Can Ozempic make you gain weight?
When I was a teenager, models had one body type: Size 0, and akin to a piece of paper.
I’d flip through magazine after magazine, scroll through pages and pages of
e-commerce, and see the same body type, over and over, on dozens of different women.
I wanted to be a model.
“But you’re… athletic,” one of my brothers said.
It broke my heart.
I didn’t want to be athletic.
I didn’t want to be strong.
I wanted to be a size 0 piece of paper.
That desire didn’t originate from me – it was a result of being saturated in a culture obsessed with thinness.
When I was in my early teens, I developed an eating disorder that lasted until my early 20s.
Today, I’ve recovered from that eating disorder and radically, organically shifted my idea of beauty, both for myself and what I find attractive in others.
I find it shocking that one body type – that size 0 piece of paper – was the only beauty standard I grew up with.
To my young, sponge-like brain, it was the only option, if I wanted to truly be beautiful.
I’m not saying that body type can’t be beautiful – it absolutely can – but for the media to feed it to us as the ONLY option? Really?
That truly stuns me, to this day.
Over the last 10 years, there’s been a massive rise in body positivity and body diversity throughout the media.
At the same time, in the past 2-3 years skinny culture has had a strong reemergence, creeping up through the concrete.
Of course, it never fully went away, but it had subsided significantly.
Now, it’s hard to avoid on TikTok – and all social media – but it’s been especially prominent on TikTok:
“Influencers” berating their viewers for being “lazy” and “fat.”
People posting their bodies and asking for commenters to be mean to “inspire” them.
A “Skinni Coach” who teaches eating disorder strategies and includes underage members (including high school students) in her paid groups.
TikTokers hoping for “A Euro summer and Ozempic allegations.”
“Wellness influencers” obsessed with facial slimming tools and techniques.
Now, you (might) know I’m body-positive and fat-positive.
I don’t think fat is a problem by default, or that weight gain is automatically an issue.
Of course, I’m not ignorant of the health issues that can accompany fat gain, especially in areas surrounding vital organs, like the belly.
Still, it’s more nuanced than that.
There are studies that show larger people can be healthy, and sometimes, weight gain can be a very good thing – like if you’ve struggled with undereating.
I’m also thin-positive.
I think you can be thin and healthy, and I don’t think wanting to lose weight is always a problem.
It all depends on the context and motives.
There’s a healthy mindset and healthy steps you can take to lose weight, if that’s what you want, and if it’s appropriate for your unique body type and overall health condition.
But today a lot of people are using disordered tactics and risky medications to lose weight short-term, and the negative side effects may outweigh the fleeting benefits.
Ozempic has been at the center of this skinny culture resurgence.
What if you could just take a magic shot that would decrease your appetite and make weight loss easier?
To some it sounds like a dream, and there’s people who are experiencing dramatic short-term results, but at what cost?
First of all, what is Ozempic, exactly?
Ozempic (semaglutide) is a GLP-1 medication used to manage type 2 diabetes and help trigger weight loss.
While it may help manage blood sugar and promote short-term weight loss, several studies have shown negative side effects, including long-term weight gain due to an increase in fat cells.
Yes, Ozempic may ultimately create MORE fat cells in the body.
The very drug people are taking to lose weight might leave them heavier and more prone to health issues in the long run.
This is heart-breaking.
Not because weight gain is always bad, and certainly not because weight gain is the worst case scenario – we’ll get into more of the side effects of Ozempic shortly.
It’s heartbreaking because many Ozempic users have been trying to lose weight for years or decades.
They finally find what they think will be a solution, only to experience the opposite long-term effect: Their last resort for weight loss ultimately causes weight gain.
How does Ozempic potentially create more fat cells and weight gain long-term?
Ozempic has been shown to influence fat cell dynamics, particularly in the context of obesity and type 2 diabetes.
While it helps with weight loss at first, it may affect the formation and function of fat cells in ways that could have long-term implications.
Let’s get into how Ozempic may ultimately lead to more fat cells and weight gain…
1. Fat Cell Rebound and Hyperplasia
Ozempic initially reduces appetite and body weight, but studies show that it may increase adipose progenitor cells (precursors to fat cells) during treatment.
When you stop taking the drug, you might regain the weight you lost, and potentially wind up with more fat cells than before, leading to more weight gain, beyond the amount you lost.
Hyperplasia (an increase in fat cells) is harder to reverse than hypertrophy (fat cell size increase), which may set you up for a tendency toward fat storage for years to come.
2. Weight Regain When You Stop Taking It
A major 2022 study published in Diabetes, Obesity and Metabolism showed that patients regained about two-thirds of their lost weight within one year of stopping Ozempic.
The underlying metabolic and behavioral drivers of obesity – hormonal signals, food cravings, and reduced energy expenditure – often return once the drug is stopped.
3. Changes in Appetite and Brain Chemistry
One of the main effects of Ozempic is decreased appetite.
There’s some concern that prolonged use could alter the brain’s natural appetite regulation, potentially leading to long-term overeating and weight gain.
4. Muscle Loss During Weight Loss
Ozempic-induced weight loss often includes lean muscle mass, not just fat.
Losing muscle can reduce basal metabolic rate (BMR), meaning fewer calories are burned at rest, making future weight gain more likely.
5. Natural Set Point Defense
The body tends toward a natural weight – the weight you are when you’re generally healthy and not trying to lose or gain weight.
If you lose weight quickly and artificially, like with Ozempic, the body may respond with increased hunger and decreased metabolism, leading to weight regain if medication is stopped.
TO RECAP…
Increased fat cells = increased long-term fat storage
Drug discontinuation = significant weight regain seen in studies
Brain adaptation = increased hunger and difficulty reading fullness signals
Muscle loss = lower metabolism, higher fat regain risk
Quick weight loss = increased hunger and weight regain
Ozempic affects fat in several ways: It can change how new fat cells develop, help turn white fat into brown fat (a more active type of fat), and influence how the body stores and uses fat.
These effects may help with short-term weight loss, but they might also lead to long-term changes in body fat, creating more fat cells and making it easier to gain weight.
What are the other side effects of Ozempic, besides possible long-term fat cell increase and weight gain?
Common and Serious Side Effects
Gastrointestinal Issues: Nausea, vomiting, diarrhea, constipation, and abdominal pain are often reported. In clinical trials, 36.6% experienced nausea, and 8.6% had diarrhea. Severe gastro-related hospitalizations have also been documented.
Drug Trial Snapshot: Ozempic
Ozempic Side Effects: Are They More Common in Females?
Semaglutide: Double-edged Sword with Risks and Benefits
Gallbladder Disorders: Conditions like gallstones and cholecystitis have been reported. In type 2 diabetes trials, cholelithiasis occurred in 1.5% of patients treated with 0.5 mg and 1 mg Ozempic, compared to 0.4% in placebo groups.
Kidney and Pancreatic Concerns: Acute kidney failure and pancreatitis have been reported, though the incidence is low. A meta-analysis did not indicate a significantly elevated risk of acute pancreatitis.
Thyroid Tumors: Animal studies suggest a potential risk of thyroid C-cell tumors, including medullary thyroid carcinoma. The FDA prescription label for semaglutide has a boxed warning for thyroid C-cell tumors in rodents.
Emerging and Rare Side Effects
Gastroparesis and Intestinal Obstruction: Studies show there’s an increased risk of delayed gastric emptying (gastroparesis) and intestinal obstruction, which can lead to severe complications if untreated.
Vision Problems: A study found that patients with type 2 diabetes taking semaglutide had more than a 4x higher risk of experiencing vision loss.
Hair Loss: An analysis of FDA reports suggests an association between Ozempic and hair loss, with a 52% higher risk compared to other treatments.
Bone Health: There are concerns about bone loss, particularly in older adults and women, because of a decrease in essential nutrients, like calcium and vitamin D, linked to decreased appetite.
Skin and Sensory Effects: Reports include burning sensations on the skin, joint pain, and nasal issues. Some people have also experienced altered or reduced taste, sometimes referred to as “Ozempic tongue.”
Psychological and Reproductive Considerations
Mental Health: Psychiatric disorders like anxiety, insomnia, and depression have been reported, though the incidence varies across studies.
Ozempic has many potential side effects beyond long-term weight gain, making it a risky option for weight loss.
Ok, so what’s an effective, healthy approach to weight loss?
Like I’ve said, I’m not anti-thin, and I’m not anti-weight loss.
I think it’s possible to be thin and healthy, and it’s possible to want to lose weight and still be a healthy person – both mentally and physically.
Intuitive eating is what helped me recover from my eating disorder and reach a place where I eat stress-free, never overeat, and feel great in my body.
In my coaching practice, I’ve helped dozens of women do the same.
If you’re looking for a healthy, non-restrictive approach to weight loss, these five steps are a great place to start:
1. Focus on high-quality whole foods: Fruits (mostly raw) and vegetables (mostly cooked, with a focus on root vegetables), eggs, dairy, meat, fish, beans, and high-quality grains. Evaluate the role of stimulants like coffee, tea, chocolate, and alcohol.
2. Learn which foods work for you: Start a food journal where you note your symptoms after eating different foods. If you struggle with a lot of symptoms, get testing done.
Jon Mitchell is a great resource for this.
3. Listen to your hunger and fullness signals: Eat sitting down, and as slowly as you can. Focus on chewing, pausing, and breathing. Remind yourself that you can always eat more later if you’re truly hungry. Practice self-love by honoring your hunger and fullness signals.
4. Add in resistance training: Doing body weight exercises and/or weight lifting increases lean muscle mass, which increases your metabolism. The higher your metabolism, the more calories you burn, even when you’re sleeping or laying down watching TV.
5. Spend time in nature: Sunlight and fresh air are essential for metabolic health. So is grounding – simply walking in nature or in your yard, ideally barefoot. Nature helps us offload toxins that can lead the body to hold onto fat.
Unhealthy weight loss trends will never disappear completely.
By calling them out, debunking them, and discussing healthy solutions rather than shaming people who want to lose weight, we can stay healthier as a society – both physically and mentally.
It’s your birthright to feel good in your body.
Self-love and acceptance today create the foundation for any changes you want to make with your health.
“The curious paradox is that when I accept myself just as I am, then I can change.”
– Carl R. Rogers, one of the founders of humanistic psychology
If you take a self-shaming approach, it’s likely to backfire.
If you reach for a quick fix like Ozempic, it may set you up for frustration for years – or decades – to come.
Have you noticed the resurgence of skinny culture? Has it affected you?
Let’s support each other in the comments below.
Much love,
Lula