An examination of user reviews finds that people continue off-label Ozempic when it delivers results, even if side effects persist.
Study: Patient Perceptions of Ozempic (Semaglutide) for Weight Loss: Mixed Methods Analysis of Online Medication Reviews. Image credit: Alex Malt/Shutterstock.com
A recent study in the Journal of Medical Internet Research examined patients’ experiences with off-label Ozempic use for weight loss and identified factors that influence user satisfaction and treatment discontinuation.
The Growing Obesity Crisis and Treatment Landscape
Obesity is a chronic metabolic disease characterized by excessive body fat accumulation and is associated with a higher risk of cardiovascular disease, type 2 diabetes (T2D), and cancer. Since 1990, obesity rates have more than doubled worldwide, driving a corresponding increase in weight-related chronic diseases.
Although lifestyle modifications, including dietary interventions and physical activity, remain the recommended first-line approach for weight management, these strategies often fail to produce desirable results. Besides lifestyle interventions, bariatric surgery has exhibited promising results for many patients; however, this strategy poses substantial risks of morbidity and mortality. In contrast, glucagon-like peptide-1 receptor (GLP-1R) agonists have emerged as an obesity treatment, offering significant weight loss and meaningful improvements in associated health outcomes.
Semaglutide is a GLP-1R agonist that regulates blood glucose levels through multiple mechanisms, including suppressing glucagon release, activating insulin secretion, delaying gastric emptying, and modulating brain pathways that control appetite and satiety. The first FDA-approved formulation of semaglutide was marketed as Ozempic.
Clinical trials on Ozempic demonstrate reductions of 7.9 % to 17.3 % in body weight, decreases in HbA1c levels, and reductions in waist circumference and blood pressure. Despite the fact that Wegovy is the FDA-approved semaglutide formulation specifically designed for obesity treatment, mainstream and social media platforms promoted off-label Ozempic use for cosmetic weight loss.
Although semaglutide treatments have shown significant efficacy in weight loss, approximately 41.9 % to 82.8 % of patients experience gastrointestinal complaints such as nausea, vomiting, constipation, and diarrhea. Other adverse events reported in trials include headaches, allergic reactions, and gallbladder-related complications. This creates a critical tension between achieving weight loss goals and tolerating side effects, making adherence a central challenge in optimizing treatment outcomes.
Study Design and Data Source
A mixed-methods infoveillance approach, combining quantitative data with qualitative analysis, was adopted to examine attitudes toward Ozempic among individuals with lived experience of off-label use. Researchers conducted a thematic analysis of user-generated reviews posted on Drugs.com, followed by quantitative modeling to assess how emergent themes were associated with perceived efficacy and treatment discontinuation.
This methodology enabled the discovery of unexpected patterns without predetermined hypotheses, capturing authentic patient voices through publicly available online data. The current study collected data in the form of reviews from Drugs.com, an independent medication information platform serving over 24,000 drugs. The site allows users to provide narrative feedback and numerical effectiveness ratings on a 1-10 scale. Reviewers described their experiences, including benefits, adverse effects, and dosing details, but did not provide demographic information.
The authors obtained data in June 2023, with reviews dated from February to June 2023, and no retrospective time limit was imposed. Of 78 total reviews, 60 were analyzed before reaching thematic saturation. The analysis proceeded in two phases. First, researchers identified themes from narrative reviews using inductive coding. Second, they tested statistical relationships between these themes and user satisfaction scores or discontinuation decisions.
Weight Loss Effectiveness, Not Side Effects, Drives Treatment Decisions
Thematic analysis of 60 user reviews revealed three major themes. Theme 1 encompassed weight-related outcomes. Forty of 60 respondents (67 %) reported reductions in weight, appetite, or cravings. Specifically, 33 of 60 (55 %) reported weight loss at some point during treatment. Weight loss was the most common outcome, with median satisfaction ratings of 8.5. Around 37 % of users also experienced appetite suppression, while 13 % reported reduced cravings for sugary and greasy foods.
However, 18 % of users experienced minimal weight loss or weight rebound. Some users found that initial benefits eventually plateaued or reversed over time, a pattern that mirrors clinical trial extension data showing weight loss often plateaus after approximately one year of semaglutide therapy.
Theme 2 encompassed side effects. Around 80 % of users reported non-weight-related symptoms, including gastrointestinal complaints (62 %) such as nausea, vomiting, and constipation, and other physiological symptoms (67 %), including headaches, gallbladder complications, dehydration, anemia, and dizziness. While gastrointestinal symptoms were common, they did not significantly influence satisfaction ratings or decisions to continue treatment. Two respondents reported worsening depressive symptoms during treatment. Only 13 % reported no distressing side effects.
Theme 3 addressed treatment continuation. Of 20 respondents, 6 planned to continue despite side effects, with a median rating of 9.0, while 14 planned to discontinue with a median satisfaction rating of 3.0. Users who gave high ratings were more likely to report weight loss and appetite suppression. Those who gave low ratings more often experienced minimal weight loss, other physical symptoms, and planned to stop treatment. Stomach-related side effects were common in both groups. All users planning to continue treatment reported weight-related benefits, while both continuing and discontinuing users experienced similar rates of adverse events.
Across the 54 respondents who provided numerical ratings, responses were bimodal, with more than half (52 %) rating Ozempic either 1 or 10, reflecting polarized experiences. Statistical analysis also confirmed that the 60-review analytic sample did not differ significantly from the broader 78-review dataset available at the time of collection.
Tolerability matters less than results
The current study findings highlighted that users' decisions about continued Ozempic treatment depend primarily on perceived weight-loss efficacy, despite the high prevalence of adverse events. While most users reported positive weight-related outcomes, including weight loss, appetite suppression, and reduced cravings, a notable subset experienced minimal benefits or weight rebound over time.
Importantly, dissatisfaction and discontinuation were more strongly associated with minimal weight loss and nongastrointestinal side effects than with common gastrointestinal complaints, suggesting that for many users, perceived effectiveness outweighed tolerability concerns.
The authors also note important limitations, including the self-selected and anonymous nature of online reviews, the lack of demographic, dosing, or treatment-duration data, and the inability to independently verify clinical outcomes or adverse events. These insights underline the importance of setting realistic expectations with patients about both the potential benefits and limitations of GLP-1R agonists for weight management. They also highlight how online health platforms can offer complementary, patient-centered insights that may not be fully captured in traditional clinical trials.
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