Overeating on Ozempic this holiday-can it be dangerous?

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published December 23, 2024

Key Takeaways

Industry Insights

  • “Since Ozempic slows down how quickly the stomach empties, eating large meals can amplify bloating, nausea, and that uncomfortably full feeling that just doesn’t seem to go away. For those with preexisting gastroparesis, this effect is often even stronger.” - Harsh Sheth, MD

  • “Alcohol alone can both lower blood sugar levels and interfere with the body's response to hypoglycemia, so this risk would be compounded for those also taking GLP1s." - Michael Baumholtz, MD

Ozempic was the topic for one of the biggest discourses of this year. With one in eight adults in the US having tried a GLP-1RA and 6% currently on one, it’s likely you’re seeing more of these patients in your practice.[]

As the holiday season rolls in, many of these patients might be inquiring how they can enjoy all the delicious food without derailing their treatment for diabetes or obesity. But what happens if they end up overeating while still on Ozempic?

Gastroparesis

Ozempic is designed to suppress the appetite by delaying gastric emptying; therefore, consuming large meals goes against the body's natural signals of fullness. Overeating may amplify these effects, leading to acute symptoms like nausea, cyclic vomiting, bloating, and even gastroparesis.

Bariatric and GI laparoscopic surgeon Dr. Harsh Sheth shares, “Since Ozempic slows down how quickly the stomach empties, eating large meals can amplify bloating, nausea, and that uncomfortably full feeling that just doesn’t seem to go away. For those with preexisting gastroparesis, this effect is often even stronger.”

Furthermore, according to a 2022 systematic review, high-fat-containing greasy food, common around holidays, can slow down gastric emptying even further.[] The body struggles to process the extra food, increasing the risk of gastroesophageal reflux, dyspepsia, and, in severe cases, intestinal blockage or ileus. 

Hypoglycemia

Ozempic lowers blood glucose by enhancing insulin secretion and reducing glucagon release. But if your patients are overeating, the risk of hypoglycemia increases even further. This vicious cycle is created by a combination of excessive insulin release from postprandial glucose spikes and hypoglycemia due to delayed gastric emptying and postponing carbohydrate absorption. That’s why Dr. Sheth advises his patients to avoid consuming larger food options while on Ozempic. 

Dr. Sheth adds, “For those on sulfonylureas or insulin along with Ozempic, there’s an even greater increased risk of hypoglycemia.” This is shown in the prescribing information for Ozempic.[3] With GLP-1RA monotherapy, symptomatic hypoglycemia occurred in 1.6%-3.8% of cases, while combination therapy of a GLP-1RA with insulin or a sulfonylurea increased the risk to nearly 17%-30%. 

Elevated pancreatic enzyme levels

Current evidence suggests a very small risk of pancreatitis with GLP-1RAs, but according to a 2024 review from Cureus,[] many observational studies have noted pancreatic enzyme elevation. The LEADER trial, involving over 9,000 T2DM patients, observed an elevation in serum amylase and lipase with liraglutide. 

According to board-certified plastic surgeon Dr. Michael Baumholtz, overeating and prolonged gastric retention might theoretically exacerbate pancreatic enzyme activity further, especially in patients with preexisting pancreatic dysfunction.

Interactions with alcohol

In animal models, semaglutide has been found to reduce alcohol drinking by modulating central GABA neurotransmission.[] However, the binge drinking spree around holidays still poses a risk since both alcohol and semaglutide can cause hypoglycemia. The "empty calories" in alcohol also counteract Ozempic's weight loss benefits. 

Dr. Baumholtz states concerningly, “Alcohol alone can both lower blood sugar levels and interfere with the body's response to hypoglycemia, so this risk would be compounded for those also taking GLP1s. Alcohol can also irritate the stomach lining, which, combined with Ozempic’s effects on gastric motility, may lead to heightened gastrointestinal distress.”

Exacerbation of pre-existing eating disorders

Dr. Shethdescribes how Ozempic may relate to eating disorders: “Its (Ozempic’s) appetite-suppressing effects can unintentionally encourage restrictive eating habits, which might later lead to binge episodes when the appetite returns.” 

Taking GLP-1 agonists can itself function as an eating disorder behavior, as the medication can be used to manage anxiety about weight, body shape, or eating. This was the conclusion from a report in the International Journal of Eating Disorders by researchers who examined the use of GLP-1 drugs in eating disorder populations. [] They described reliance on GLP-1 agonists as an 'eating disorder behavior,' used as an appetite suppressant, for compensatory purposes after overeating or binging, or alongside fluid loading to create a false sense of fullness. As with other eating disorder behaviors, they wrote, “this could interfere with recovery.”

We are already starting to see the patterns of abuse in patients. An analysis of the FDA Adverse Events Reporting System (FAERS) Pharmacovigilance Dataset shows evidence of GLP-1 receptor agonist misuse and abuse when compared to other similar drugs:[]

  • Semaglutide was more frequently associated with cases of "drug abuse," "drug withdrawal syndrome," and "use without a prescription."

  • These abuse/misuse adverse events were reported at a rate of more than 3.5 times higher than for other GLP-1 analogs and the combination drug phentermine-topiramate.

  • "Intentional product misuse" was reported almost twice as often with semaglutide compared to other drugs in the class​.

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