After giving birth to her third child, 31-year-old Donjete Maloku from Prishtina tried to maintain a certain weight but couldn’t. A financier by profession, Maloku learned about Ozempic through social networks, a drug used to treat type 2 diabetes that also promotes weight loss. Last year, she chose this drug as an easy way to manage her weight.

“I haven’t engaged in physical activities because it’s too tiring. I wanted something easier and faster,” she said.

Maloku didn’t consult any specialists before using the medication. Instead, she bought it at a pharmacy in Prishtina, following a relative’s recommendation, who had “assured” her there would be no problems.

“I used it last year and over three consecutive months, I lost 18 kilograms,” she said. She knew Ozempic was a medicine for people with type 2 diabetes but believed and hoped it wouldn’t cause any health problems. However, after starting the medication, she experienced nausea and was bedridden for several days. “Then, my body adjusted to it. On the first day I took it, I fell asleep because I felt so tired,” she added.

Over the last three years, Ozempic has dominated social media as a quick fix for weight loss, even though this isn’t its intended purpose. In 2017, the U.S. Food and Drug Administration (FDA) approved Ozempic to treat type 2 diabetes. Ozempic contains the active ingredient semaglutide, which not only regulates blood sugar levels but also helps control hunger. Semaglutide slows gastric emptying and extends digestion time. This mechanism increases satiety and reduces appetite, leading to a lower calorie intake.

In June 2021, the FDA approved a higher dose of semaglutide under the brand name Wegovy, specifically for chronic weight management. As the role of semaglutide in weight loss gained attention, global interest in using it grew. However, this medication should only be used under specialist supervision, as it can cause side effects and contraindications in some users.

Nausea, fatigue and lack of energy led Maloku to stop using Ozempic after three months. These side effects are also listed in the FDA approval document. Maloku said that after stopping Ozempic, she regained the weight, and now she not only avoids the drug but also advises others against using it.

“Now even remembering its smell, I feel pain,” she said. Due to the use of Ozempic, she also suspects that her vision worsened.

“Sometimes my vision blurred and I believe my eye prescription increased after using Ozempic. I haven’t proven that Ozempic was the cause, but I did change my glasses. I think it was because I often experienced a loss of vision when I was using it,” she said.

In a two-year trial documented by the FDA on the side effects of Ozempic, 3% of patients with type 2 diabetes experienced complications related to retinopathy, compared to only 1.8% of patients given a placebo. Retinopathy is a condition affecting the retina, the inner layer of the eye that senses light and sends visual signals to the brain.

The FDA recommends starting the drug at a dose of 0.25 milligrams, which can be increased to one milligram after eight weeks.

The popularity of Ozempic comes in response to one of the biggest public health problems: chronic obesity. The World Health Organization estimates that the number of people who are overweight and obese are rising in most countries, affecting both adults and children. Several factors contribute to obesity, including lifestyle choices, the consumption of calorie-rich and fatty foods, lack of physical activity, sedentary habits and socio-economic factors.

Being overweight is linked to a number of chronic diseases and health problems, including cardiovascular disease, type 2 diabetes, some types of cancer and other conditions. This makes the prevention and management of obesity an important health priority in many countries.

There are several ways to prevent obesity, such as healthy eating, balancing calories, consuming fruits and vegetables and, most importantly, engaging in regular physical activity. However, these options are not always feasible due to the demands of daily life. As a result, people often seek easier and faster methods to lose weight.

This is how Blend Zymi, a 38-year-old businessman from Prishtina, began using Ozempic a year and a half ago and has continued ever since. He started using it without a doctor’s prescription, even though he knows the medication is intended for people with type 2 diabetes.

“I don’t go to the doctor because I’m afraid he will stop me from using it,” Zymi laughed.

Zymi is a big fan of food. “I love it very much. I have a big appetite and it’s a habit,” he said. He chose this drug as an easy way to lose weight, as he hadn’t even managed to shed any pounds jogging in Germia Park early in the mornings.

“I don’t remember who mentioned Ozempic to me, but I went and bought it at the pharmacy. I started with a dose of 0.25 milligrams and increased it to one milligram after eight weeks. I’ve been using it for a year and a half now,” he said. Unlike Maloku, Zymi stated that he has not experienced any problems with this medication. The initial problems, such as diarrhea and headaches, have faded over time.

“It has completely changed my life. I’m no longer stressed, I’m much calmer,” said Zymi.

Zymi knows that Ozempic is intended for people with diabetes, a condition he does not have, but he said he undertook this risk knowingly. He now sources Ozempic from abroad through his company because it is cheaper. He takes a one milligram dose once a week, which keeps him feeling full all the time.

Both Maloku and Zymi bought Ozempic in pharmacies in Prishtina without a doctor’s prescription. As a result, the Ministry of Health’s Pharmaceutical Inspectorate conducted inspections and found that pharmacies began selling Ozempic without a doctor’s prescription in 2022. In the last three years, authorities have imposed 18 fines. Additionally, in 2023, inspectors issued two fines based on suspicions that products sold as Ozempic were illegal and counterfeit.

Ozempic has received permission to be sold on the Kosovo market as a medicinal product. The Agency for Medicines and Medicinal Products issued a Marketing Authorization for Ozempic in 2021 for three doses: 0.25 milligrams, 0.50 milligrams and one milligram. Pharmacies sell this product for 135 euros for a “pen” that contains four needles, enough for the doses prescribed by a doctor for one month.

Over the past two years, there have been ongoing reports of Ozempic being sold without a prescription in Prishtina’s pharmacies, with prices reaching up to 90 euros. Additionally, reports indicated that endocrinologists prescribed the drug for weight management even without approval from the FDA or European Medicines Agency.

Ozempic should not be prescribed for weight loss

Doctors do not prescribe Ozempic exclusively for weight loss, as the drug is intended for people with type 2 diabetes.

Type 2 diabetes is a complex chronic disease marked by elevated blood sugar levels, caused by insulin resistance and later by reduced insulin production. The main risk factors for developing this disease include obesity, genetic factors and the use of certain medications. Type 2 diabetes can also lead to complications in the eyes, heart and lower limbs due to hyperglycemia. Patients with this disease can be treated with other medications that are less expensive than Ozempic.

Merita Emini-Sadiku, an endocrinology specialist and director of the Clinic of Endocrinology at the University Clinical Center of Kosovo (UCCK), explains that Ozempic works by mimicking incretins, which are gut-derived hormones that promote insulin secretion and help regulate weight. In patients with type 2 diabetes, these incretins are unstable, leading to issues with insulin regulation and weight management.

Emini-Sadiku adds that clinicians only prescribe Ozempic to non-diabetic patients when they have insulin resistance that could lead to type 2 diabetes. In these cases, prescribing Ozempic aims to reduce insulin resistance.

She added that patients with insulin resistance initially produce too much insulin. However, it becomes ineffective, preventing glucose from entering the cells, which causes blood sugar levels to rise. Emini-Sadiku explains that this condition is the first indicator of type 2 diabetes. While overweight individuals may have insulin resistance, their blood sugar levels often remain normal. She also mentioned that, while they receive requests to prescribe the drug for weight management purposes, they do not approve them.

Ozempic does not reduce weight by burning fat but instead stimulates other processes in the body that lead to weight loss. Emini-Sadiku explained that Ozempic works by entering the bloodstream and signaling the brain’s satiety center, making patients feel full shortly after starting treatment. Over the following weeks, patients feel less need for food and eat less, leading to a calorie deficit.

“Consequently, the body needs to burn other substances and start using fat tissue, but not to the extent that it induces ketogenesis. All of this happens naturally, mimicking a normal process,” she explained. Ozempic also slows down the movement of food through the intestines, causing food to stay in the system longer.

She added that Ozempic also helps prevent serious cardiac events and supports kidney health.

According to Emini-Sadiku, Ozempic also causes side effects, primarily gastrointestinal issues such as vomiting, nausea, diarrhea and constipation. These impact about 30% of patients. Less common side effects include acute pancreatitis, worsening of kidney stones and eye maculopathy.

The decision to take Ozempic without consulting specialists goes beyond whether or not one has diabetes — Ozempic can pose serious health risks for certain individuals based on family history and health conditions. In medicine, not all treatments or drugs are suitable for every patient. These situations are known as contraindications, and are divided into two groups: absolute, where the patient should not be treated with that method or drug due to a higher risk of harm than benefit, and relative, where the treatment is used but with extra caution.

Ozempic has absolute contraindications. Emini-Sadiku emphasized that people should not use this medication without consulting a doctor.

“Ozempic is contraindicated for patients at risk for medullary thyroid cancer or multiple endocrine neoplasia,” she explains. “These are instances where Ozempic is completely contraindicated and we always avoid prescribing it to those patients, even if they are obese with type 2 diabetes.”

Emini-Sadiku said that these cases are identified through anamnesis, family history and thyroid ultrasound to see if the patient has any nodules that they may never be aware of. And the use of Ozempic, although it does not cause thyroid cancer, would make it worse in those who are predisposed, especially if there is a family history of the disease. According to her, this is one of the key reasons why Ozempic should not be used without an endocrinologist’s recommendation.

Feature Image: K2.0 via cc.

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