A New York dermatologist coined the phrase “Ozempic face” to describe the sagging, deflated facial features that develop after weight loss achieved with the drug semaglutide, a glucagon-like peptide, or GLP-1, agonist sold by Novo Nordisk as Ozempic for type 2 diabetes or Wegovy for weight loss. Ozempic users typically lose 10-16 pounds, more with the higher-dose Wegovy. The drugs are injected once weekly, accompanied by nausea and vomiting in 50% of users, can increase risk for thyroid cancer and pancreatitis, and cost around $1000-$1500 per month. Although initially approved only for type 2 diabetes, the weight loss effect has caused a shortage of the drugs in some locations, since people eager to lose weight have emptied pharmacies.
But this phenomenon highlights several drawbacks of losing weight by this route:
- GLP-1 drugs work by reducing appetite and thereby calorie intake. Weight loss achieved by reduced calorie intake are associated with loss of muscle. For every 10 pounds lost, about 3 pounds are from muscle loss. This is not a benign phenomenon, as it is associated with reduced metabolic rate that makes future weight loss more difficult, sometimes impossible. It is also associated with increased mortality, despite the benefits of fat loss.
- Most of the fat lost is from subcutaneous fat in the buttocks, thighs, chest, arms, and, yes, face, less lost from abdominal visceral fat. This is a problem because nearly all the problems associated with overweight and obesity are not due to subcutaneous but to abdominal visceral fat. Abdominal fat that surrounds the intestines, liver, pancreas, etc. is responsible for most of the health problems associated with excess weight such as insulin resistance, hormonal disruption, and increased potential for type 2 diabetes, high blood pressure, heart disease, cancers, and cognitive decline/dementia. Weight loss with GLP-1 agonist drugs improves modestly on this profile with an approximate 50:50 loss of subcutaneous:visceral fat. Because there is subcutaneous fat lost with most diet and GLP-1 agonists, the loss of facial fat is an issue that can provide the appearance of accelerated aging.
Of course, dermatologists are stumped since their thinking rarely goes beyond topical steroids and filler injections. They are therefore advising people with the sagging skin of Ozempic face to undergo costly cosmetic procedures to remedy the appearance of accelerated aging. It’s the typical healthcare paradigm: “treat” with pharmaceuticals and procedures, then introduce more pharmaceuticals and procedures to fix the problems that result. After all, healthcare is about money, not health.
Wouldn’t it be better to lose weight with a method that specifically favors loss of abdominal visceral fat and thereby yields greater metabolic improvements while not causing loss of subcutaneous fat from your face? You achieve this by addressing insulin resistance through changes in diet (eliminating foods that provoke insulin such as wheat, grains, sugars), addressing common nutrient deficiencies such as magnesium, omega-3 fatty acids, iodine, and vitamin D that influence insulin responses, then managing your gastrointestinal microbiome, i.e., all the strategies we use in my programs and outlined in my books and DrDavisInfiniteHealth.com website. There is therefore less loss of subcutaneous fat from areas such as the face, since normalizing insulin responsiveness favors loss of abdominal fat. There is also little to no loss of muscle mass.
Go a few steps further and engage in strategies that increase dermal collagen and preserve or increase muscle mass, as outlined in this previous blog post. Losing weight this way is inexpensive, yields a long list of other health benefits, no costly fillers or other procedures required to compensate.