A woman who says a diet pill has changed her life believes around half her friends are now on it too, losing weight. 

Pamela (not her real name), 54, said she was probably among the first in Malta to catch on to the Ozempic trend last April – before it took Malta by storm.

Ozempic, also known as Semaglutide, is an injectable prescription medicine used along with a healthy diet and exercise to improve blood sugar in adults with type 2 diabetes and to reduce the risk of heart attack and stroke.

But it is also being sought simply for weight loss purposes.

Pamela struggled with her weight all her life and said her metabolism had degenerated to "that of a 75-year-old". 

"You cannot understand what it means to be a fat person, walk into a shop to buy clothes, and find nothing fits you," she said. 

Stuck at a plateau of 85kg, Pamela said she was riddled with aches and pains and felt her body was shutting down. The weight just would not budge – no matter what she did.

She was ready to do anything and when she read the Hollywood headlines, she was determined to give Ozempic a go.

The drug was propelled to stardom by Sharon Osbourne, who also lost 20kg, then picked up by the Kardashians, and by last April, Pamela was using the pen, which could still be bought over the counter, four times a month.

Doctors caution that there are no long-term studies about Ozempic's impact on life expectancy, or of the drug's impact if taken by people who are not considered obese. 

Common side effects include nausea, with some patients unable to tolerate the drug and having to stop, as well as headaches, diarrhoea, constipation, abdominal pain and fatigue.

Serious side effects included gallstones, pancreatitis and an increased risk of thyroid cancer.

But those concerns have not discouraged people like Pamela from giving it a go. 

“If it was safe for diabetics and high-risk patients, I figured it would be safe for me too," she said. 

Under the guidance of a GP, and following blood tests, Pamela, who is borderline diabetic and on medication for a slow thyroid for the past couple of years, started on a low dose and has never taken the full amount out of fear of vomiting – a side effect of the drug that could be “traumatic” for the body.

Before she knew it, she started losing weight, but was at first cagey about the reasons why her body was finally transforming.

Eventually, when she saw how much Ozempic was helping her, she started telling overweight friends who were asking, or who were “stuck” in menopause and could not shift their weight. And the popularity of the drug exploded locally, she claimed.

Twenty kilos off the scales later, Pamela makes a case for the medication, saying it was hard for someone who had been struggling with weight all their life to understand what it meant to finally stop walking around with “two bags of oranges” in their arms, weighing her down and making her feel heavy.

She now describes the drug as the "magic pill" she always dreamt of finding. 

Prescriptions mandatory

Four months after she started taking Ozempic, the surge in uptake meant supplies were running short at pharmacies, Pamela continued, leading the government to make prescriptions mandatory to be sure diabetics did not run out of it.

“I panicked,” she admitted.

Stocks had run out earlier in Europe and English friends were asking to buy it here. In the US, people would cross over to Mexico to get it, she said.

“Fantastic” was the word Pamela now used to describe how she felt, following a painful childhood of being teased, bullied and unable to play sports, a lifetime of diets and weights peaking at 105kg.

“I have been XL all my life. Now, when I walk into a clothes shop and fit into size S jeans, I literally do a dance of joy in the changing room and the salesgirls wonder what I’m on about.”

Seven months after starting, Pamela had dropped 20kg, and now, at 65kg, she may still see her old self in the mirror, but her clothes size indicates otherwise, and she has had to alter her entire wardrobe.

“The tailor has told me she cannot take my suits in anymore as they are losing shape with the number of alterations.”

Pamela is far more confident and a “new person at work, at home, on holiday. I am totally different in every situation and all for the better.

“Even from the pain point of view, I do not suffer half as much as I did with my back.”

The drug does not come cheap. At €130 a pop, it is out of reach for the vast majority of people. 

Now, when I walk into a clothes shop and fit into size S jeans, I do a dance of joy

Ozempic lowers blood sugar levels by mimicking a hormone involved in blood sugar regulation. It also slows down food's movement through the stomach, leading to a reduction in appetite - and therefore weight loss. 

As things stand, Pamela says she has no appetite and she eats just three meals a week.

“I never get hungry and eat nuts, yoghurt and fruit,” she said, although she still goes to restaurants, sprinkles chocolate on her cappuccino and adds sweetener too.

“I am no longer a chocoholic; I will eat one chocolate as opposed to four,” she said.

As with most other drugs, its impact ends the moment a user stops taking it. That means users must either continue taking it, or train themselves to eat less once off it if they are to avoid an ‘Ozempic rebound’ - piling the weight back on once they stop taking it.

Pamela says her new-look body is motivation enough.

“When you lose so much after being overweight all your life, you are encouraged to keep it that way”.

Asked if she was afraid of unknown repercussions, Pamela said she got the “stamp of approval” when she visited her gynaecologist with her routine blood tests in hand.

He was silent as he looked at them; then told her she could stop all medication she was on and, bewildered, asked her what she had done.

Pamela was “afraid” to tell him she was taking Ozempic, but he was pleased she had “braved it”, saying “you would have come to me in 10 years as a diabetic and a heart patient”.

Her results were normal for the first time in 14 years, and it was music to her ears.

“I am not entering my 60s as a diabetic or cardiac patient. At least I got myself in order. My message is that it is beneficial to move into your 60s a bit healthier. We are all looking better.

“My pharmacist is monitoring me; he has been like my bodyguard for the past eight months,” Pamela said.

Now, her doctors have told her to stop before she loses too much weight and starts “looking ill” – as people are prone to ask.

“I will not be negative about this when I fought so much to lose this weight. Ozempic changed my life. I feel more empowered.”

Doctor’s orders

You could go to the doctor with the wrong reasons to take Ozempic, but it could still be OK, according to longevity medicine specialist Philip Borg – as long as it was used in the correct medical context and with the correct subset of patients.

Drugs like Ozempic, Wegovy and Mounjaro have a role in reducing weight – always, however, in combination with lifestyle changes, Borg insisted, and with the correct patient selection.

That would be people with a body mass index (BMI) of 30 or higher (obesity), or BMI above 27, especially with evidence of insulin resistance and other health conditions related to weight, such as high blood pressure, high cholesterol or obstructive sleep apnoea.

While licensed for type 2 diabetes, it could be used for overweight people, improving health outcomes, he said, explaining that conditions related to being overweight and obese included the risk of cardiovascular disease, stroke and cancer.

Borg insisted, however, that not all weight loss was healthy.

“To improve health, we want to lose fat, not muscle,” he explained.

Resistance training and a high-quality protein intake were, therefore, vital to increase muscle mass and bone density because the drug led to the loss of muscle, apart from fat.

Shedding excess fat mass had many beneficial effects on health, while shedding lean mass – which included muscle and bone – was associated with poorer health and a reduced lifespan.

To improve health, we want to lose fat, not muscle- Longevity medicine specialist

A consultant cancer interventional radiologist at Manchester’s Christie Hospital, Borg, who is the pioneer of longevity medicine both in Malta and the UK and has opened a longevity clinic at Saint James Hospital, has so far only prescribed Ozempic to a couple of patients here. But he believes its popularity has increased in Malta over the past year.

He said most patients asking about Ozempic were not diabetic but wanted to lose weight.

These drugs were sometimes prescribed to patients who were not obese, Borg acknowledged, adding doctors needed to take a proper medical history, be selective and follow up.

The risk of doing nothing

But the risk of doing nothing if “massively overweight” cannot be underestimated, Borg insisted, adding this could lead to dropping dead from a heart attack or stroke and an increased risk of cancer.

Obesity is on the increase, and by 2035, 50 per cent of the world’s population will be overweight or obese. And Malta is topping the European charts.

So, even if losing weight to feel better was the ultimate goal, it would be OK to take Ozempic so long as the patient was actually overweight and at increased risk of diseases, Borg said.

Pointing out the failure to educate about the importance of decreasing calorific intake, Borg said that from the health economic point of view, obesity was a “time bomb”.

The cost of Ozempic was nothing compared to the state’s spend on, for example, stents for heart conditions.

From the health economic point of view, obesity is a time bomb

Prevention is better than cure and it is cheaper to treat obesity before the complications around it arise, Borg continued.

“I can see a future where Semaglutide or Mounjaro become widely prescribed by governments because it makes sense from the economic point of view.”

While giving the “miracle drug” a clean bill of health, Borg also highlighted the downsides of Ozempic, which included the monthly cost and the fact that most patients will put the weight back on when they stop using it.

The question is: do they need to continue for life?

Because they may need to be on it for long periods, there are also cost implications, while the weekly injectable has to be refrigerated and this could prove problematic logistically, such as for frequent flyers.

“We also do not have any data of use in patients who are not overweight or obese as no studies have been carried out,” Borg highlighted, adding that long-term data on whether Ozempic is actually increasing people’s lifespans is still lacking.

“Only time will tell.”