Explaining the semaglutide craze and what comes with using the medication

By Kindred Hurtado

Tracy Byers (left) lost 45 pounds in six months while on the semaglutide drug, Zepbound.

Tracy Byers' experience with semaglutides began dramatically with her first dose, marking a significant turning point in her relationship with food.

For the first time in her life, she would forget to eat because she wasn't hungry.

The senior healthcare IT executive at Optum lost 45 pounds in 6 months.

“The single factor that's been so shocking to me is the reduction or elimination of food noise in your head,” said Byers. 

Byers is not alone.  Many consider semaglutides transformational and highly recommend it.

“It was transformational for me, so I would highly recommend it,” she said. “I do think that doing a program where you combine nutrition and exercise is super important.” 

How semaglutides work

Initially developed to assist individuals with type 2 diabetes, semaglutides have gained popularity as a weight loss drug, Ozempic being one of the most popular. 

Semaglutides help your body manage blood sugar levels. They work by mimicking a natural hormone that tells your pancreas to release insulin when you eat, and at the same time, they lower another hormone called glucagon that raises blood sugar. 

Basically, they help the body respond better to food and keep blood sugar from getting too high.

And this all prevents the body’s inclination to store fat because stable blood sugar levels equal more effective fat burning so excess energy is not being stored as fat. 

Dr. Vennie Ying, a nurse practitioner, adds that semiglutides slow gastric emptying, allowing people to feel full more quickly and for a longer time. 

This reduction in hunger is the magic that promotes weight loss because people just eat less. 

Social media gives semaglutides a boost

When semaglutides first hit the market as a weight loss solution, many users were hesitant to discuss their use due to stigma. Byers recalls that when she started taking the medication, it was a sensitive subject, and she felt a sense of shame in needing medical assistance to control her eating habits.

But 2022 marked a turning point. Social media exponentially increased awareness of the drug, particularly through the viral hashtag #Ozempic, which garnered over 500 million views. 

Influential figures like Elon Musk openly attributed their physiques to fasting and using Wegovy, further igniting interest. In 2023, Oprah Winfrey publicly revealed her use of a weight loss medication, describing it as a source of "relief," "redemption," and "a gift" in her battle against yo-yo dieting.

These celebrities not only shared their journeys but also initiated a movement that dismantled the stigma surrounding using medication for weight management. What was once viewed as a private medical decision has transformed into a widely shared experience, aided by a cultural shift encouraging openness. 

Social media platforms like TikTok and Reddit played a crucial role in this transformation, fostering a sense of community among users as the hashtags #OzempicJourney and #WegovyWeightLoss became ubiquitous. 

Users flooded their feeds with before-and-after photos, influencer testimonials, and humorous memes. Influencers such as @Smallersam_PCOS and @brooke_lynnmilne amassed thousands of followers eager to document their weight loss journeys. Notably, @Smallersam_PCOS partnered with Weightcare to offer a discount on semaglutides, encouraging others to join the movement.

As these high-profile influencers helped to destigmatize semaglutides, their usage surged, with approximately 5 million Americans now using them. 

Doctors are prescribing semaglutides for weight management to many more patients than just those with diabetes. A study showed roughly 25% of all prescriptions for Ozempic and  Mounjaro were for weight management in non-diabetic patients.

Lifestyle changes still important 

While semaglutides have undeniably revolutionized weight management, medical experts and users caution that they are not a standalone solution. 

Professionals emphasize the need for sustainable changes in physical activity and eating habits. Without these adjustments, users may experience extreme fatigue, brain fog, and the rebound effect, resulting in regaining lost weight after discontinuing the medication.

"When people stop taking the medication, it is not a permanent fix for your body,” said Wes Dudgeon, Dean of Health Sciences at the College of Charleston. “It is merely a temporary change. If you don't modify your diet and lifestyle, you will experience a rebound effect."

A study conducted by MedicalNewsToday found that users, on average, lose 17.3% of their body weight while on semaglutides but tend to regain over 11% after stopping. 

Dudgeon explains that this rebound effect stems from the reality that many individuals need support to make lasting lifestyle changes.

Byers, who has been using semaglutides for two-and-a-half years, learned firsthand how the medication affected her eating habits. It significantly reduced her cravings and food-related thoughts to the point where she sometimes forgot to eat. 

There were days when it would be two or three o'clock in the afternoon, and she realized she hadn’t had anything to eat, which posed a problem during the initial months of treatment. 

She would experience fatigue and brain fog, making her feel unlike her usual self.

"I quickly realized that because I wasn't eating enough protein, I wasn't fueling my body and was probably losing weight too quickly," Byers explained. "I started needing afternoon naps because I had no energy. I had to teach myself to eat, even when I wasn't hungry, just to function."

Like many other users, Byers had to adjust her eating habits by incorporating more protein and prioritizing substantial morning meals. She made these nutritional changes and began to exercise regularly.

Over the past two years, Byers has managed to maintain a stable weight while on a maintenance dose of semaglutide.

Dr. Ying agrees that semaglutides are most effective when combined with intentional lifestyle changes. 

She advises her patients to prioritize hydration to counteract potential side effects like vomiting and diarrhea. Additionally, she emphasizes consuming enough protein and calories because appetite suppression may lead to decreased food intake, resulting in insufficient calories.

"We tell patients to ensure they are getting enough protein in their diet—even if they don't feel like eating. This is essential for protecting muscle mass and ensuring sufficient calorie intake," Dr. Ying stated.

Dudgeon notes that this advice is particularly crucial for middle-aged women. 

Losing both fat and muscle mass while using semaglutide can increase the risks of osteoporosis and frailty. Therefore, strength training, weight-bearing exercises, and adequate protein intake are not just recommended but essential.

“We are seeing some success with those people who are actually making lifestyle modifications,” said Dudgeon, noting that a healthier diet plus exercise and strength training as part of a regular routine helps a lot. “If you are making lifestyle modifications, which means you are doing weight-bearing activities, for a middle-aged female, that means you are stressing your bones in a good way that can help strengthen them.”

While semaglutides are a powerful tool for weight management, the results may be temporary without accompanying lifestyle changes in diet and physical activity. As Byers noted, the most surprising aspect of her journey was how vital these lifestyle elements became:

"Just taking the drug without making any other changes in your life is probably not sustainable," she said. "Incorporating changes in nutrition and exercise is necessary for long-term success."

Semiglutides are not ‘miracle drugs’

There are many benefits to taking semaglutides, including improved self-confidence, mental clarity, overall health benefits, and weight loss. 

But users and medical professionals alike acknowledge that it is not a miracle drug. Along with the positives, there are many physical side effects, emotional challenges, and ongoing debates regarding safety, access, and ethical use.

In the initial weeks of using semaglutides, users often experience gastrointestinal issues. 

Byers had expressed concern about the gastrointestinal side effects she had heard about before starting the medication. 

Nausea is the most common complaint, followed by diarrhea, vomiting, constipation, and fatigue – which often intensify as the dosage increases, Dr. Ying noted. 

There are also additional risks associated with the drug. Users must be cautious about low blood glucose levels to avoid hypoglycemia. Semaglutides are not recommended for anyone with a personal or family history of medullary thyroid cancer or pancreatitis.

And there are mental health concerns too, particularly when users attempt to discontinue the medication. 

"I did experience a considerable amount of anxiety when I tried to go off it,” she said. “My appetite returned quickly, and I gained 10 pounds." 

Losing weight on the drug and gaining after stopping is called the rebound effect and is one of the drug’s most troubling aspects. 

Byers has now returned to a low-dose maintenance plan.

Dudgeon highlighted that this issue underscores a flaw in how the medication is utilized.

“On one hand, I think these medications are great to address a major public health issue because there's so many negative health consequences associated with obesity,” Dudgeon said. “But on the flip side, are we just creating a whole new set of problems to deal with.” 

He added that the best outcome is for these medications to “springboard” to lifestyle chages.

“But I know that's not the reality,” Dudgeon said. “The reality is some people will be taking these things for a long time now.”

Dudgeon also pointed to a hidden risk associated with the medication that is particularly problematic for women –  muscle loss. While semaglutides effectively reduce fat, they also lead to decreased lean muscle mass, which can be particularly hazardous for middle-aged women and may increase the risk of osteoporosis.

"The lack of long-term research is another concern," he added. "We do not yet know the effects of taking these medications for five, ten, or even twenty years, especially in non-diabetic patients using them solely for weight loss."

Several factors contribute to the controversy surrounding semaglutides. These include the side effects, management dosages, limited research on long-term effects, and cost. Semaglutides are not inexpensive, averaging around $1,000 per month without insurance, and most insurance plans do not cover them. 

"It was a significant out-of-pocket expense,” Byers said.

Dr. Ying concurred.

"The medication is quite expensive without insurance coverage," she said.

Additionally, there was a significant medication shortage in 2022, which was only resolved this past February. 

"The manufacturing company that produces the semaglutides has struggled to keep up with production, leading to a medication shortage," Dr. Ying explained. 

This situation prompted users to seek to get the medication from alternative sources, such as compound pharmacies, which may not have FDA approval but are still considered safe. In some extreme cases, users turned to unregulated sources to obtain the medication. 

"I have heard that some patients are still unable to access it, even through compound pharmacies. I do not know where these patients are obtaining their medications or how they are being manufactured," Dr. Ying said, noting her serious concern and advice against getting the medication this way.

The controversy surrounding semaglutides extends beyond cost and quality. Some influencers are marketing and promoting them as a "miracle weight-loss drug," using their platforms to share discount codes and recommend unregulated providers. 

While the drug has assisted many users in gaining control over their eating habits and achieving weight loss, it does not come without significant red flags. Users and potential users should proceed cautiously, as the side effects and controversies are impossible to overlook.

Semaglutides and mental health

Semaglutides are primarily prescribed for individuals with type 2 diabetes or weight loss. Their effects extend beyond physical health, with many users reporting significant changes in mental clarity, confidence, and overall emotional well-being. 

But some have also experienced anxiety, a loss of identity, and a fear of regaining weight. The psychological impacts of these drugs are often overlooked and can be complex for users to navigate.

Byers mainly experienced a positive emotional shift and an immediate mental transformation while using semaglutides.

"I had spent most of my life fixating on diet, exercise, and what I was going to eat each day. But that all seemed to disappear," she said. "I felt a real optimism and clarity of thought. It was like the food noise in my head had finally quieted down, and I no longer had to stress about binge eating." 

This mental "quieting" of food-related concerns is one of the most liberating effects reported by users. For many, it transcends simply losing weight and managing cravings; it represents freedom from an internal struggle they have faced for so long.

But the relief is never permanent. 

When Byers tried to stop taking semaglutides, the return of hunger brought more than just physical discomfort; it triggered anxiety about regaining weight.

This fear of weight regain often negatively impacts mental health. Elise Hussey, a Licensed Professional Counselor associate at the College of Charleston, notes that the emotional toll of stopping the drug or even contemplating it can be significant. 

"Like any rapid weight loss, there is always the fear of returning to old habits," she said. "People may make choices driven by panic rather than health, and this anxiety can reshape behavior in unsustainable or unhealthy ways."

Hussey also emphasizes the impact of identity loss on users. "Food is not merely fuel; it often plays a vital role in social life, routines, and personal joy," she explained. "When that relationship changes or disappears too quickly, it can leave people feeling untethered, leading to grief, anxiety, or a diminished sense of self."

Additionally, appetite suppression can be destabilizing. While it helps reduce calorie intake, it can also eliminate the emotional and social cues typically associated with eating. "When you're no longer sharing meals, cooking favorite dishes, or enjoying food in social settings, it can feel like you're losing a part of yourself," Hussey noted.

On a positive note, many users, particularly those who have struggled with self-confidence related to their weight, report improved self-esteem and mental energy. 

"I could focus better at work," said Byers. "I wasn't obsessing over food or judging myself for what I ate that day."

Although the physical effects of semaglutides dominate headlines and social media, the mental effects also deserve attention. They can be just as positive—or even more so. 

Dr. Ying noted that semaglutides are not just medications; they serve as lifestyle and identity-altering tools that impact every aspect of life and require acknowledgment of their influence on both the body and the mind.

Experts like Hussey stress that these mental and emotional shifts—whether positive or negative—require support to prepare for potential changes in mental health. 

"I would definitely recommend that anyone starting semaglutides also talk to a therapist," Hussey advised. "Change is difficult—even when it's positive. It's essential to have space to process how your body and identity are evolving."