I've read (anecdotes from people in the fitness/body-building space) that the default dosing could be too high for many people. And the side-effects seem to ramp up with the dose.
IE, if you're getting weight loss at 1/2 the default dose, you might want to stay there, even if your MD wants you to increase to the default.
[default uses loosely here - people build up from a low dose over the span of weeks/months]
And the weight gain is due to a lack of lifestyle change. The drug just numbs your appetite, so you don't eat as much. If you go off the drug and return to over-eating, yep, you gain the weight back.
I also suspect many people lose the weight too fast and go too far. "Ozempic butt" is a joke for a reason - people loose a bunch of fat, but the massive calorie deficit also means they aren't exercising (no energy, and they probably weren't before the drug either), so they've probably crashed their metabolism.
I tried it. I started down about 80 lbs from my heaviest, but a good 40 lbs from ideal/20 lb from healthy weight.
The first time I tried it I followed dosing guidelines for ramp up; side effects were horrible, didn’t lose much weight, and it just kept getting worse.
Second time, after a few months off, I started at lowest dose and stayed there. Side effects were better to start but ramped up again. Eventually my digestion stopped entirely and I couldn’t eat without pain; that actually was good for weight loss but very unhealthy (e.g. despite being hungry and lightheaded the pain kept me from eating more than 400 calories). Eventually it passed but I couldn’t justify taking it after that.
Basic side effects: exercise intolerance (higher starting rate, much faster increase exertion, chest pain after ~150bpm when previously I could run nearly an hour and go up past 180 without issue), fatigue in the morning (despite essentially maintaining my pre-ozempic nutrition), significant increase in resting heart rate, significant decrease in HRV, and digestive upset (basically alternating diarrhea and constipation).
Many of these side effects are well known, others less so.
Ozempic, when micro dosed, did help reduce hunger and make a weight loss diet easier to sustain, until the side effects got so bad I wanted to comfort eat. But mindfulness and healthy lifestyle are similarly effective without crippling side effects.
Try Zepbound. You lose more weight with far fewer side effects.
Although, you may still have issues. It does just sound like there's something unique about your chemistry. I don't think that many of those side effects are even in the ballpark of normal.
I would like to try it, but I don’t think it is available from shady internet doctors and insurance won’t cover it because I’m not diabetic. Shady internet ozempic passes the cost-benefit test (barely, considering I can successfully lose weight without it it’s just hard). Full cost out of pocket it does not. Maybe in a few years.
I would worry that the side effects I care about are not the side effects that others report being improved on zepbound.
Protip: Get an ultrasound on your liver. Almost every obese person has (what used to be called) fatty liver, and that's usually enough to justify the prescription to your insurance company.
Have you looked into Tirzepatide? Basically a combo of ozemspic plus a GIP drug. Again, anecdotes from bro-science, but appears to allow lower dosing and reduced side-effects.
Very much the default is too high and the bro-science was indeed early on this. I’m super sensitive and had the bad negative reactions at 1/10th the starting dose. It’s been a wonder drug for me though, finally able to put my life back together after ME/CFS all but destroyed it.
IE, if you're getting weight loss at 1/2 the default dose, you might want to stay there, even if your MD wants you to increase to the default.
[default uses loosely here - people build up from a low dose over the span of weeks/months]
And the weight gain is due to a lack of lifestyle change. The drug just numbs your appetite, so you don't eat as much. If you go off the drug and return to over-eating, yep, you gain the weight back.
I also suspect many people lose the weight too fast and go too far. "Ozempic butt" is a joke for a reason - people loose a bunch of fat, but the massive calorie deficit also means they aren't exercising (no energy, and they probably weren't before the drug either), so they've probably crashed their metabolism.