Is She on Ozempic?

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Rhea Schmidt felt a small sting in the left side of her abdomen where an eight-millimetre needle punctured her skin. 

Just a few months ago, these injections caused Schmidt anxiety, and she wondered if she was making the right decision.

Now, roughly 30 lbs lighter, this is Schmidt’s new normal. Every Monday, at 9:30 a.m., she injects her weekly dose of Ozempic. 

Starting Ozempic to lose weight wasn’t a decision Schmidt took lightly. She spent hours scrolling through Facebook and TikTok consuming “success” stories from people who lost a significant amount of weight. She also saw many horror stories about the drug causing severe side effects.

Headlines about Ozempic started popping up in 2021 after Dr. Robert Kushner, an obesity researcher from Northwestern University, spoke out about the drug on The Dr. Oz Show, describing it as a “gamechanger” for people with obesity. TikTok users started posting their weight loss results under #ozempic, and support groups formed on Facebook. Through social media, people learned about the drug from users who documented their experiences, both good and bad.

The rapid increase in popularity invited scrutiny, causing a stigma to develop around using Ozempic for weight loss instead of simply “putting in the work” and losing weight through a change in eating habits and physical activity alone.

After years of unsuccessful lifestyle changes, Schmidt decided Ozempic would be worth a shot.

‘The scale has never moved fast for me’

Schmidt, 32, has been over weight since she was a teenager. Between raising her three-year-old daughter and running her home business, Rheadiant Beauty, Schmidt said it’s difficult to find time to prioritize herself.

“Even when I do exercise and try to eat nutritious food, I don’t see the results that I am looking for,” said Schmidt. “The scale has never moved fast for me.”

Schmidt said her first step in losing weight was her breast reduction. Last May, she went to her doctor to discuss a nagging pain in her neck and shoulder area.

After explaining her symptoms, Schmidt’s doctor said she would be a candidate for a breast reduction.

“I really felt like I needed to do it,” said Schmidt. “My doctor was super supportive and got me in to see someone within six months.”

“It was the best decision of my life,” she said.

After the procedure, Schmidt said roughly 11 lbs were removed from her breasts. Although the recovery was painful and she was bedridden for over two weeks, now that she is fully healed, she feels more comfortable in her everyday life, especially while working as a beauty technician where she spends hours at a time sitting in a bent position.

A few months into recovery, she went back to her doctor to discuss possible next steps.

She told him she had seen a lot of success from people who have tried GLP-1 agonists to lose weight and said she wanted to be healthy for her daughter.

In 2010, Health Canada approved the first GLP-1 agonist, Victoza, for the treatment of Type 2 diabetes. Now, GLP-1 agonists are commonly associated with weight loss.

GLP-1 (Glucagon-like peptides) agonists help manage glucose levels (blood sugar) in people with Type 2 diabetes. The small intestine naturally produces GLP-1, which triggers the pancreas to release insulin, according to an article published by Harvard Health Publishing.

Insulin is an essential and natural hormone that moves glucose from the blood into cells, allowing the body to use it for energy. If the glucose is not moved into the cells, it builds up in the blood, leading to high blood sugar.

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With Type 2 diabetes, the pancreas either doesn’t produce enough insulin or the insulin isn’t being used properly. An article by Cleveland Clinic Journal of Medicine said GLP-1 agonists are not approved for people with Type 1 diabetes, but it’s in the testing phase, and some doctors prescribe it off-label, which means prescribing a drug for a different purpose than what it’s approved for. 

GLP-1 also slows the rate that food digests, meaning the food releases less sugar into the bloodstream making a person feel full for longer periods.

This combination of increased insulin and slowed digestion causes the drug to lower a person’s blood sugar.

In 2021, Health Canada approved Wegovy, another GLP-1 drug, specifically for weight loss. Novo Nordisk — a global pharmaceutical company — makes both Wegovy and Ozempic.

The only difference between the two drugs is the dosage and how they are marketed, said Jennifer Lake, Assistant Professor at Leslie Dan Faculty of Pharmacy.

“It’s actually very odd that one company would make a drug and market it two different ways,” said Lake. “It doesn’t happen very often.”

“One of the drugs you see is ibuprofen, which is the class of drug, and they have a bunch of different drugs under it, such as Advil or Motrin,” said Lake.

She explained the reason for this is usually to encourage buyers to use one brand over another, except this isn’t the case because Ozempic and Wegovy come from the same parent company.

It doesn’t matter whether you are on Ozempic or Wegovy, both medications have the exact same effects and side effects, said Lake. 

Lake said the only differences are Ozempic is marketed toward people with Type 2 diabetes, while Wegovy is marketed for people with obesity. She noted that Wegovy goes up to a higher dose than Ozempic and has more flexibility in dose size.

She said some people have the misconception that Wegovy comes with more severe side effects, but in reality Wegovy just comes in higher doses, which increases the chance of risky side effects.

Schmidt considered taking Wegovy before her doctor prescribed her Ozempic. She said it didn’t make a difference to her which one she ended up going on.

Schmidt’s father has been on Ozempic for just over two years. She said he also struggled with his weight for a long time and started to experience health complications because of it. In 2019, he had a heart attack, and his cardiologist suggested he try Ozempic to see if it would help with his weight.

“It worked very well for him,” said Schmidt. “He looks great, and he feels great.”

Schmidt said her dad has lost roughly 70 pounds since he started the medication, and to her knowledge, he has only experienced minor side effects.

On average, people lose 15 per cent of their body weight on GLP-1 agonists, said Lake. She adds that some people have lost up to 25 per cent. 

While Lake doesn’t do obesity research specifically, she said obesity researchers are starting to compare taking Ozempic to bariatric surgery.

Bariatric surgery, also known as gastric bypass surgery, can reduce the amount of food a person needs to eat in order to feel full or reduce the absorption of calories from the food a person eats and in some cases both, depending on the type of bariatric surgery, according to Obesity Canada.

The most common type is Roux-en-Y gastric bypass surgery, which reduces the size of the upper stomach to a pouch similar to the size of a walnut by cutting and sealing off the top of the stomach. The pouch can only hold about an ounce of food compared to the typical three pints. 

The surgeon will then attach the pouch to a part of the small intestine. This causes the food to bypass the rest of the stomach and upper part of the small intestine, reducing the amount of calories and fat absorbed, according to Mayo Clinic’s website.

The first dose

On Monday, Sept. 16 of 2024, Schmidt injected her first dose of Ozempic.

At this time, Schmidt said she was the heaviest she had ever been at 327 lbs. Her doctor suggested she start at a very low dose to see how her body responded to the new medication. He started her doses at 0.25 milligrams.

“I just thought to myself, if it’s meant to be for me, it will be okay.”

Schmidt braced herself for the bad side effects she saw on the internet but was pleasantly surprised when all she had after her first dose was a mild headache.

Ozempic affects every individual differently, but some common side effects are nausea, vomiting, constipation, diarrhea, and stomach pain, according to WebMD’s website. Since the medication triggers the pancreas to produce insulin, in very rare cases, users can develop pancreatitis, which is when the pancreas becomes inflamed.  

Schmidt said she noticed a difference in her eating habits almost immediately. 

“I wasn’t thinking about food. Normally I would be like, ‘What are we going to eat?’ or ‘What should we get for dinner?’” Schmidt said. “Food was always on my mind.”

She called this “food noise,” and explained it is something that people who are overweight often experience.

“After just my first dose, it just wasn’t there as much.”

10 pounds down

Schmidt grabs two slices of pizza out of the Pizza Hotline box on her coffee table before settling into the couch.

She slowly makes her way through the first piece of pepperoni pizza. When she starts on the second piece she already feels full. She leaves half of the slice uneaten on her plate.

Schmidt looks at Connor and tells him she can’t eat anymore. She knows if she does, she will feel sick.

“I just don’t feel as hungry, and I feel hungry less often,” she said.

Before taking Ozempic, Schmidt said when she would order pizza, she would eat around four to five slices. 

“It feels really weird,” said Schmidt. “I feel as full as I do when I am overeating, but I am eating way less.”

Schmidt said she also noticed a difference in the foods she wanted to eat. She now finds certain foods make her feel sick.

“I ordered quesadillas, and they came with a side of fries, and I only had a few, but it made me feel sick,” said Schmidt, adding she doesn’t view this as a bad thing.

“It’s good, because they really aren’t good for you anyways.” 

She said that along with losing cravings for certain foods, she has developed new cravings for other foods such as salads.

While Schmidt still hadn’t experienced any major side effects, she pointed out one that surprised her.

Schmidt has had psoriasis — an autoimmune disease that causes patches of skin to become inflamed and itchy — around her neck and ears for most of her adult life. Since starting Ozempic, she said the spots were less itchy and less visible.

“It’s really weird, I know,” she said. “Usually you scratch it and flakes reappear, but they are like totally gone.”

While she didn’t know if this was directly related to the medication, she found it interesting and “pretty nice.”

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The link between psoriasis and obesity isn’t clear but what experts do know is that people who are overweight or obese are more likely to experience psoriasis, according to WebMD. This is because psoriasis is an inflammatory disease, and the extra fat cells release inflammatory chemicals that could potentially play a role in worsening psoriasis symptoms.

Studies show that semaglutide therapy has shown promising result in reducing psoriasis in patients with Type 2 diabetes, according to Endocrinology, diabetes & metabolism case reports.

Schmidt said the medication can be expensive. It costs her about $500 per month, and her insurance covers half of it. 

She said her doctor is looking into getting full coverage, but for now she has to pay to keep the doses coming. 

“It’s actually not that bad,” said Schmidt. “It seems expensive, but I am eating way less than I was before.”

Schmidt said she spends less money on groceries and doesn’t order in or eat out as much as she used to. Since she changed her eating habits, her husband Connor has unintentionally changed his too.

Increasing the dose

A little over two months in, Schmidt decided to try increasing her dose from 0.25 milligrams to 0.5 milligrams.

She said her side effects were worse than when she started the injections. She was nauseous and threw up multiple times, but the symptoms didn’t last long.

When Schmidt needs advice or has Ozempic-related questions, she goes to the Facebook support group she joined when she first started thinking about starting Ozempic. She said part of the reason she decided to start was because of all the people who posted in the group.

Schmidt said there’s a stigma around taking GLP-1 drugs to lose weight, but seeing these people’s successes helped her make the decision to try Ozempic.

Schmidt has debated making a post about her Ozempic use. She said she is worried that if she does make a post when she loses a significant amount of weight people will make statements like, “you didn’t do the work” or “your just taking an injection.”

“If it’s helping me, I don’t think it should be a bad thing.”0

She said a lot of people struggle with obesity, and if there can be something that helps people lose weight without having to get surgery, people should accept it.

“I like to encourage people not to be embarrassed,” said Hartley Macklin, who started the private Facebook group titled Ozempic and Wegovy (semaglutide) Canada support group that Schmidt is a part of.

Macklin started taking Saxenda (a daily injection GLP-1 agonist) in 2016. Macklin said the drug was originally for Type 2 diabetes before it was released with double the dose for weight loss. 

Macklin said when Health Canada approved Ozempic for Type 2 diabetes in 2018, it was also being tested on people with obesity. He qualified for testing and got prescribed Ozempic.

“It worked better than Saxenda,” said Macklin. “And it was weekly injections instead of daily.”

He said that while Saxenda worked well, Ozempic killed his appetite immediately. 

“Appetite is not the same as hunger. We all feel hungry … but appetite is something else.”

Macklin started the support group because when he began Ozempic, it wasn’t very popular, and he wanted to share what GLP-1 drugs could do for people with obesity. He also said he knows that when people are obese, they are often blamed for “lack of willpower” or inability to eat well, and he knows that a lot of the time that’s not the case.

Macklin said he was a very skinny kid but started to gain weight in his late twenties.

“In my early twenties I was six feet tall and 160 pounds, and at one point I topped out at over 300 pounds.”

The group now has more than 300,000 members and counting. Macklin said he wishes there was something like this 20 years ago.

Lake said as a pharmacist who works mostly with family doctors, she hasn’t seen much of a stigma around people taking Ozempic for obesity, but more so around people who are a normal weight coming into doctors’ offices and asking for Ozempic.

“It turns into more of a cultural conversation, and where is this coming from?” said Lake. 

She said we live in a society that values skinny people, and that the world is very “fatphobic.”

Lake said she worries about people who might have eating disorders or people whose mental health is tied to their weight. She said it’s important to understand why someone wants to go on Ozempic. 

“I will ask patients, ‘Why do you want to lose weight?’ and ‘What’s the reason for it?’” 

She said from there she tries to talk to them and understand what the patient really needs.

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In January, Schmidt increased her dose again to one milligram — the highest she said she would ever go — but after two weeks she went back to 0.5 milligrams.  She spent days with a headache and three days in bed with a stomach ache and nausea.

“The most difficult part about this whole process so far is managing the symptoms when you increase the dose,” said Schmidt, adding she plans to try increasing her dose to one milligram again at some point, but she would take a more gradual approach. 

Schmidt said she now feels more comfortable and confident talking about her Ozempic use with her friends, family, and clients. She said some clients are surprised and ask about the side effects.

“I have received so much support from my family,” she said, noting the odd person may have something negative to say.

Schmidt said the more weight she loses, the better she feels. She acknowledged that while Ozempic or other GLP-1 agonists might not be the best option for everyone, she would encourage anyone living with obesity and looking to make lifestyle changes to give it a try if they have the means to do so.

“I would choose to go on Ozempic again and again.”