Ozempic: the price of losing weight without willpower
Ozempic: you lose fat, but muscle mass too. The rebound after stopping is real, but no extra weight is gained. And the heart comes out ahead, according to the SELECT study.
English · Original discussion in Spanish · Published
Ozempic: the promise of effortless weight loss comes with fine print
A 50-year-old man arrives at the emergency room with massive ventricular failure. His medical history includes Ozempic. The cardiologist has no doubt: semaglutide has destroyed the heart muscle. This story, circulating online, is the dark side of a drug that promises what no willpower can achieve: losing pounds without going hungry.
Muscle loss, the big concern
It is not a myth. In the body composition substudy of the STEP 1 trial –140 participants, 68 weeks–, 2.4 mg semaglutide produced a 15% weight loss versus 3.6% with placebo. Total fat mass fell by 19.3%; visceral fat by 27.4%; and lean mass by 9.7%. In other words, muscle is lost in absolute terms. But fat is lost at nearly twice the rate, so the proportion of lean mass in the body ends up rising: the fat proportion dropped 3.5 points.
The rebound after stopping
The STEP 1 extension, published in 2022 with 327 participants trinc up to week 120, confirms it: when the drug is stopped, the weight comes back. At week 68, the average loss was 17.3%. One year after discontinuation, they regained 11.6 points –two thirds of what was lost–. But the final balance was still 5.6% below the starting weight. Almost everything comes back, but not more. Critics argue the sample size is insufficient; the evidence shows no extra weight is regained.
The heart: damaged or protected?
The anecdote of ventricular failure contrasts with the SELECT study: 17,604 patients with cardiovascular disease and overweight or obesity without diabetes. Semaglutide reduced serious cardiovascular events by 20% compared with placebo. The drug does not damage the heart; it protects it. The problem is that clinical reality and popular perception go down different paths.
While some see Ozempic as the end of gluttony, others see a business designed to keep customers hooked. The truth lies in between: it works, but it is not free. Muscle is paid for with muscle; the rebound, with patience; and the heart, with data.
A 50-year-old man arrives at the emergency room with massive ventricular failure. His medical history includes Ozempic. The cardiologist has no doubt: semaglutide has destroyed the heart muscle. This story, circulating online, is the dark side of a drug that promises what no willpower can achieve: losing pounds without going hungry.
Muscle loss, the big concern
It is not a myth. In the body composition substudy of the STEP 1 trial –140 participants, 68 weeks–, 2.4 mg semaglutide produced a 15% weight loss versus 3.6% with placebo. Total fat mass fell by 19.3%; visceral fat by 27.4%; and lean mass by 9.7%. In other words, muscle is lost in absolute terms. But fat is lost at nearly twice the rate, so the proportion of lean mass in the body ends up rising: the fat proportion dropped 3.5 points.
The rebound after stopping
The STEP 1 extension, published in 2022 with 327 participants trinc up to week 120, confirms it: when the drug is stopped, the weight comes back. At week 68, the average loss was 17.3%. One year after discontinuation, they regained 11.6 points –two thirds of what was lost–. But the final balance was still 5.6% below the starting weight. Almost everything comes back, but not more. Critics argue the sample size is insufficient; the evidence shows no extra weight is regained.
The heart: damaged or protected?
The anecdote of ventricular failure contrasts with the SELECT study: 17,604 patients with cardiovascular disease and overweight or obesity without diabetes. Semaglutide reduced serious cardiovascular events by 20% compared with placebo. The drug does not damage the heart; it protects it. The problem is that clinical reality and popular perception go down different paths.
While some see Ozempic as the end of gluttony, others see a business designed to keep customers hooked. The truth lies in between: it works, but it is not free. Muscle is paid for with muscle; the rebound, with patience; and the heart, with data.
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Summary of a discussion on Burbuja.info - Foro de economía, actualidad y política., translated from Spanish and reviewed before publication. Read the full discussion (31 replies).
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