By Michael Meyer

If you’ve been paying attention to pop culture, you’ve no doubt heard the term “Ozempic” used a lot lately. From the latest Kardashian accusations to a joke by Jimmy Kimmel at the Oscars, everyone seems to be talking about how this sensational drug is revolutionizing weight loss in Hollywood and beyond.

But what is Ozempic, how does it apply to medical aesthetics, and what are the pros and cons of offering this treatment to your patients? There may be more things you’ll need to consider than you might imagine.

What you need to know

Ozempic is a semaglutide-based drug that was originally developed to help treat symptoms of type 2 diabetes. It is administered by injection once a week, and weight loss is among its potential side effects (as are several other nasty conditions, including hypoglycemia and kidney failure). Essentially, the drug creates a pancreatic response to rising blood sugar levels, which acts as an appetite suppressant.

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Additional Semaglutide Information

For more information on using semaglutides in a medical spa practice, including podcasts, blog posts and links to FDA resources, visit AmSpa's semaglutide resource page.

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Anecdotally, this has caused people to lose a good deal of weight fairly easily, typically without excessive exercise (although Novo Nordisk, themanufacturer of Ozempic, recommends regular exercise as part of the course of treatment). In fact, some Ozempic users have lost so much weight that they’re developing what’s known colloquially as “Ozempic face”—an overly gaunt look that manifests when people lose a great deal of weight very quickly.

Ozempic is approved by the U.S. Food and Drug Administration to treat type 2 diabetes but its off-label use as a weight loss drug is perfectly above-board if the drug is prescribed by a physician or other independent practitioner who has conducted a good faith exam. (Because it is administered via injection, so it is considered a medical treatment.) It is also worth noting that Novo Nordisk has also created a drug named Wegovy, which is approved by the FDA for treatment of obesity and is nearly identical to Ozempic, although it is administered in higher doses. Ozempic, however, remains the drug that people look to for this type of treatment.

“It’s blown up, because not only does it help with weight loss, but it offers some blood sugar control and other health benefits on top of losing weight,” says Vrinkley Pruna, MSN, NP, assistant clinical director at Shape & Skin Medical Spa & Weight Loss in Huntington Beach, California. “I think that’s why people have been extremely successful with it.”

Winning weight loss

Pruna is a supporter of semaglutide treatments.

“There are a lot of pros,” she says. “One of them is that it’s not controlled and it’s a non-stimulant—a lot of weight loss medications, like phentermine and others, are controlled substances. So, it opens up more opportunity for patients who have heart issues such as hypertension or severe cardiovascular disease. It’s nice that there’s an option for them to be on an appetite suppressant like semaglutide.”

The fact that the drug is administered via injection also helps take uncertainty out of the equation.

“It’s just a once-weekly injection, so it’s not a daily pill that our patients are taking,” Pruna says. “It’s a lot easier to manage on a day-to-day basis, because the patients don’t have to remember to take different medications at different times. It’s nice that they just get to come into our office, get an injection and then go on with their day.”

Additionally, patients can use semaglutide for as long as they need to in order to achieve their weight-loss goals.

“It’s safe for long-term use, which is something we can’t say about other drugs, such as oral appetite suppressants, which are approved for short-term use—about 12 weeks,” Pruna says. “It’s nice that there is an alternative option that can be used long-term, until our patients can really get to their goal weight.”

Red flags

All this is very encouraging for people who want to lose weight using Ozempic or Wegovy. However, there are a handful of concerns that people wishing to use or administer these drugs should be aware of.

“A high percentage of those who take semaglutide, specifically, have experienced nausea and constipation as a side effect,” Pruna says. “I think that would be the biggest struggle for most people if the symptoms are not managed. Knowing that there is a high risk of nausea and constipation, at our clinic, we give our patients anti-nausea medications as needed. We have a lot of fiber supplements and different stool softeners to try to help prevent the constipation.”

There also are certain conditions in patients that preclude them from being suitable candidates for these treatments.

“You need to be very careful in terms of patient selection,” says Pruna. “Patients aren’t good candidates for this medication if they’re type-1 diabetic or if they have a family or personal history of thyroid cancer. And thyroid cancer is somewhat prevalent and common in our population. So, knowing that people who have a history of thyroid cancer cannot take it, getting a very thorough medical history, surgical history and family history is incredibly important for ruling out any possible interactions or contraindications.”

Also, in the relatively short history of semaglu¬tide’s use for weight loss, a fair amount of anecdotal evidence suggests that the weight loss people experience while on the drug is rarely permanent when the drug is removed from the equation.

“When patients are able to lose all their weight, by the time that they get off of the medication, they often haven’t fully developed a healthy lifestyle to maintain the weight loss,” says Pruna. “What I’m hearing a lot is that, with semaglutide, there’s a lot of weight regain and fat rebound after the medication is stopped. I think a lot of it is because these patients haven’t been able to get on a good nutrition and diet plan, exercise regularly, get adequate sleep, and all the other lifestyle factors that really, at the end of the day, will affect their weight. I think my biggest concern is that people will depend on this medication to be like a magic trick to lose weight, and then, when they’re off it, they expect it to keep working. My biggest concern is that there are no lifestyle changes on top of it.”

Finally, the widespread use of Ozempic for weight loss rather than the control of type 2 diabetes have caused global shortages of semaglutide in 2022 and 2023. Production has caught up with demand, but it is difficult to justify semaglutide’s use for elective aesthetic purposes if it is causing people who need it to maintain their health to lose access to it.

Expanding your horizons

While adding Ozempic or Wegovy to your medical spa’s menu of treatments might seem appealing, Pruna warns that it’s not as simple as learning how to administer the injections. This treatment demands a level of conscientiousness that practices that aren’t experienced with medical weight loss might not be familiar with.

“It shouldn’t just be given just because it works and it’s easy to give to patients,” Pruna says. “I think there must be a lot of research behind it and an actual medical weight loss program that supports the weight loss in general. If they’re not able to monitor them very closely or have nutrition guidelines, and there aren’t people who can take their weight and their blood pressure and really get an in-depth medical background of the patient every week, I don’t think it should be widely used.”

However, if all precautions are taken, Pruna thinks semaglutide treatment can be very beneficial.

“I love this medication,” Pruna says. “I love talking about it because I know it really works. It’s exciting to be able to talk about it and teach more people about it.”

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