weekly.
One source of measuring obesity is someone's body mass index (BMI). Someone who is “obese” can be defined by a BMI of 30 or greater, and this is the prescribing point for Wegovy. However, measuring BMI is not accurate in assessing obesity alone. BMI measures the weight-to-height ratio, but the weight is not specific to fat. Excess weight could be from increased muscle mass or bone density. For example, a
bodybuilder may have a BMI greater than 30 but has excess muscle and low-fat percentage, still placing them high on the scale or weight can also account for a decrease in muscle mass and an increase in fat percentage (sarcopenia or muscle wasting). BMI cannot distinguish fatty tissue from the rest of someone's body weight. BMI could be an initial starting point, but an assessment and plan around obesity should consider other data before turning to medication:
Bloodwork (CRP markers, gut dysbiosis, hormonal imbalances, etc)
Side Effects and Risk Factors for Semaglutide
Side effects of semaglutide include:
Loss of muscle mass over time
Risk Thyroid C-cell tumours
Acute kidney injury
*Patient’s doctors should consult them on other diabetic medication use, as it should be reduced or stopped while on semaglutide.
*Higher doses of semaglutide will have a higher chance of side effects and risk factors.
The FDA has deemed semaglutide injections “safe,” but many side effects are undesirable. These side effects can affect one’s daily quality of life and be a daily challenge. Obesity can be preventable with proper lifestyle modifications, and a more enjoyable life is possible without the stress of these side effects.
Semaglutide is Not Suitable for Long-term Weight Loss
Batterham et al. (2022) studied Wegovy treatment by giving 2.4 mg subcutaneous injection for 68 weeks to 327 participants. During the first 68 weeks, participants had an average weight loss of 17%. After 68 weeks, the treatment stopped, and a year later, at week 120, most participants regained two-thirds of the weight they lost. The study said that lifestyle counselling was provided during the first 68 weeks and then stopped. However, the specific lifestyle factors are not specified. The limitations say that there was no assessment of the participant's exercise, training, nutrition, sleep cycles, or other stressors in their day-to-day life during the 68 weeks of the semaglutide injections or the year after. People who are not obese using Ozempic off-label or Wegovy for weight loss will not be able to sustain their results when they cease using the medication without lifestyle modifications. People who are free from disease can learn how to use nutrition and exercise to aid in a healthy and maintainable outcome regarding body composition, and those with diabetes can use ozempic as a tool combined with lifestyle modifications (nutrition and exercise) to help achieve blood sugar regulation, and eventually be able to depend on lifestyle alone to manage the disease.
Diabetes and Obesity are Modifiable Risk Factors for Heart Disease
Risk factors for acquiring disease can be non-modifiable or modifiable. Non-modifiable risk factors can’t change, whereas modifiable risk factors can. Non-modifiable risk factors consist of:
Heart disease is a risk that comes from both diabetes and obesity, and both diabetes and obesity are two of the eight modifiable risk factors for heart disease. Diabetes and obesity have common controllable risk factors surrounding nutrition and physical activity.
*How to Regulate Your Blood Sugar Naturally with Nutrition
Nutrition is the key to regulating blood sugars and promoting fat loss, as our bodies are made up of what we consume and by how much. Many foods can help positively affect blood sugar regulation, hormonal balance, and overall quality of life.
1. Protein Consumption
Satiation and reduced cravings: Having adequate protein or increasing your protein consumption makes you feel full faster, reducing the amount of calories you eat. Protein reduces your hunger hormone ghrelin and boosts the peptide YY, which makes you feel full.
Protein consumption can boost metabolism and increase fat burning: Our bodies need energy to digest food, and the measured energy for this is called the thermic effect of food. Protein requires much more energy than carbs and fats when digested, so eating more protein results in more calories burned.
Increasing protein during a calorie deficit: A high-protein diet can have sufficient fat loss when in a calorie deficit compared to a low to moderate-protein diet in a calorie deficit.
2. Fibre Consumption
Our body cannot break down fibre (fruits and veggies), so our blood sugar does not increase when digesting fibre.
Fibre prevents the absorption of some triglycerides and cholesterol, which can reduce the amount of fat circulating in our body and deposited in our tissues.
Fibre also makes you feel full faster as we cannot digest it, and it moves through our system slowly.
Fibre has low calories.
3. Low Glycemic Index Carbohydrate Consumption
The glycemic index (GI) measures how fast and how much glucose is released from food when being digested. Low GI food releases low amounts of glucose slowly, whereas high GI foods release much glucose quickly, causing blood sugar to spike. Low GI foods can help regulate a diabetic’s blood sugar by keeping blood sugar consistent. Low GI foods can also help with weight loss as less excess glucose results in less fat storage.
Low glycemic index foods consist of:
Fruits (berries, pears, cherries, peaches, apples)
Tofu and soy product
Naked Versus Clothed Carbohydrates
High GI carbohydrates are usually simle, consisting of one to two sugar molecules, and low GI carbohydrates are typically complex, composed of three or more sugar molecules. When we consume simple carbohydrates alone, they are called “naked.”
Since they digest so fast, blood sugar spikes, but when we pair naked carbohydrates with a complex carbohydrate and fat or protein, they are “dressed up” or “clothed.” Complex carbohydrates, fats and protein take more energy to break down than simple carbs, so it slows down the digestion process, therefore resulting in less drastic spikes of glucose.
Exercises for Blood Sugar Regulation and Fat Loss
Exercise can help manage blood sugar because when you are physically active, you use your muscles, which utilize stored glycogen (derived from glucose) from the muscles and liver, circulating them into the blood for fuel. When people have insulin resistance, their bodies have trouble getting glucose from circulating blood into their cells. Movement and exercise allow our cells to ‘open up the gates’ and let glucose enter our cells from the bloodstream and utilize it for fuel. Movement after meals (walking, doing chores, etc.) can also assist in regulating blood sugar from blood into cells. As glucose moves into our cells, it leaves our blood and lowers blood sugar.
Benefits of Cardio Training for Diabetics
Cardio workouts are a physical activity that increases heart rate and respiration through large muscle group coordination and rhythm. More oxygen is available for energy utilization in our bodies when the heart beats faster than at rest, pumping more blood to the lungs and increasing oxygen. These workouts are great for cardiovascular disease prevention as your heart pumps and moves your blood faster through your vasculature, becoming less stagnant and flowing more smoothly. Cardio is also great for glucose re-uptake, as the muscles we use during these workouts require energy, and we use our available glucose for this. Cardio workouts can vary from steady-state, low-intensity cardio to high-intensity interval training (HIIT) cardio.
1. Steady State Cardio
Aerobic- relies primarily on oxygen from the lungs to fuel the workout.
Workouts maintaining a consistent heart rate over a long period can be low-impact (walking) or high-impact (running).
Fat breaks down during steady-state cardio.
Examples: running, swimming, skipping, walking.
2. HIIT Cardio
Anaerobic- does not rely primarily on oxygen to fuel a workout, fueled mostly by stored carbohydrates.
Workout alternates between high-intensity workouts (and high heart rate) and short rest periods.
A short rest period allows you to recover quickly and then return to an intense workout.
Examples: sprints, sled push/pulls, bodyweight workouts - timed performing at high intensity with short breaks between intervals.
3. Strength Training
The main difference between strength training and cardio is that our muscles need much more glucose when challenged with resistance. Our muscles require more energy compared to cardio. During strength training, we usually deplete stored glucose in our muscles and use circulating blood glucose. Since our muscle storage is empty after we work out, the stores fill up again when we eat. The glucose we intake from our meal is quickly drawn back into the muscle cells for storage, increasing our insulin sensitivity and decreasing our blood sugar level.
Benefits of Strength Training for Fat Loss
For fat loss, cardio exercises may burn more calories during the activity, but we challenge our muscles with resistance during strength training. Muscles then break down and need rebuilding, which requires glucose and calories. Also, roughly 48 hours after weight training, our bodies require more calories, creating a thermogenic response (our bodies burn overall more calories to build muscle). To lose body fat, one must be in a calorie deficit, with more energy expended than consumed. Strength training is the root of increasing muscle mass, which increases thermogenesis (the ability to burn calories and create energy) and allows us to utilize and burn excess fat as energy, resulting in fat loss. Practicing strength training throughout a calorie deficit will help the fat-burning process further. Post-workout muscles will need to heal and re-fuel, and they take more circulating glucose from the blood to replenish their energy storage, which also decreases any excess glucose from being stored as fat. How to Prevent Insulin Resistance and Illness
In summary, Obesity affects many lives today and is still a leading cause of chronic illnesses like diabetes. But as discussed, tools and lifestyle modifications can help aid in sustainable health and prevent insulin resistance, obesity and disease. These can be summarized by:
Decreasing the intake of ultra-processed foods
Reducing intake of food with low nutritional value and high sugar content
Increasing the intake of low-GI carbohydrates, protein, and fibre
Clothing consumption of simple carbohydrates with complex carbs, protein or fat
Practice intentional exercises like strength training, especially during a calorie deficit when fat loss is a goal
Practice cardiovascular exercise to increase heart health and further disease prevention
People with diabetes may need additional help from medication like ozempic to help regulate blood sugar and can benefit significantly from pairing ozempic with these lifestyle modifications. Ozempic can help get these people to a healthier position with diabetes, but with these tools listed and practiced, when they do get to a more beneficial point of disease management, they can maintain their disease without using Ozempic, and this should be the goal. Semaglutide is intended for people with chronic diseases and should be reserved for this. With proper education and personal accountability, body composition and disease management can be accomplished alone without medication. Written By: Lauren O'Malley, RN Edited By: Bree Lowry, BKin
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*This blog provides general information and discussions about health and related subjects. The information and other content provided in this blog, website or any linked materials are not intended and should not be considered or used as a substitute for medical advice, diagnosis or treatment.*