Given the huge demand for Ozempic, the blockbuster drug that treats diabetes and is also being prescribed off-label for weight loss, it’s not uncommon to meet someone just starting out or already taking the drug.

Novo Nordisk Data, which makes Ozempic, suggests US providers were writing about 60,000 new weekly prescriptions for the drug as of April. But far fewer patients have been taking the drug for years, since it’s relatively new, can cause side effects, and is expensive without insurance coverage.

Barbie Jackson-Williams, 54, of Des Moines, Iowa, said she started taking Ozempic in early 2021 to lose weight and manage her type 2 diabetes. She said the drug helped her make previously challenging changes, like substituting lean protein for pasta, her old favorite, and eliminating sweetened iced coffees from her diet.

“People take it to lose weight and that’s not true,” he said. «You have to do the work, and people don’t realize that.»

NBC News identified and spoke to seven people who have been at Ozempic for between a year and a half and two and a half years. In general, everyone agreed that medication was not a quick step towards good health. Although Ozempic has helped them lose weight, lower their blood sugar levels, or both (the reasons for taking the drug vary from person to person), maintaining those changes takes effort, they said.

Matas has been at Ozempic for one year and seven months.NBC News / Courtesy of Edward Matias

“This is not a magic wand or a pill,” said Edward Matias, 45, a Connecticut resident who works in IT. “It’s not the fountain of youth. It requires work and commitment. If people ask for this drug because they want to lose weight and think they can eat anything, they’re in for a rude awakening.»

Matías said that because of his diabetes, he still has to be careful about eating foods that are high in sugar or carbohydrates. But his weight has dropped from about 310 pounds to 230 while he was taking Ozempic, he said.

Most of those interviewed said that rather than being a panacea, Ozempic has initiated lifestyle changes, such as allowing them to exercise in ways they couldn’t before.

Jackson-Williams said losing weight has led her to feel more energetic and less inclined to sit still.

“I want to be active. I want to be doing things. I can’t sit and watch TV like I used to,” she said.

Photos of Barbie Jackson-Williams, before (left) and after (right) starting Ozempic
Jackson-Williams lost 180 pounds while taking Ozempic. NBC News / Barbie Jackson-Williams

Ozempic and its sister drug, Wegovy, approved for weight loss in obese or overweight people with weight-related medical conditions, are considered long-term or lifetime treatments. But Ozempic has been on the market for less than six years and Wegovy for two, so doctors and patients are learning in real time what it’s like to use the drugs for long periods of time.

Dr. Eduardo Grunvald, an obesity physician at UC San Diego Health, said he is awaiting trial results to see if Ozempic and Wegovy reduce the risk of heart disease, as is the case with Trulicity, another weight-loss drug in the same class.

There is also a possibility that the drugs could reduce bone density or increase the risk of thyroid cancer, which was detected in animal studies involving Ozempic, Grunvald said.

“Are we going to see that show up with millions and millions of patients on these drugs?” she asked. But more likely, she said, the benefits «probably still outweigh the risk.»

Ozempic may allow people to exercise more

To manage his prediabetes, Arnob Alam said he does 30-minute cardio nearly every day (up from two to three times a week before starting Ozempic) and has started lifting weights.

“You still have to make adjustments to your diet and exercise. But avoid overeating because you get sick if you eat too much,» said Alam, who works for the Department of Defense in Washington, DC.

Jackson-Williams attributes her 180-pound weight loss to a combination of taking Ozempic and working out. She previously weighed over 400 pounds, she used an oxygen mask and slept in a recliner because she couldn’t breathe while she was lying down.

“I would just walk out of my apartment to my mom’s car, I would have to sit for 10 minutes to catch my breath,” she said.

Now, Jackson-Williams said, she walks around the track and uses the elliptical in the gym. Her blood sugar level dropped to pre-diabetic levels and she no longer needs oxygen support.

“I used to be dead from the waist down. very dead But now I’m not,” she said.

But several people said they saw their weight gain when they stopped exercising or ate more than usual while taking Ozempic.

Alam said he takes the drug to help him control his blood sugar and lose extra pounds, but he has gained back about 17 of the 25 pounds he originally lost after starting the drug. Traveling and returning to the office disrupted some of his healthy routines, Alam said, though he still feels more agile.

Grunvald said that many people who take Ozempic or Wegovy find it easy to lose weight at first, but eventually their bodies resist losing any more weight. Regardless, he said, the healthiest thing to do is exercise and eat right along with taking the medication.

“These drugs need to be used with lifestyle modifications. If you have to watch your diet and exercise on medication, that’s what they’re meant for,” Grunvald said.

Healthy eating just got easier for many at Ozempic

Those who have been taking Ozempic long-term said the drug reduced their cravings for fatty or sugary foods and nearly eliminated the urge to mindlessly eat.

Kimberly Tabor, who takes Ozempic for her type 2 diabetes but battled severe obesity for years, said she had changed her family’s diet before taking the drug but didn’t notice significant weight loss until after starting Ozempic.

“Working all the time and having a small child, I stopped doing things for myself. And then I started ordering fast food, the things that you could microwave or put in the oven already made, because I didn’t feel like I had the time,” she said.

Now, he said, he can control snacking better and eats smaller portions.

Kimberly Taylor before (left) and after (right) starting Ozempic
Tabor before Ozempic, on the left, and while taking the medication.NBC News / Kimberly Taylor

Serafina Raskin, general counsel for Found, a weight-loss company that offers online consultations for drugs including Ozempic and Wegovy, said she has found that taking Ozempic is easier than following the diets she used to rely on. She had never eaten soda or fast food before, she said, but now she eats pasta on the weekends, a food she used to avoid.

«It’s really the first time in my life that I feel like I have some room to not eat perfectly,» said Raskin, who is taking Ozempic off-label for weight control. “I don’t really restrict my carb intake anymore. And I get a signal from my brain that says, ‘Oh, you’ve had enough. You don’t need to eat anymore.’”

Of course, people who have had positive experiences taking Ozempic, and minimal side effects, are the most likely to continue taking it long-term. Interviewees said they were now virtually free of side effects, but other people reported vomiting, fatigue, headaches, and stomach cramps that forced them to stop taking the drug.

Challenges in maintaining weight loss

Ozempic and Wegovy are versions of semaglutide, a drug that can lower blood sugar and suppress appetite by mimicking a hormone that tells the brain that a person is full. Like many drugs, the effects do not last after patients stop taking them, so people tend to regain most of the weight lose if they stop taking the drug.

Grunvald said many patients are under the false impression that they can stop taking Ozempic or Wegovy after reaching their goal weight. Others, he said, see their weight plateau and mistakenly assume they’re not making progress.

“A lot of people think the drug doesn’t work anymore,” Grunvald said. «It’s working very well, because otherwise you would have gained the weight back.»

Although much remains to be learned about the long-term effects of Ozempic and Wegovy, similar drugs may offer insight. In A study Of the people who took the weight-loss drug Saxenda, about half of those who lost at least 5% of their body weight after one year maintained their weight after three years of taking the drug in combination with regular exercise and a low-calorie diet. But only 25% of those treated with Saxenda in 2021 followed it for more than a year, according to data from Novo Nordisk.

For those committed to staying at Ozempic for the long term, high prices and tight supplies can pose challenges. The Food and Drug Administration has reported the limited availability of the three lower doses of Wegovy and the highest dose of Ozempic. Medications can also cost more than $1,000 a month without insurance.

Wendy Tell before (left) and after (right) starting Ozempic
Tell him before Ozempic, left, and after losing 30 pounds on the drug.NBC News / Wendy Tell

Wendy Tell, a retired teacher from Yorktown, Virginia, said she’s not sure she can afford to stick with Ozempic, which she takes primarily for type 2 diabetes. Although she has Medicare, she said, she currently pays more than $700 for a 90-day supply due to coverage limits in her prescription plan.

Tell said he’s afraid to regain the 25 pounds he’s lost.

“I am in a dilemma,” he said. “Am I going to get it again? Because who has that much money?