Ozempic for Obesity
By now, I have treated patients taking Ozempic for around 5 years. Ozempic, also known as under its generic name semaglutide, has altered the way healthcare providers think about treating obesity. Before that, there were few medications for obesity, and the ones that did exist were of limited utility or had limits on their use. Understanding what Ozempic does explains why it can treat obesity.
Complex Causes of Obesity
As a younger dietitian, I thought that obesity was all about diet. I assumed that the patient with obesity must simply be eating too much and they need to just stop eating so much. I didn't spend too much time wondering w hat caused some people to eat more. It did not occur to me that different people experience the drive to eat differently.
As I gained more experience as a dietitian, I began to see some distinct differences between types of obesity. Obesity is not monolithic--there are different causes of obesity. Therefore, treating it cannot be a one size fits all approach. Adding to the complexity, an individual patient's obesity can be multifactorial. Sometimes one factor is most prominent, and sometimes a few factors play an equal role.
Obesity from Excessive Drive to Eat
Obesity is often caused by calorie intake that exceeds calorie needs. But the question is: why is this person intaking more calories than they need? Sometimes it can be due to inadequate understanding of nutrition or unusually low energy needs, but more often, it seems to be due to higher levels of drive to eat. This excessive drive to eat should not be confused with lack of willpower or self control.
Let's use an example to illustrate the point. Say it is a very hot day, and you are out on a hike, sweating away in the sun. In your backpack you have a water bottle. You are getting hotter and thirstier, and you want--no, you need-- a drink. All you can think about is how thirsty you are and you mind is consumed with the idea of drinking water. I am hiking along with you, and I say to you, "just have some self control and don't drink water." You would think I am crazy. Clearly you are dealing with a strong physiological drive. There is only so much that you can "have self control" and not drink.
I think that this is comparable to some people's experience with food and eating. A person with a normal weight might see a donut and think, "Hey, that's a donut. Looks good." A person with an excessive drive to eat might see the donut and not be able to stop thinking about it. They feel that they must have the donut. This person might spend much of their time between meals thinking about food: when they will eat next, how they will get the food, which specific foods they want to eat, and that they want to eat now. Another person might not think about food unless they are planning a meal or physiologically hungry.
How do we address this type of obesity? By understanding what is the cause of this obesity. It is not lack of willpower. It is increased physiological drive to eat. Addressing the physiological drive is important.
What Does Ozempic do to Decrease Obesity?
What does Ozempic actually do in the body? Ozempic is not simply a weight loss medication. It is a medication that alters the drive to eat. It decreases the drive for food in the hedonic reward system in the brain. This leads to suppression of appetite and decreased intake of food. Studies show it decreases calorie intake by 35%!
I think that the weight loss success many people have with Ozempic underscores the impact of excessive drive to eat as a cause of obesity. My patients on Ozempic tell me that they are no longer thinking about food all day long. They don't think about food between meals. They usually tell me that they still get hungry before meals, but they reach satiety faster.