For Edmonton native Susanne Brown, Ozempic has been life-changing. After being prescribed the drug, she climbs mountains, she’s training for a 10-kilometre run, and she’s ziplined through tropical forests in Mexico and swum in cenotes.
“I do whatever I want because I can,” she says. “It has changed my life completely. It’s taken the fear out of everything that I do physically.”
But Brown wasn’t prescribed Ozempic for its on-label use as a Type 2 diabetes treatment; she takes it off-label, for obesity. She’s certainly not the only Canadian to do so, but it can be difficult for people with obesity to speak publicly about using the drug to manage weight.
Ozempic crashed into mainstream consciousness early this year, as shortages of the drug in the U.S. and Australia led to media narratives that people abusing the drug to lose weight were keeping it out of the hands of people with diabetes who need it most.
But this account leaves out the growing number of people who take Ozempic to lose weight under informed doctors’ orders, to prevent heart disease and diabetes, address chronic pain and in some cases live healthier, more capable lives.
And while people love to speculate who in Hollywood might be taking the drug, those before-and-after pictures conceal the truth: that Ozempic is not some miracle cure for weight loss.
For Brown, losing weight on Ozempic came with major downsides — but the downsides were worth it for her for managing her obesity, a chronic condition that she will likely struggle with for the rest of her life. Not to mention a fringe benefit: she feels society treats her better now that she lives in a smaller body.
Misconceptions about Ozempic abound, and they often go hand in hand with misconceptions about obesity and those diagnosed with it.
Misconception 1: Ozempic is just for diabetes
Ozempic is a brand-name diabetes medication manufactured by Novo Nordisk, but the medical ingredient in it is called semaglutide. Semaglutide works by mimicking a hormone called glucagon-like peptide-1 (GLP-1), which stimulates the release of insulin and helps to reduce blood sugar spikes.
It also suppresses appetite, by helping patients feel fuller, faster — making it an effective treatment for weight loss.
Novo Nordisk actually manufactures two drugs where semaglutide is the only medical ingredient: Ozempic for Type 2 diabetes, and Wegovy for obesity. Both drugs have been approved for use in Canada, Ozempic since 2018 and Wegovy since 2021.
Though Wegovy has been approved in Canada for obesity for two years, a prescription for the drug has never been filled here. It’s still not available due to short supply. So, to get that same drug to their patients, doctors have begun prescribing Ozempic off-label for obesity.
“It’s the same drug, it’s the same factory, same company. It’s just a different pen so you can administer a larger dose easier,” says Dr. Michael Lyon, medical director of the Obesity Medicine & Diabetes Institute in Coquitlam, B.C.
So why do we have two names for it, approved for different conditions, if the drug is exactly the same?
“It’s really a marketing problem for the drug company,” Lyon says.
He doesn’t care what the trade name is, he just prescribes semaglutide.
Dr. Sean Wharton, an internal medicine physician and weight management specialist, explains that regulators like Health Canada and drug companies like Novo Nordisk can be interested in marketing the same drug differently for different medical issues to monitor side effects and dispensation and to adjust price.
But he sees the confusion around Ozempic and Wegovy and wishes they had just been called the same drug from the outset to clear the air.
Semaglutide has been approved for obesity, so if prescribing Ozempic is the only way people living with obesity can access it, they should get to use it, Wharton says. And when Wegovy is available in Canada, that’s the drug that ought to be used.
He says since there’s no shortage of Ozempic in Canada, there’s no reason to restrict access to it for people living with obesity.
Misconception 2: Obesity is a lifestyle choice
Brown, a 40-year-old massage therapist, tried everything to lose weight the way people are “supposed” to. She ate healthy and worked out regularly, but without medical intervention, those lifestyle changes didn’t lead to meaningful weight loss.
“I had done every single diet on the face of the planet and failed at every single one of them,” she said. “They’d all work for a certain period of time and then they wouldn’t.”
Doctors now understand obesity as a lifelong, complex disease, with several potential causes that lead to excessive body fat and sometimes, poor health.
“We make these assumptions and apply this kind of bias and bigotry towards people that have excessive weight. If they had high blood pressure, you wouldn’t feel so obliged to moralize the problem, and would probably realize that there’s a lot of complexity there and maybe medications are sometimes appropriate or essential,” Lyon says.
For years we have tried to treat obesity by putting people through diets and exercise regimes, but evidence shows that doesn’t always work, and often, weight shed via diets tends to be put back on over time. That’s why Lyon and Wharton agree that Ozempic and other medical interventions can be a powerful tool to kick-start weight loss in conjunction with lifestyle changes.
In 2013, Brown underwent bariatric surgery, the removal of a large part of the stomach to reduce hunger signals and induce weight loss. She lost 100 pounds and ran a half marathon to mark the occasion. She calls it one of the best decisions of her life.
But in the years that followed, her weight eventually started creeping back, no matter what she did to try and stop it. In 2019, her obesity specialist suggested Ozempic.
The combination of surgery and Ozempic have been instrumental for Brown to reach some of her fitness goals, recording personal-best weightlifting records and running times. She knows that losing weight and keeping it off could prolong her life and it’s relieving stress on her joints. Taking the drug is not without sacrifice, however, and she warns it’s not appropriate for people to use if they’re just looking to slim down.
In her experience, Ozempic came with some serious side effects.
Misconception 3: Losing weight on Ozempic is a quick, painless process
Brown says taking Ozempic is akin to “doctor-approved anorexia.” For her, the feeling of losing weight on the drug was “addicting.”
When she first started on Ozempic, it led to dangerous eating habits, where she would “eat two pieces of cauliflower and be full.” If a patient so desires, they could stop eating entirely by taking more and more of the drug, Brown warns.
Brown recalls that she had to take caffeine supplements to stay awake during the day and to have enough energy to work out because she wasn’t getting enough nutrition on Ozempic. Eventually, she became anemic and her hair started to fall out.
Even with these distressing downsides, Brown said she would never discourage someone with obesity from taking Ozempic, in part because of how much better society treats her now that she’s physically smaller.
“The way that the world treats you as well is very, very different,” she said.
Men who knew her when she was heavier all of a sudden wanted to date her. She runs long-distance races now; when previously, at a heavier weight, strangers would stop her on the street and tell her to stop running because of her size.
Brown’s experiences bring into focus the weight bias that many people experience when they live in larger bodies, and how Ozempic can feel like a godsend. But in the wrong context, Ozempic can do more harm than good.
She worked with a therapist and personal trainer to improve her body image and relationship with food. She went from being scared to eat to “eating more food than I’ve ever eaten in 10 years” by tracking her macronutrients like protein and carbohydrates. She was still losing weight, but she was also gaining muscle.
Brown believes that the psychological impacts of taking Ozempic and losing weight should be studied more to understand how addictive the process can be. She wants people to understand that losing weight while facing obesity can be important to protecting one’s long-term health, but not if it means sacrificing the food and nutrition needed to function.
Lyon agrees that in isolation, Ozempic won’t do much to address the root of obesity, and the drug needs to be taken as part of a broader program that targets a patient’s mental health.
Lyon is an advocate for “health at any size,” a growing movement in public health that acknowledges that skinnier doesn’t always mean healthier, and that weight bias and the pressure to lose weight can often cause serious health problems — both physical and mental.
For that reason, he believes Ozempic for weight loss should only be reserved for people with obesity and facing adverse health problems that make the risk of taking the drug worth it.
As Wharton puts it: “If you’re a larger body size and perfectly healthy, then you should be called beautiful. You should not have the suggestion that you should be on a medication.”