Can You “Lose Weight Effortlessly” with Semaglutide? Doctor: Ineffective for About 15% of People, Dietary Adjustments Also Required with Medication

The weight loss drug “Semaglutide” (Ozempic), which gained popularity due to Elon Musk, was officially announced for commercial launch in China on November 17.
Produced by the multinational pharmaceutical company Novo Nordisk, this drug is the world’s first and currently only weekly glucagon-like peptide-1 (GLP-1) receptor agonist for long-term weight management, administered as a subcutaneous injection. Its mechanism of action involves binding to GLP-1 receptors, stimulating insulin synthesis and secretion in a glucose concentration-dependent manner, and reducing glucagon secretion. Additionally, it acts on GLP-1 receptors in the central nervous system, suppressing appetite, reducing food intake, slowing down the movement of food from the stomach to the small intestine, and increasing feelings of fullness, thereby achieving the effects of lowering blood sugar and weight loss.
Novo Nordisk’s Semaglutide actually comes in three “versions”: an oral tablet for lowering blood sugar, an injectable form for weight loss (Ozempic), and an injectable form for lowering blood sugar (Rybelsus).
Back in 2021, Rybelsus, used for the treatment of type 2 diabetes, was approved for launch in China. Three years later, Ozempic, used for weight loss, was formally approved in June 2024 and commercially launched on November 17. According to public reports, on November 18, Ozempic was prescribed for the first time in China at Zhongshan Hospital of Fudan University and the First Affiliated Hospital of Jinan University.
Recently, a reporter from The Paper interviewed Han Xiaodong, a surgeon specializing in weight loss and metabolism at Shanghai Sixth People’s Hospital. He stated that the use of Ozempic has strict indications, and obese patients with clinical weight loss needs should visit formal medical institutions for assessment and diagnosis to undergo scientific weight loss treatment. “The use of weight loss drugs requires standardized management. Relying solely on drugs for ‘effortless weight loss’ is difficult. Changes in lifestyle are also necessary. We recommend that individuals seeking weight loss consult doctors with professional diagnostic and treatment qualifications to ensure the rational and effective use of this drug.”
“The drug is ineffective for about 15% of people, so it shouldn’t be regarded as a miracle drug.”
With the introduction of the weight loss version of “Semaglutide” into medical institutions, the number of consultations at related weight loss and endocrine clinics is gradually increasing.
“Currently, in weight loss and metabolism clinics, about one-third of patients inquire about this drug.” Han Xiaodong, an associate chief physician in the metabolism department of Shanghai Sixth People’s Hospital, said in an interview with a reporter from The Paper. Not long ago, he encountered a 45-year-old female patient who was 156cm tall and weighed 150 pounds, with symptoms of insulin resistance, inquiring about the use of this drug. “When encountering such patients, we usually tell them first whether this drug is suitable for them, what effects they can expect if they use it, and what precautions they need to take. This is the most crucial.”
Han Xiaodong indicated that for most people, like the aforementioned individual with a weight of 150 pounds, weight can be controlled through lifestyle adjustments. If lifestyle adjustments are not effective, relying solely on this injectable drug is not feasible in the long term, as it will not be effective forever. Even with this drug treatment, lifestyle changes and dietary adjustments are necessary to manage weight. “It should be noted that this drug is actually ineffective for about 15% of people. Everyone should avoid treating this drug as a miracle drug and must approach weight loss in a reasonable and scientific manner.”
Han Xiaodong believes that obesity, due to individual differences, is caused by various reasons, and it is necessary to determine the true cause of obesity to provide targeted suggestions.
“Only those who have carefully understood this weight loss drug, are fully aware of its indications and side effects, and know how to manage their weight in the long term can use this drug in a standardized and reasonable manner.” Han Xiaodong further stated that in his clinic, many people are not even aware of whether this drug is suitable for them. They merely heard about it or saw others around them using it and thinking it is effective, so they want to try it themselves. Some people are not even obese but blindly pursue the concept of “thin is beautiful” or have “body anxiety,” seeking a weight loss number that does not fit their actual situation. This is not recommended.
“If the body mass index (BMI) is less than 27, we generally do not recommend using this injectable drug.” Han Xiaodong pointed out that according to the instructions for Ozempic, it is suitable for long-term weight management of adult patients on the basis of controlled diet and increased physical activity, with an initial BMI ≥ 30 kg/m² (obesity), or a BMI ≥ 27 kg/m² to < 30 kg/m² (overweight) and at least one weight-related comorbidity such as high blood sugar, high blood pressure, abnormal blood lipids, obstructive sleep apnea, or cardiovascular disease. Furthermore, Han Xiaodong noted that Semaglutide carries a potential risk of thyroid C-cell tumors and should not be used in patients with a history or family history of medullary thyroid carcinoma (MTC) or type 2 multiple endocrine neoplasia syndrome (MEN2). Patients should be fully informed about the potential risk of MTC and the symptoms of thyroid tumors. "Medullary thyroid carcinoma is an absolute contraindication, and there are many relative contraindications. For example, people with high blood lipids may be prone to acute pancreatitis; those with personal emotional issues may experience food suppression, low mood, etc. when using this drug. Some may also experience acid reflux, increased risk of constipation, and so on." Han Xiaodong explained that everyone should recognize that this drug cannot fundamentally improve a person's metabolic capacity. It only achieves weight loss by suppressing appetite and slowing down gastrointestinal motility. "If you think that after using this drug, you can achieve 'effortless weight loss,' then you are mistaken." Study: Weight may rebound after stopping GLP-1, while continued use can lead to further weight loss. Since 2011, Han Xiaodong has been focused on the diagnosis and treatment of individuals seeking weight loss and has encountered many patients in his clinic who have used incorrect weight loss methods, causing adverse effects on their bodies. "Some patients use weight loss drugs that have not been approved by the national drug regulatory authorities. These drugs contain ingredients that cause appetite suppression, diarrhea, or even nervous stimulation, and many may also cause significant damage to the heart, liver, kidneys, etc." Han Xiaodong said he has encountered patients who took "weight loss drugs" of unknown origin and couldn't sleep, with their hearts beating very fast. Some patients rebounded after using some weight loss drugs and became even heavier than before weight loss. Han Xiaodong has also encountered individuals who followed "experience posts" on social platforms for weight loss, achieving temporary weight loss but then rebounding. "Weight loss is a difficult task that requires long-term persistence and guidance in terms of specialization, individualization, and lifestyle, not just during hospital consultations." Han Xiaodong said. Many people know that weight loss requires "controlling your diet and increasing physical activity." In Han Xiaodong's view, "controlling your diet" is the priority: "This means that dietary management is crucial for weight loss. Many people believe that relying solely on exercise can also lead to weight loss, but scientific evidence shows that the role of exercise in helping you lose weight is not as high as you might think. Exercise can burn some calories, but most importantly, consistent exercise can improve your mood and help you persist in weight loss. Essentially, weight loss is a matter of 'balance'—consuming fewer calories than you take in will lead to weight loss. Following this logic, controlling your diet is the foundation, while increasing physical activity is a bonus." However, Han Xiaodong also mentioned that some people rely solely on starving themselves to lose weight, but they can't endure it for long or experience even more severe rebound. Conversely, if you persist in exercise, it will not only increase your basal metabolic rate but also improve your mood, reducing the risk of binge eating. Simply put, exercise makes "controlling your diet" easier. "Whether weight loss drugs cause rebound after use" is a concern for many doctors. In the "Guidelines for the Diagnosis and Treatment of Obesity (2024 Edition)" released by the National Health Commission on October 17, 2024, the issue of rebound with weight loss drugs is specifically mentioned: A real-world data study based on the U.S. population showed that among patients who started using GLP-1 as a weight loss drug in 2021, about two-thirds stopped using GLP-1 within a year due to various reasons (including drug side effects, financial burden, health insurance coverage, etc.). Some studies have focused on the weight loss effects after stopping GLP-1, and the results all show varying degrees of weight rebound after stopping the drug, while continued use can lead to further weight loss. Additionally, there are differences in the response of obese patients to drug treatment, and some patients may not achieve clinically significant weight loss (at least 5% weight reduction) through drug treatment. In such cases, it is recommended to stop drug treatment. "Obesity is the most complex chronic metabolic disease, and it requires comprehensive medical intervention measures, not just the pursuit of short-term efficacy." Han Xiaodong said. At the same time, Han Xiaodong also