It’s being hailed as the biggest breakthrough since statins – at least that’s how some experts are heralding the latest finding about the weight-loss ‘wonder drug’ Ozempic.
Administered as a once a week do-it-yourself injection – much favoured by celebrities including Oprah Winfrey and pop star Boy George – Ozempic has already earned a formidable reputation as a treatment for obesity, thanks to its key ingredient, semaglutide.
This is the drug in both Ozempic (which is licensed for use in type 2 diabetes in the UK) and Wegovy (usually a slightly higher dose but licensed here only for weight loss).
It works by mimicking the effects of a hormone called glucagon-like peptide-1 (GLP-1), which is released by the gut after we eat, to send a message to the brain that we are full.
Television sensation Oprah Winfrey has trimmed down in recent years thanks to Ozempic
Semaglutide activates GLP-1 receptors in the brain which register fullness in the stomach after minimal amounts of food. As a result, people feel full after even small amounts of food.
And since losing weight is one of the most effective ways of warding off heart attacks and strokes, the health benefits were already obvious.
But what’s really caught the attention and made headlines worldwide today is new evidence that the drug dramatically reduces the chances of heart disease – by 20 per cent – even if patients don’t necessarily lose weight while on it.
It suggests that Ozempic and other drugs in the same class may have a direct and positive effect on the heart – separate from weight loss – which on the face of it could elevate it to super drug status.
Add to that the emerging evidence that the same drugs might also be effective against other killer conditions such as cancer, Alzheimer’s, Parkinson’s disease and even multiple sclerosis (MS), and it begs the question – will we all end up on them eventually?
Sir John Bell, former Regius Professor of Medicine at Oxford University, told BBC Radio Four’s World at One: ‘ This is the beginning of the evolution of these drugs where they will become like statins, where lots of people take them and may stay on them for a long time.’
It’s a major moment in medical science – but is it really as important a breakthrough as it sounds, or is it being overhyped? Here we provide the answers to all these crucial questions and more.
Q: Why is this latest research causing such excitement?
Because the SELECT study, led by researchers from University College London, is the largest ever investigation into the cardiac benefits of semaglutide – and the scientists were very surprised to see the drugs worked even when patients didn’t lose weight.
The research involved 17,604 adults aged over 45 with a high body mass index (BMI, a measure of weight compared to height) and had suffered a previous cardiac ‘event’ – such as a heart attack.
Sharon Osbourne has spoken openly about using Ozempic to slim down after saying she had struggled with her weight for many years
For nearly four years, they either had a weekly 2.5mg shot of semaglutide (the higher dose used in Wegovy jabs – the amount in Ozempic is usually a lot lower), or a placebo jab.
The results, presented at a major obesity conference in Venice earlier this week, showed that out of the 8,803 patients on the placebo jab, 701 (or 8 per cent) suffered a heart attack. But in the semaglutide group it was only 569 (or 6.5 per cent).
Crucially, the fall in heart risk was seen even in those who hadn’t yet lost a lot of weight. And heart attack and stroke rates started to drop within weeks of starting the GLP-1 drugs.
In fact, the fall in risk was similar in those who lost less than 5 per cent of their bodyweight – or even put on a few pounds – as it was in those who shed over 5 per cent.
(And this was before most patients reached their maximum weight loss, which was a year or so into treatment.)
‘This is super interesting,’ says Dr Alex Miras, clinical professor of medicine at Ulster University and an expert in obesity treatment.
‘We did not know this before – it may be the drug is having a direct effect on the heart, independent of weight loss.’
One explanation may be that the jab reduces the kind of chronic, low-level inflammation in blood vessels that can cause them to become blocked – leading to a heart attack or stroke.
‘But there’s also evidence that the GLP-1 hormone has a kind of anti-clotting effect and that’s very exciting,’ says Dr Miras.
Q: So should we all be on it?
If semaglutide can reduce heart disease risk even when patents on it don’t lose lots of weight, should millions more of us be taking it to keep our hearts healthy – just as we do with statins?
‘No,’ says Dr Miras. ‘Studies so far only show that the drug is effective in people who are already obese and also have established heart disease – they’ve either had a heart attack, a stroke or a clot in the blood vessels in the legs.
‘From what we know, semaglutide is unlikely to work as well in the primary prevention of heart disease’. This is where patients have risk factors, such as a family history or high cholesterol, but have not actually suffered a heart attack or stroke.
‘The drug has a much greater effect in those with existing heart disease.’
It’s possible that will change as we learn more.
Dr Miras adds: ‘It’s possible that 10 years down the line you might be given the drugs if you have a strong family history of heart disease but there’s no evidence base for that yet.’
Q: Is it true it can help prevent other conditions like Alzheimer’s?
Weight-loss and heart problems aside, some evidence is emerging to suggest Ozempic and similar medicines could potentially tackle other modern-day killers.
These range from bowel cancer and Alzheimer’s disease to multiple sclerosis and Parkinson’s disease.
A three-year trial is already underway at various centres across the UK to see if people with mild cognitive impairment – often an early stage of Alzheimer’s – will benefit from taking a daily semaglutide tablet.
Again, inflammation is known to play a part in the progress of Alzheimer’s, raising the likelihood of harmful deposits – called plaques – forming in the brain. The theory is that the drug given early enough will stop further plaques from forming.
Meanwhile, a December 2023 study in JAMA Oncology found that type 2 diabetes patients given semaglutide had a 44 per cent fall in the risk of bowel cancer (probably because of its anti-inflammatory effects) while last month scientists at Toulouse University Hospital in France reported a daily injection of semaglutide slowed the progression of Parkinson’s disease.
‘We’ve known for years from animal models that semaglutide has anti-inflammatory effects,’ says Dr Miras.
‘But the GLP-1 hormone also seems to protect against damage to nerve cells’ – the kind of damage seen in Parkinson’s and MS.
Sharon’s daughter Kelly Osbourne has also used the weight-loss drug, but shared that she felt it had gone ‘too far’
Q: Is it true Ozempic can stop you drinking?
One of the many varied effects of the drug seems to be that it can curb the desire to drink alcohol.
A 2023 study at Gothenburg University in Sweden found that rats given the drug consumed 60 per cent less than those not injected with semaglutide.
Similar research is underway at Oklahoma State University, involving 80 heavy drinkers, to see what effect weekly injections of the drug have over a three-month period.
It’s not clear why the drug might make alcohol less appealing but one theory is it dampens down the ‘reward’ hit that the brain gets when alcohol is consumed – reducing the urge to keep drinking.
Q: What about side-effects?
Like all prescription medicines, semaglutide can have unpleasant consequences.
For example, studies show around one in 100 people develop gastroparesis (or stomach paralysis) where the stomach muscles become weakened or may even be paralysed, meaning food moves through the digestive system much slower than normal and in some cases it may not move at all. This can cause nausea, pain and bloating and it has been claimed in one report to trigger cyclic vomiting syndrome, where people vomit several times a day.
Around half those who develop gastroparesis also become constipated which can last six weeks or more.
It can also cause severe diarrhoea – some patients report soiling the bed at night.
Some also complain of foul-smelling ‘rotten egg’ burps. It may be because the drug increases the number of sulphur-producing bacteria in the gut, by altering the microbiome (the community of bacteria, viruses and other microbes that live there). Another theory is that because it slows the gastric-emptying process, food lingers for longer than normal – causing more unpleasant aromas.
Then there’s so-called ‘Ozempic face’, an often-reported side-effect where accelerated facial ageing – more wrinkles and saggy skin – develops after a few months on the drug.
It’s thought this is due to the rapid weight loss leading to a reduction in facial fat; when it disappears, the skin can appear to be saggier.
Perhaps more worrying is the suggested link with suicidal thoughts.
Latest figures from the Medicines and Healthcare products Regulatory Agency – the body that vets drug safety in the UK – show it has received over 100 reports since 2019 linking semaglutide with depression and 38 cases where it has allegedly triggered suicidal thoughts.
In one case, the drug has been blamed for a patient committing suicide.
However, it’s not clear if the drug was actually responsible and a study published in journal Nature earlier this year by experts at Case Western Reserve School of Medicine, which looked at the records of 1.8million people on the drugs, found no evidence of a link with suicidal thoughts.
Kelly Clarkson attributed her weight-loss to a prescription drug that helped her body break down sugar, but said it wasn’t Ozempic
Q. What are the long-term risks?
Some patients on Ozempic for their type 2 diabetes for have reported significant side-effects such as pancreatitis (inflammation of the pancreas), kidney failure, gall bladder inflammation and even vision problems while taking the drug.
And although the drop-out rate during clinical trials run by the drug’s manufacturers was only around 8 per cent of patients, a study in the BMJ in 2022 – which looked at 589 Britons who had been prescribed GLP-1 medications for type 2 diabetes – showed the drop-out rates in real life were 45 per cent after one year and 65 per cent at two years.
Nevertheless, Sir John Bell says: ‘These drugs have been used for the treatment of diabetes for more than 15 years and we have a lot of experience with them – there’s quite a big database on their safety and they work pretty well.’
Q: I’m tempted but how can I get the jab?
Wegovy (the weight loss version) is only available on the NHS if you have a BMI of at least 35. As a rough example, this could be a man who is 5ft 10in tall and weighs almost 18 stone. In exceptional circumstances, you may get it if you have a BMI of 30 (eg: a 5ft 3in woman who is 12 stone) but usually only if you have a range of other risk factors mainly for heart disease or stroke – such as high blood pressure.
It’s also available privately from online pharmacies, starting at around £150 a month, but you will need a private prescription from a doctor first.
But be warned – you can currently only stay on the drug for two years – as the trials upon which the drug’s approval were based only lasted two years. The SELECT study lasted four so now there are calls for this to be extended and most people regain at least some of the weight when they quit.
Q: But isn’t Ozempic in short supply?
Some online pharmacies say they cannot take on new patients for Ozempic for several months due to long-running shortages of the drug. Instead, they are having to reserve the supplies they do have for existing patients. The charity Diabetes UK warned recently the supply issues are expected to run into 2025 and some new patients are struggling to get their medication despite being prescribed it.
Diabetes UK blamed the high level of ‘off label’ prescribing of the drugs Ozempic to those private patients desperate to use them for weight loss.
Q: I hate injections – can I get a tablet instead?
Semaglutide is already available in the UK as a pill called Rybelsus. But it’s only available on prescription for people with diabetes, not for weight loss, and in a much higher dose than the weekly jab (50mg versus just 2.4mg in the injection). That’s because taking it orally means much of the active medicine gets ‘lost’ or destroyed by stomach acid on its journey through the gut, before finally being absorbed into the bloodstream. With an injection, virtually all of the active ingredient is guaranteed to be absorbed into the bloodstream and then circulate to the brain.
Sir John Bell says: ‘There are a series of oral drugs coming through which are going to be much cheaper than the injected form.’
