Why WADA Has Its Eye on Ozempic

The weight-loss journey of 47-year-old Corine Rogers began with her late husband, Chris Holley, who made a name for himself in triathlon after dropping more than 200 pounds to become a four-time Ironman finisher. To lose such a massive amount of weight, Holley laser-focused on diet and exercise (specifically, triathlon training) and leveraged metabolic efficiency and a ketogenic diet to achieve his goals. But for Rogers, such tools weren’t as effective, and she eventually turned to a compounded version of the blockbuster drug semaglutide – marketed as Ozempic when used for diabetes and Wegovy when used to treat obesity – to help her shed the excess weight she felt was holding her back.

The change in her body came quickly, as she lost nearly 20 pounds in less than three months while training to run the 2024 Chicago Marathon.

“It felt great to run almost 20 pounds lighter,” she says. “It was amazing to feel like my sports bras and running shorts were fitting. I had barely any chafing,” she says.

Even more importantly, her blood work showed an across-the-board improvement in metabolic health markers including cholesterol, triglycerides, and blood sugar levels.

Rogers successfully completed the Chicago Marathon in October and has now turned her attention to qualifying for the Boston Marathon and preparing for a half-iron triathlon.

But could her use of the medication that literally helped her get to the starting line now bar her from certain competitions in the future? Perhaps, depending on the outcome of an ongoing investigation period imposed by the World Anti-Doping Agency, the international organization working to keep sports fair.

The semaglutide revolution

First developed in 2012 by researchers at Danish pharmaceutic company Novo Nordisk, semaglutide is one of a new class of powerful medications called glucagon-like peptide-1 receptor agonists or GLP-1s. Semaglutide, which was approved in 2017 to treat Type 2 diabetes under the brand name Ozempic (and in 2021 as Wegovy to treat obesity), boosts insulin production in the body.

This increase can help patients overcome insulin resistance, a key feature of pre-diabetes, Type 2 diabetes, and obesity. As such, semaglutide has recently exploded into the public consciousness as a potential “silver bullet” for America’s burgeoning obesity epidemic.

While semaglutide has gotten the most chatter, it’s one of several forms of GLP-1 medications currently on the market.

Types of GLP-1 medications

While each one of these medications is a little different, they all work “basically as a gastrointestinal hormone mimic,” says Dr. Allison Rhodes, a primary care physician with dual board certifications in internal medicine and obesity medicine at The Ohio State University Wexner Medical Center in Columbus.

GLP-1 analogs, also called incretin mimetics, work in several ways. They:

• Slow gastric emptying, which can help you feel fuller longer
• Increase the release of insulin when sugar is present, which can help ward off spikes and crashes in blood sugar levels
• Suppress glucagon secretion, which in turn reduces liver glucose output
• Stimulate glucose uptake into cells and increase glucose uptake and storage in muscles so you have energy at the ready
• Increase proliferation of the beta cells in the pancreas that make insulin, which boosts the availability of blood-sugar-modulating insulin
• Decrease hunger through multiple pathways in the brain, including a “quieting” of food noise that can reduce the drive to binge eat or seek emotional comfort in food

Taken together, these actions often add up to rapid and significant weight loss. “Overall, these collective effects reduce food intake, increase satiety, and improve glucose metabolism, which can lead to robust weight loss,” Rhodes says. In some trials, participants shed 15% to 20% or more of their total body weight.

Rhodes explains that these medications were originally developed to treat diabetes but research shows they may have applications for several chronic health conditions, ranging from obesity and heart disease to metabolic-associated steatotic liver disease (aka fatty liver disease) and osteoarthritis-related knee pain. Additionally, many patients report a reduced desire to drink alcohol or engage in other compulsive or addictive behaviors, such as smoking, shopping, and nail-biting.

“It opens up a lot of reflections, not only in sport in our environment but also in society in general,” says Dr. Olivier Rabin, senior director of science and medicine with the World Anti-Doping Agency in Montreal, Canada. “It goes beyond a simple drug for obesity.”

Ozempic for athletes: Miracle drug or cheat code?

Because of the near-miraculous effects GLP-1 medications can have on certain users, it could be argued their use amounts to cheating in a sports context.

The potential advantages are “absolutely valid in triathlon,” Rabin says. “If you can improve your weight-to-power ratio, you’re going to have a benefit in cycling, running, and possibly in swimming as well.”

This isn’t to say that turning to a GLP-1 medication for support if you need to lose weight or regulate your blood sugar is “cheating” in the broader sense. For individuals who have not found sustainable blood sugar management or weight loss success by other means, a GLP-1 medication can be a useful tool for managing weight and improving health, despite the enduring stigma surrounding their use.

But “cheating the system” to lose weight is not what we’re talking about here; that reductive labeling of GLP-1 medications as subterfuge of the “hard work” and “willpower” required to shed excess weight is not accurate, nor is it helpful to any rational discussion of the potentially wide-ranging health benefits this group of medications appears to provide.

But when it comes to endurance athletes, there may be potentially dangerous downsides to using GLP-1 medications. For starters, there is the potential for abuse, which is a major concern in a sport with a high prevalence of disordered eating. Additionally, these medications have not been tested in endurance athletes who typically have a different relationship to blood sugar than the average sedentary American adult, says Dr. Brian Quebbemann, an obesity medicine specialist and inventor of the S.L.I.M.M.S. Procedures.

“These medications are designed to treat pathological blood sugar balance in people with diseases that result in an inability to control blood sugar. Since the body of a well-trained athlete is already highly sensitive to insulin, any unnatural increase in insulin could throw them off balance, and result in a dangerously low blood sugar level,” Quebbemann says.

“For example, if an endurance athlete took a dose of insulin during a competitive event, that would cause a profound drop in their blood sugar.” This could lead to hospitalization or even death.

Why anti-doping agencies are monitoring semaglutide

Semaglutide made its way into WADA’s Monitoring Program in 2024 and will remain there in 2025. This designation doesn’t mean that WADA has banned the medication – even for the most elite triathletes. It simply means WADA is studying the medication to understand how athletes are using and whether there’s a pattern of abuse of this substance in certain sports.

Currently, WADA prohibits several weight control medications, such as certain stimulants and diuretics. But the debate around semaglutide is a little different because of its potential to supersede the conventional “calories in, calories out” philosophy.

“The change in paradigm with the GLP-1 analogs is that in the past, weight control was part of a certain routine and effort,” Rabin says. “Athletes needed to really pay attention to the diet, to the number of calories that were taken in. This was part of the conditions that allow an athlete to perform at the best level.”

But now with GLP-1 analogs, “the paradigm has changed a little bit because you do not necessarily need to make that effort to control your weight and have this embedded as part of your regimen to perform at the highest level,” Rabin explains.

To determine whether a drug should be banned, WADA uses a three-pronged test. Banned drugs must fulfill at least two of three criteria:

1. It has the potential to enhance or enhances sport performance.
2. It represents an actual or potential health risk to the athlete.
3. It violates the spirit of sport.

In the case of semaglutide, all three of these criteria may come into play. “But we’re not there yet,” Rabin says. “We are collecting information and looking at this. We’re going to analyze urine and blood samples and we’ll see, as we have for other substances, whether we observe a pattern of abuse.”

Those samples are collected from athletes at a wide range of competitions and processed at 30 accredited anti-doping labs around the world. These labs report their findings to WADA, which further crunches the data to look for patterns.

How long a medication stays on the monitoring list can vary depending on the medication, its effect, and how widely it’s being used.

“It’s really up to the expert group to decide whether they’ve got enough information and whether they consider they’ve got a robust view of the risk of abuse, if any,” Rabin says. For some substances, the monitoring timeline may be a few months, while for others it can last much longer. It’s not clear yet where semaglutide falls on that spectrum.

While several similar medications are now on the market, only semaglutide has been added to the monitoring program so far because it’s the most prescribed medication in this category. Indeed, the name Ozempic has become shorthand for all of the GLP-1 medications.

What’s more, because GLP-1s are not banned, there’s no need to name the others specifically while the advisory group collects data on how the market leader is being used, Rabin says.

Distinguishing between use and abuse isn’t always straightforward, and it can depend on the sport. In an endurance endeavor such as triathlon – where hauling extra body weight around a long course can pose a distinct disadvantage – the potential for abuse of this medication is much higher than in a sport that doesn’t necessarily favor lower body weight, such as archery or weightlifting.

Patterns of abuse can also be geographically based. For example, in a country like the United States, where rates of people being overweight and obesity are soaring, it stands to reason there may be more people using the medication therapeutically than in another country with lower rates of weight-related conditions. Such regional variations in disease prevalence must be taken into account when assessing a drug’s possible prohibition, Rabin says.

For those who are using semaglutide to treat disease, take heart; if WADA eventually bans semaglutide – and at the moment that’s still a big “if” – exemptions for its use by certain individuals would apply.

“The minute a drug becomes prohibited, a mechanism called the therapeutic use exemption kicks in,” Rabin says. TUEs allow athletes with legitimate medical conditions to continue accessing the prohibited substance as part of their therapy.

What athletes should know about GLP-1 weight loss medications

As effective and potentially life-changing as these weight-loss medications can be, they’re not meant to be used by the average weekend warrior looking to cut a couple of pounds to notch a PR. Currently, semaglutide is only intended for use in treating diabetes and obesity – not missing out on an Ironman World Championship slot.

But if you’re an endurance athlete and planning to give semaglutide or another GLP-1 medication a try for any reason, be aware that you’re likely to experience significant impacts on hunger, satiety, and thirst drive, Rhodes says.

“An athlete may feel full, like they do not need or maybe even cannot eat any more but can still end up in a significant caloric deficit given the increased caloric expenditure that occurs in training for and participating in endurance sports,” she explains.

For this reason, Rhodes cautions that endurance athletes carefully track water intake and electrolyte replacement, as their natural thirst signals may no longer be adequate to let them know when they need more fluid.

When working with athletes or individuals with higher muscle mass, Rhodes also recommends indirect calorimetry testing “so we can precisely measure their resting metabolic rate or RMR to better estimate how much nutrition their body needs once we multiply this by an activity factor.”

This tailored approach is important because “often an athlete’s metabolism will be very different than what is calculated using our standardized equations, as these do not consider muscle mass or an individual’s metabolic efficiency.”

Side effects can also be problematic, with some of the most common being gastrointestinal – nausea, heartburn, and constipation. “Working closely with a medical provider to ensure these symptoms are well-managed and the dose of the medication is optimized is key to ensuring that an athlete or patient has the fewest possible challenges to maintaining healthy nutrition and hydration,” Rhodes says.

GLP-1 medications can also cause muscle loss. “The loss of lean body mass, or muscle, occurs as a normal result of substantial weight loss in people who have excess body fat and who live sedentary lives,” Quebbemann says.

You can offset at least some of this muscle loss by prioritizing protein intake and strength training during treatment, but “major weight loss always results in loss of some lean body mass, as every competitive bodybuilder will tell you,” Quebbemann says.

Rhodes also notes that these medications can increase heart rate. While she says this is a “rare, non-dangerous side effect” that’s most likely to show up after an increase in dose, for athletes who use heart-rate zones for training, it may impact how you train.

Should Ozempic be legal in triathlon? 

While WADA continues its investigation, some athletes are making their own assessments about whether to use GLP-1 agonists as part of their overall health plan. And their results have been mixed.

For Daneen Zehner Colligan, 56, a hospice nurse and triathlon coach from Indiana who was an NCAA Division I distance runner at Ohio State in the 1980s, the adverse effects she experienced from semaglutide weren’t worth the benefits.

“I was looking for that next way to lose more weight,” she says. She acknowledged that reclaiming the 113-pound elite runner body she had in college was an unrealistic goal, but she still hoped for a kick-start for weight loss to help her achieve her goal of completing a full Ironman.

When Colligan’s triathlon workouts got longer as her goal race approached, her tolerance for the medication decreased. “As my rides increased over three hours, I would come back and feel horrible. I wasn’t under-eating, but I’d be so nauseous on the rides.”

The slowing of gastric emptying these medications are known for had stalled her digestive system to the point of making her ill. Colligan understood the problem and realized it was time to stop taking the compounded version of semaglutide she’d been using.

“I still have a lot of weight to lose,” she says, “but I don’t think I want to do semaglutide again.” The high cost of the medication is also a factor in her aversion.

But for Rogers, who’s struggled with her weight for years, the shift in how she thinks about food has made such a profound difference to how she moves through the world. She intends to keep going.

“It’s the quietest my brain has ever been [about food],” she says. Before, she used to think about food constantly and was incessantly battling a desire to binge; now she actively schedules meals so she doesn’t forget to eat at regular intervals.

Though Rogers reports no adverse effects from taking semaglutide, she also acknowledges that because these medications are so new, it’s still uncertain whether there could be long-term adverse effects waiting for her down the road: “I don’t know what will happen in 10 years – will my ears fall off or will I grow a third eyebrow?”

But she’s willing to take that chance in exchange for feeling better and running well now.

For his part, Quebbemann is unequivocal that semaglutide shouldn’t be permitted in elite competition. “In my opinion, any drug that can artificially enhance the performance of a subset of athletes, while other athletes achieve no benefit, should be outlawed in regulated competition. And GLP-1RA medications have a variable effect from person to person.”

Whether WADA agrees with him remains to be seen.