Once upon a time, losing weight involved enduring cabbage soup diets, step aerobics videos, and pretending rice cakes were crisps. Fast forward to 2025, and a new contender has entered the weight loss scene: semaglutide, known as Ozempic or Wegovy.
If you’ve been on social media or at a dinner party lately, chances are someone has mentioned “that diabetes drug that makes you skinny”. So, what’s all the fuss about?
What exactly is Ozempic?
Ozempic is the brand name for semaglutide, a GLP-1 analogue. According to Dr Charlene Wolberg, a GP with a master’s in Nutritional Science at Netcare Linksfield Hospital, it’s a molecule that mimics a hormone naturally produced by your gut (glucagon-like peptide-1 or GLP-1) which is released when you eat. This hormone signals fullness and helps regulate blood sugar.
In SA, semaglutide is approved for Type 2 diabetes (as Ozempic, 1 mg) and for weight loss (as Wegovy, 2.4 mg).
Dr Wolberg explains it like this: “This molecule, in addition to sugar control and weight management, exerts pleiotropic beneficial effects on various organs, including the cardiovascular system, brain, kidneys, and liver.”
How does it work?
Think of semaglutide as a multitasker.
Dr Wolberg explains that when it comes to diabetes management, it stimulates insulin when your blood sugar is high, tells your liver to reduce sugar production, and slows down how quickly food leaves your stomach. This last point also makes you feel full for longer, which leads us to weight loss.
“The GLP-1 hormone increases our feelings of ‘fullness’,” she adds. “Patients feel full sooner and for longer periods of time.” In fact, Dr Wolberg points out that it even targets the brain’s pleasure centres to reduce emotional eating.
You know that moment when you’ve had dinner and are full, but somehow still manage to eat the whole chocolate slab while watching telly? semaglutide helps suppress that urge.
Why is this drug so different?
Unlike older weight loss drugs that were quick fixes and often had some dodgy side effects, semaglutide is part of a newer generation approved for long-term use. That’s a big deal.
“Obesity is now recognised by the medical community as a chronic disease, akin to hypertension or high cholesterol,” Dr Wolberg notes. “GLP-1 analogues are deemed safe for long-term use.” So, no more crash diets. This is about sustained health management supported by science.
What’s the catch?
As with most things, there are side effects, explains Dr Wolberg. The usual suspects include nausea, vomiting, diarrhoea or constipation, and the odd tummy cramp. But as she adds, these usually fade over time, especially if the dosage is increased gradually.
Rare but serious side effects (like pancreatitis and gallstones) can occur. Dr Wolberg stresses these are uncommon but worth discussing with your doctor. A warning exists due to thyroid cancer seen in rat studies, so it’s not recommended for people with personal or family history of thyroid cancer.
And then there’s gastroparesis: delayed stomach emptying, which can complicate anaesthesia and recovery. This is especially important if you’re undergoing surgery, as you may need to pause certain medications beforehand.
Another unexpected side effect: unplanned pregnancies. Because semaglutide can slow the body’s absorption of oral medications, including the Pill, there have been reports of surprise babies. “On top of that, a high BMI is associated with decreased female fertility,” says
Dr Wolberg. “Weight loss induced by semaglutide can therefore enhance fertility.”
So, what happens if you stop taking it?
Unfortunately, it seems that semaglutide requires a lifelong commitment. Just as discontinuing blood pressure medication would cause your BP to rise again, stopping semaglutide typically brings you back to your original weight set point.
“Chronic use is essential for sustained weight management,” says Dr Wolberg.
“Several studies have demonstrated that once a patient reaches goal weight, an abrupt cessation of the medication will result in weight regain. It is therefore advised to work together with your healthcare practitioner in finding the lowest possible dose that will prevent weight regain. Several different dosing strategies are being investigated for chronic weight management.”
Semaglutide works best as part of a comprehensive plan: consider smaller, more frequent meals, reduce processed foods, increase protein and fibre intake, engage in regular exercise, and consider cutting out fizzy drinks and fatty and spicy foods.
But what’s exciting is that semaglutide is showing benefits beyond the waistline. “Studies have shown they offer a 20% reduction in various forms of heart disease in high-risk patients,” points out Dr Wolberg. “They also decrease the incidence of stroke by 39%, offer kidney protection, in addition, inflammation can be reduced by as much as 38%.”
Is semaglutide the future of obesity and diabetes treatment? It appears so, but only with medical guidance and a full health plan.
