Considering Ozempic? Here’s what you should know.

For many of us, the battle with the scales is one we’ve waged all our lives – watching our mothers squeeze at their bellies despairingly, subjected to tabloids that criticise very normal bodies for the sin of cellulite, and the 10lbs we’d give anything to lose so we could fit into that pair of trousers we looked great in during our early 20s.

If you’ve battled with weight all your life, drugs like Ozempic or Wegovy may seem like a lifeline. A lifeline, which in Hong Kong, is about to get a whole lot cheaper.

In March 2026, the patent for GLP-1RAs like Ozempic and Wegovy expired in Hong Kong, China and India among other countries. This means Novo Nordisk, the original creator, no longer has a monopoly on selling the drug – it’s going generic, which will mean more affordable versions will arrive on the market. United Laboratories, a leading Chinese pharmaceutical company intends to go live with its generic before July this year.

According to the New York Times, analysts have suggested that the price for generics could eventually drop as low as $15 a month. At an ankle-scraping price, it’s likely that the 50% of us considered overweight in Hong Kong could turn to GLP-1RAs as a way to manage their weight.

How do GLP-1s help with weight loss?

Ozempic and other weight loss injections are glucagon-like peptide-1 receptor agonists (GLP-1RAs) which mimic the natural hormone GLP-1 by activating its receptors. There are several on the market, including semaglutide (Ozempic and Wegovy), tirzepatide (Mounjaro) and liraglutide (Saxenda).

The natural hormone GLP-1 is released in your gut when you eat. It slows digestion to manage blood sugar levels and prolongs your feelings of fullness. GLP-1RAs are more colloquially known as GLP-1s.

When you take a GLP-1 it binds to receptors in the pancreas, brain and gut. In the pancreas, it prompts the production of insulin, which turns food into energy and helps store excess glucose in the liver as glycogen for later use. It also helps reduce glucagon levels, preventing blood sugar spikes.

GLP-1s slow digestion and the emptying of the stomach, promoting feelings of satiety after eating. They also suppress the hunger hormone ghrelin and reduce your appetite, leading to lower caloric intake and weight loss.

A 2021 study on semaglutide indicated that 86% of participants achieved weight loss of 5% or more, with an average of 15% loss in body weight, which was achieved by 50% of participants. A 2022 study showed that over a 72 week period tirzepatide could decrease body weight by 15 – 20% depending on the dose.

Despite the glowing results from these clinical trials, real world results paint a vastly different picture. A 2023 study which followed people taking semaglutide for 52 weeks outside of the clinical environment showed that they only lost on average 4.4% of their body weight.

Additionally, this ‘miracle drug’ doesn’t work for everyone. 14% of participants in the 2021 study did not even achieve 5% weight loss, and studies show that around one in 10 people are what is known as ‘non-responders’ – GLP-1s don’t work on them.

Side effects of GLP-1s

In the 2021 study, 4.5% of participants taking semaglutide dropped out of the study due to stomach problems; in the research conducted in 2022, an average of 5.8% of participants dropped out due to side effects.

The most common side effects of GLP-1RAs are gastrointestinal issues. “Among my patients who are on Ozempic, the most common side effects are stomach pain, digestive discomfort and diarrhoea,” confirms Naturopathic doctor Ardyce Yik.

In a study of 300,000 people, 9% experienced vomiting and nausea; 0.53% experienced stomach paralysis – a small percentage, but those taking GLP-1s were 66% more likely to develop this symptom; 7.5% had reflux and were 52% more likely to have this symptom than the control group.

Constipation, stomach pain, poor nutrition, headaches, hair loss and pancreas problems are also side effects of GLP-1s. Tirzepatide can decrease the effectiveness of oral contraceptives, and you should use condoms when you start taking the drug, and whenever you increase your dose. These drugs are very new, so it’s hard to accurately define how common these symptoms are, as well as the long-term effects.

GLP-1s can reduce your muscle mass. “When you lose weight rapidly or through severe caloric restriction, you will lose both fat and lean muscle mass,” says Dr Ardyce.

Studies have shown that around 20% of the weight that you lose is fat-free – meaning it comes from muscles, bones and other tissues.

“And when weight is regained, which is usually the case when you stop taking GLP-1s, it is typically regained as fat,” she adds.

What happens when you stop using Ozempic?

To maintain weight loss, GLP-1s are intended as a lifelong medication, but the research reports that they’re not used this way. Studies show that after one year, 47% of patients discontinue use, and after two, 70% of patients have stopped use.

The amount of activity created by GLP-1s is superhuman compared to our natural hormonal levels. That’s why doctors recommend tapering your doses off, rather than going cold-turkey. Stopping GLP-1s, even if you do decrease your dosage over time, can be shocking as you experience going from having very little appetite, to being overwhelmed by the return of hunger which was suppressed by the drug – this is particularly notable for those who experience repetitive, intrusive thoughts about food.

“Often, people with food addictions reach for food often uncontrollably without knowing why. To break the cycle, I look beyond the action and I help the patient map the triggers and identify the "payoff" in order to understand what the behaviour is trying to achieve or soothe,” says Dr Ardyce.

“Food addictions could be a coping mechanism to deal with stress, anxiety or depression, or it could have stemmed from environmental conditioning, like if good behaviour was rewarded with food, or if emotional intimacy was replaced with food during childhood,” Ardyce says.

“Due to a combination of physical and psychological factors, most of my patients regain the weight they lost after they stop using the drug if they don’t have the proper support,” she adds.

The research proves this - the University of Cambridge meta-analysis showed that among 3,000 participants taking GLP-1s, 60% of the weight they lost was regained.

A review by University of Oxford researchers supports this. It evaluated 37 studies on over 9,000 participants. On average the participants were on the weight loss drug for 39 weeks, and their progress tracked for 32 weeks after ending treatment. After coming off the GLP-1 the participants gained on average 0.4kg per month. This was faster than those using a lifestyle intervention like diet or exercise by 0.3kg per month.

It was predicted by researchers that it would only take 1.5 years for those taking weight loss drugs to return to their original weight.

If most taking Ozempic come off the weight loss drug within two years, could this create a cycle of yo-yo drug use – will this be the new, costly version of yo-yo dieting?

“Cyclical weight loss and weight gain often leads to a higher concentration of visceral fat, which is the deep belly fat around your internal organs. Visceral fat isn’t passive either – it functions as an endocrine organ, releasing hormones, increasing inflammation. It’s associated with serious, chronic health conditions,” says Ardyce.

Why do you regain the weight?

By implementing diet and exercise regimens while you’re taking GLP-1RAs, you can help create new patterns and routines when you don’t have your appetite driving your food choices. But, the key word is can – and the truth is, it’s not easy to mitigate weight regain without proper support. The physical and psychological effect of coming off a GLP-1 can be overwhelming.

After you come off a GLP-1, your body will fight for you to regain that weight. Unfortunately, it doesn’t understand the many risks that excess fat poses– it only registers fat = energy. Weight loss = less resources. Less resources = more threat to survival.

“The physical restriction of food is a biological stressor and the psychological frustration of regaining weight is an emotional stressor. Both types of stress trigger the continuous release of cortisol, the body's primary stress hormone that, if chronically high, further promotes the storage of visceral fat and increases cravings for highly palatable, sugary, fatty foods,” says Dr Ardyce.

Additionally, when you lose weight, your metabolism will slow, and you’ll burn fewer calories at rest, or when performing the same task before you lost the weight. “Strength training can act as a preventative measure, increasing your metabolism,” says Dr Ardyce.

“For many, GLP-1s won’t treat hidden, underlying factors that could be leading to weight gain, like hormonal imbalances, food intolerance and SIBO. In these instances, GLP-1s simply mask the symptom (weight gain) rather than treating the root cause,” she adds.

In summary

Ozempic and weight loss drugs have moved into the limelight. With celebrity endorsements, from Oprah Winfrey to Whoopi Goldberg and Meghan Trainor, you might be considering whether the weight loss drug is right for you.

Though they have been shown to help many people lose weight and improve cardiovascular outcomes, there are possibilities these drugs won’t work for you. The side effects may prove too much, or you could be one of the 10% who are non-responders.

If you decide that this is the right route for you, it’s important to implement diet and exercise changes to help maintain weight loss and muscle mass.

 “When supporting clients taking GLP-1s, I recommend that they add a protein powder to their supplement regimen. This is essential for preserving lean muscle mass during rapid weight loss, especially when food intake drops significantly,” says Ardyce.

“As well as reducing your appetite, GLP-1s can also inhibit natural signals for thirst. Electrolytes help prevent fatigue and dizziness that can occur when food or fluid intake drops,” she adds.

“And, when you’re eating less, it’s possible that you could develop nutritional imbalances – multivitamins help replenish any gaps while you’re taking GLP-1s.”

“The lifestyle changes and supplements in the weight loss management programme I run are designed to support metabolism and curb cravings. During the month-long programme, I work with patients to address the underlying cause of their weight gain, so that they reach a new equilibrium,” Ardyce adds.

Whether you choose to take a GLP-1, or not, weight loss is best achieved alongside someone who can personalise your treatment plan to meet your body’s unique needs.

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