A two-year trial (STEP 5) found that overweight and obese patients taking Wegovy lost an average
15.2%
of their body weight
Ozempic costs between
S$3,466 and S$4,333
annually while Wegovy costs around
S$15,600
per year
Issue 55
Sep 2025
ETHICALLY SPEAKING
By Nanette Ryan, Research Fellow, Centre for Biomedical Ethics (CBME), NUS Yong Loo Lin School of Medicine
Are weight loss drugs really the wonder panaceas that they’ve been made out to be, or is there more to it than meets the eye?
If you’ve travelled on the SMRT lately, there’s a good chance you’ve seen the new LTA Move Lite campaign. One particular Move Lite poster depicts a girl pointing at a protruding belly, with the caption: “So that my girlfriend will stop pointing out my tummy… hahaha.”
If you’ve seen this poster and can relate, you may be thinking that it’s probably high time you moved lite away from your girlfriend. It may also, however, get you thinking about other ways to improve your health.
Nutrition-focused diets and regular exercise are widely recognised as key strategies for promoting health. For some people, however, these strategies are either insufficient or unrealistic. Biology, busy lifestyles, and health misfortunes can sometimes make these goals difficult—if not impossible—to achieve.
One option that a growing number of people are turning to, with significant success, is Ozempic. Initially developed to treat type II diabetes, Ozempic has also gained widespread popularity—and controversy—as a weight-loss drug. Celebrities such as Oprah Winfrey have praised Ozempic as a “miracle for weight loss,” while others, like Kourtney Kardashian, are now releasing their own over-the-counter versions.
But is Ozempic safe, and is it something we should be incorporating into our healthcare plans?
Strictly speaking, Ozempic is not a weight-loss drug. Its primary purpose, as stated by its manufacturer Novo Nordisk, is to treat type II diabetes. Its sister drug, Wegovy, however, is specifically approved for weight management. Both Ozempic and Wegovy contain the same active ingredient: semaglutide. They are administered via a once-weekly injection—ranging from 0.5mg to 2mg for Ozempic, and from 0.25mg (starting dose) up to 2.4mg (maintenance dose) for Wegovy.
Semaglutide works by mimicking a hormone that the body naturally produces to help regulate insulin production. It also slows digestion, helping you feel fuller for longer, and silences ‘food noise’—those persistent, intrusive thoughts or cravings about food that can dominate your mental focus.
The results seen with semaglutide have been impressive.
In a 40-week trial (the SUSTAIN 7 study), patients taking Ozempic saw their elevated blood sugar levels—indicative of type II diabetes—return to a healthy range. Another two-year trial (STEP 5) found that overweight and obese patients taking Wegovy lost an average of 15.2% of their body weight, compared to a 2.6% reduction in the placebo group.
In addition to weight loss and blood sugar control, both Ozempic and Wegovy have been associated with improvements in cardiovascular health, including reduced risks of heart attack, stroke, and non-alcoholic fatty liver disease.
Aside from these health benefits, Ozempic and Wegovy also offer greater control over appetite. By silencing ‘food noise’, they reduce distractions caused by hunger signals, making it easier to stay focused on healthy lifestyle goals.
This all sounds incredible—a miracle, even. But where’s the catch?
The first thing to know about Ozempic and Wegovy is that they come with side effects. The most common include nausea, vomiting, diarrhoea, abdominal pain, bloating, and constipation. Other reported side effects include headaches, fatigue during exercise, and what some have called “Ozempic Face”—a term describing the sagging of facial skin and aged appearance that can accompany rapid weight loss.
There are also more serious risks, including thyroid C-cell tumours (both adenomas and carcinomas), pancreatitis, kidney failure, gall bladder disease, and diabetic retinopathy. Without appropriate nutritional support, the calorie restriction caused by Wegovy may also lead to malnutrition due to inadequate nutrient intake, and exacerbate conditions like sarcopenia—the loss of muscle mass and strength. In addition, there has also been concern about a possible association between Ozempic and non-arteritic anterior ischemic optic neuropathy (NAION), with some studies indicating an increased risk. However, the evidence remains inconclusive, and further research is needed to establish any definitive link.
The first thing to know about Ozempic and Wegovy is that they come with side effects. The most common include nausea, vomiting, diarrhoea, abdominal pain, bloating, and constipation. Other reported side effects include headaches, fatigue during exercise, and what some have called “Ozempic Face”.
Importantly, the full extent of all long-term risks and side effects remains unknown, as these medications are still relatively new to the market.
It is also important to note that significant weight regain is common after discontinuing Wegovy. In one trial (STEP 1), participants receiving once-weekly subcutaneous semaglutide (2.4mg) regained two-thirds of their prior weight loss within one year of stopping treatment. Similar reversals were observed in related health markers, suggesting that long-term use is necessary to sustain benefits.
However, Ozempic and Wegovy are costly interventions. In Singapore, Ozempic costs between $3,466 and $4,333 annually. Wegovy is estimated to cost around $300 per weekly dose—amounting to $15,600 per year. Over a lifetime, this adds up to significantly more than the average cost of an apartment.
Since Ozempic’s approval in 2017, there has been significant academic interest in its use and side effects. Ongoing research is exploring potential applications beyond its current approved uses. One ongoing trial (STEP UP T2D), for example, is examining the effects of higher doses of semaglutide for weight loss. Other studies are investigating its potential as a treatment for alcohol use disorder, Alzheimer’s disease, and various mental health conditions.
In collaboration with our colleagues at the Paediatrics Ethics Programme at NUS and the Uehiro Institute for Practical Ethics at Oxford, we are also exploring the role of Wegovy and Ozempic in paediatric care.
In Singapore, rates of type II diabetes continue to rise, with more than
400,000
people currently living with the condition
This number is projected to reach
1 million
by 2050
400,000
people currently living with the condition
This number is projected to reach
1 million
by 2050
At the Centre for Biomedical Ethics (CBmE), NUS, our research on Wegovy and Ozempic focuses on the ethical considerations of prescribing these medications in both global and local contexts.
In Singapore, rates of type II diabetes continue to rise, with more than 400,000 people currently living with the condition. This number is projected to reach one million by 2050. In 2019, the prevalence of non-alcoholic fatty liver disease (NAFLD) was estimated at approximately 1,492,000, with projections indicating an increase to 1,799,000 by 2030.
Given the health benefits that Wegovy and Ozempic may offer for managing these conditions, they could serve as important tools for advancing public health in Singapore.
Utilising the method of Collective Reflective Equilibrium in Practice (CREP—and CREP-SING in Singapore), developed by Chen Su Lan Centennial Professor of Medical Ethics and Director of the Centre for Biomedical Ethics, Julian Savulescu, a primary focus of our research is to assess the viability of Ozempic and Wegovy for public health in ways that are finely attuned to, and reflective of, Singaporean values and health needs. We have recently received the results of a population survey on Singaporean attitudes towards the use of Ozempic in healthcare—the first of its kind in Singapore! We look forward to analysing and releasing those results soon.
In collaboration with our colleagues at the Paediatrics Ethics Programme at NUS and the Uehiro Institute for Practical Ethics at Oxford, we are also exploring the role of Wegovy and Ozempic in paediatric care. Our research to date has addressed what we refer to as the ‘too many unknowns’ objection—the concern that there is insufficient evidence regarding the efficacy and long-term impacts of Wegovy in paediatric populations to prescribe it safely. We have also examined Wegovy’s impact on children’s mental health and issues pertaining to childhood autonomy. Based on the current evidence, it is our view that Wegovy may have the potential to support children’s physical and mental health. However, it should only be prescribed to children following a carefully considered risk–benefit analysis that accounts for evidential limitations, side effects, resource constraints, and individual needs.
Our future research will explore Wegovy’s potential for biomedical enhancement and manipulation in paediatrics, and the ethical considerations surrounding this practice.
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