While the weight loss may be welcome, gaunt, sallow-looking skin is less so. Known as ‘Ozempic face’, this is actually nothing to do with the medication and ‘all to do with the rapid weight loss’, says Dr Sharon Wong, a dermatologist in London.
‘The loss of fat and collagen in the skin – and elasticity – results in a more sunken appearance, with noticeable sagging and wrinkles. This is a particularly common side effect when people maximise their dose in an effort to achieve weight goals quickly – however, the faster you do this, the more likely the so-called Ozempic face will appear,’ she adds.
Charlotte Foster, a dietitian at Barts NHS Trust, says: ‘To minimise the loss, lose weight gradually – ideally 1lbs to 2lbs per week; this gives skin time to adapt, protects muscle and reduces the risk of sagging.’
Your diet is also important, as your appetite is reduced, you need to ensure that what you do eat is nutrient dense, such as fruits, vegetables, wholegrains, oily fish, beans and lentils, she explains.
‘Keep hydrated, too. Water is vital for skin elasticity, digestion, energy and overall health.’
London-based dietitian Emer Delaney adds: ‘Most important is protein – aim for around 1-1.5g per kg body weight per day.’
Losing too much muscle
A significant amount of the weight you lose is muscle – not fat. This is important as muscles burn calories when you’re at rest, too.
Muscle loss with GLP-1 drugs ranges from 25 per cent to 39 per cent of the total weight lost over 36 to 72 weeks, reported The Lancet Diabetes and Endocrinology journal last year. This is several times greater than muscle loss you’d expect through simple ageing past 40.
When you’re on weight-loss drugs, you need to ensure that what you eat is nutrient dense, such as fruits, vegetables, wholegrains, oily fish, beans and lentils
‘The reduced diet and nutrients mean muscle proteins break down faster than they can be built,’ says Dr Foteini Kavvoura, a consultant endocrinologist at the Royal Berkshire NHS Foundation Trust.
‘It has a knock-on effect on bones too; when weight loss is extreme and quick, we lose fat from inside our bones, just in the same way we lose fat from other areas.’
Muscle mass is not only vital for your metabolism – but also for muscle strength and independence, particularly as we age.
To minimise the loss, make sure you eat plenty of protein.
‘As well as meat, good sources of protein include eggs, beans, seafood, cheese, peas and nuts,’ says Ms Delaney.
‘The calorie restriction can make it difficult to consume the ideal amount so adding additional protein powder to a small pot of high-protein yoghurt – can really help.’
Professor Carel Le Roux, a professor of metabolic medicine at Ulster University, says: ‘Muscle loss can also be limited by exercise – particularly important in those over the age of 50, when you’re losing muscle anyway.
‘Resistance training such as squats, lunges, weight-lifting – even lifting water bottles in each arm – can help.’
‘Ozempic vagina’
That gaunt, saggy-skinned look that affects the face, can also affect the labia or vagina as a result of rapid weight loss.
‘Rapid weight loss on any body part can affect the skin over the fatty tissue lost – including the lower belly, mons pubis, and inner and outer labia,’ says Dr Sherry Ross, an associate professor of urology at the University of North Carolina.
While anyone can be affected by it, those more prone to the condition tend to be older women, whose skin has already lost its elasticity.
Pancreatitis
Clinical trials have shown users of GLP-1 drugs have a higher risk of pancreatitis – inflammation of the pancreas – possibly due to an overgrowth of cells in the pancreas.
‘Pancreatic inflammation is dangerous because the inflammatory process can cause complications such as cell death in the pancreas itself, potentially leading to sepsis and even death,’ says Dr Christian Macutkiewicz, a consultant general and hepato-pancreatico-biliary surgeon at Manchester Royal Infirmary.
‘Seek urgent medical attention if you have sudden severe and constant pain in your stomach area with or without vomiting,’ adds Dr Kavvoura.
Gallstones
Any rapid weight loss can increase the risk of gallstones as the liver secretes more cholesterol into the bile, which can crystallise into gallstones.
A 2022 review in the Journal JAMA Internal Medicine found that using GLP-1s increased the risk of gallstones, particularly when used for longer durations (26 weeks or more) at higher doses (1mg or more of semaglutide once a week) and purely for weight loss.
Paralysed gut
Using GLP-1s increases the risk of paralysed gut and symptoms such as vomiting, nausea and pain, reported the journal Pharmaceuticals in 2024. The research showed that liraglutide (Victoza and Saxenda) had higher odds of gastroparesis than semaglutide. The condition is reversible once you stop taking the drug.
Dermatologists are seeing an increasing number of people attending their clinics with hair shedding or thinning after using weight-loss drugs
Hair loss
‘While it’s not listed as a side effect of weight-loss medications, I see an increasing number of people attending my clinic with hair shedding or thinning after using them,’ says Dr Wong.
This is possibly caused by the dramatic weight loss – once the weight is stabilised and your diet has the optimum nutrients, the hair-shedding should gradually settle back to normal.
‘However, some experience hair loss without the extreme and rapid weight loss, suggesting there could be other mechanisms involved – such as a direct effect on hair follicle function,’ adds Dr Wong. ‘As an increasingly encountered problem, it’s an area that requires more research.’
Depression and suicidal thoughts
A study in Nature last year found there was 195 per cent higher risk of depression and a 106 per cent increased risk of suicidal behaviour in those taking GLP-1s – based on analysis of data from more than 162,000 patients.
The Medicines and Healthcare products Regulatory Agency, the UK drugs watchdog, concluded that there is no causal link between these medications and depression.
However, Professor Le Roux explains that while the drug itself will assist with physical weight loss, there’s no evidence it will improve mood or how you feel about yourself, so people shouldn’t take it in the belief it will.
‘GLP-1s must be taken under medical supervision,’ he adds, ‘so their patient’s medical history can be assessed before taking the drug’.
‘Ozempic teeth’
There are anecdotal reports of increasing numbers of people visiting their dentist with a range of oral side effects including tooth decay, inflamed gums and dry mouth after using weight-loss jabs; it’s thought the drugs could lead to an environment such as dry mouth that speeds up decay.
Vomiting, another side effect of the drugs, could erode the enamel, explains Mervyn Druian, a dentist at the London Centre for Cosmetic Dentistry.
