The Ozempic Era of Weight Loss

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From “The New York Times,” I’m Michael Barbaro. This is “The Daily.”

Ozempic and a popular new class of medications like it are revolutionizing the medical treatment of obesity and the way that we think about and talk about weight. Today, my colleague Dani Blum on the story behind these drugs and the very different experiences of two people who took them.

It’s Monday, September 18.

Dani, it is very rare to be able to say the name of a new pharmaceutical drug and have it immediately mean something to pretty much everyone, but that very much seems to be the case with the drug that you and I are going to be talking about today, Ozempic.

Yeah, I mean, I’ve never seen anything like this in my lifetime where people are tossing this name around.

It is all over social media.

It’s on TikTok.

You can’t go on YouTube or even watch TV without seeing that really catchy Ozempic commercial.

It is absolutely everywhere. And it is so massive that it’s something that I am thinking about and talking to people about, covering pretty much every day.

So how do you explain why this drug has become the subject of so much chatter, so much conversation, so many reels on Instagram that I watch at 1:00 in the morning?

I think it’s pretty simple. These drugs are really effective at helping people lose weight. And I should clarify first, Ozempic has become this shorthand umbrella term for an entire class of medications, but these drugs come at a really complicated moment in the medical community and in our culture.

Well, just explain that. What do you mean?

So we know that doctors are excited about these drugs because they offer a potential solution to what they have long viewed as a public health crisis, obesity. More than 40 percent of Americans have obesity. And while there is an evolving conversation around the link between health and body size, we know that you can be metabolically healthy and in a larger body. We also know that obesity is linked with a number of really devastating health conditions — cardiovascular disease, cancer risk.

At the same time, we also have an evolving conversation in our culture around beauty standards and body image. We’ve had this thin ideal that is deeply entrenched, I think especially in America. And over the last decade, it seemed like we were starting to finally chip away at that.

We had fashion stores start to offer a wider range of sizes. We had celebrities embrace the body positive movement. And it’s not like this movement just totally neutralizes the thin ideal in our culture, but you have real momentum, and then Ozempic walks in and just drops a bomb into that entire conversation.

So, Dani, what is the backstory of this drug, Ozempic, and drugs like it that are having such an enormous medical and cultural moment right now?

So Ozempic belongs to this class of drugs called GLP1s. That stands for glucagon-like peptide 1 receptor agonists.

It doesn’t roll off the tongue.

Exactly. And so GLP1 medications start rolling out in the US for diabetes in 2005. And that’s because they’re really effective at regulating blood sugar and insulin. But what patients and doctors also notice is they have this welcome side effect, which is they induce weight loss.

And then when pharmaceutical companies like Novo Nordisk, the company that makes Ozempic, continue to develop and study these drugs, they keep on seeing that weight loss side effect.

So weight loss is not what this medicine is at first designed to do, but it is a side effect that no doubt captures a lot of attention.

Right. And then in 2017, the FDA approves Ozempic, which is this once a week injectable that people with type 2 diabetes can take. And researchers who study semaglutide, the active ingredient in Ozempic, find that people who are on the medication for over a year lose around 15 percent of their body weight.

Which is a pretty significant amount of weight in a not very long period of time. So how do we come to understand why the drug does that?

So these medications are called GLP1s because they mimic this naturally-occurring hormone that our bodies release after we have a meal. And what that means is that these medications make you feel fuller, faster for longer. They slow down the emptying of the stomach.

But what they also do is they target the brain. So the parts of your brain that are hungry, that regulate your appetite, these medications directly affect that.

And do we know specifically how Ozempic does that?

So we don’t totally understand how it works. This is something that a lot of researchers are working to untangle, but this isn’t all that unusual. We have plenty of medications that are pretty common, like antidepressants, that we don’t totally understand just how they affect the brain and the ways that they do.

Got it.

And research has shown that if you stop taking this medication, it stops working. It’s like a statin or a medication for blood pressure. And so when people go off these drugs, they tend to regain a lot of the weight. And in some cases, they gain even more weight than they had before they even took the medication.

And so because these drugs are newer, we don’t have a ton of long term data. We just don’t know what this medication does to you after 50 years, which in theory is how long some people are going to stay on them.

This is something that comes up in conversations with doctors, especially when people are turning to these medications who are not obese, or they’re not diabetic. When people are weighing the potential costs and benefits of taking a medication like this, there are a number of open questions, especially when people try to take these drugs for things they’re not officially approved for.

Interesting. So how do we get from this approved medicine for diabetes that people realize can result in this meaningful amount of weight loss for people who take it to this drug being used out in the world for that explicit purpose that has garnered all this attention, the idea of a drug like this as an intentional weight loss treatment?

Well, people have been taking Ozempic for weight loss for a few years, but 2021 is when things really start to shift, starting in the summer when the FDA approves Wegovy for weight management. And this is a medication that is really similar. It’s a higher concentration of the same compound that’s in Ozempic, except this time it’s approved for people who have obesity or who are overweight and have a number of different health conditions related to that.

And what happens is that there is so much demand for Wegovy, there are so many people who are trying to get their hands on that drug, that then Ozempic becomes this backup plan. And it gets so prominent that people are seeking out Ozempic because they’re not able to get their hands on Wegovy.

Got it. And even though Ozempic isn’t really meant for weight loss, the demand for it exists, and it sounds like there are plenty of doctors who are willing to write a prescription for it even when the patient doesn’t have diabetes.

Exactly. And most people who take these drugs off label, their insurance company isn’t going to cover a diabetes drug unless they have diabetes. So they’re going to end up paying full price out of pocket, which is extremely expensive. It’s like around $1,000 a month.

So in spring 2022, you’re starting to see these drugs go into shortages. Demand is so high that diabetes patients are really struggling to access Ozempic. And this demand is also fueled by this real swirl on social media when people start talking about which celebrities are potentially on Ozempic.

It becomes this sort of detective game on TikTok where people are pointing to different prominent figures and saying, look at so-and-so. She dropped 30 pounds. It must be Ozempic. That’s part of how this drug becomes so popular.

And then in the fall of 2022, someone tweets at Elon Musk, basically saying something to the effect of, hey, Elon, you’re looking really fit these days. What’s your secret? And he tweets Wegovy, which with all things Elon, people become really interested in this.

So search results soar, and this is the moment it really enters the mainstream in this way where Ozempic has become a household name.

Right. And at this point, the conversation around these drugs is almost exclusively focused on weight loss rather than its original purpose, diabetes.

Exactly. It becomes synonymous with losing weight. And this is when these really important questions come up. It moves from being this tabloid fodder into the center of what I think is a really vital discussion about weight and weight loss and health in our society. And we know that obesity is linked with a number of really devastating conditions, but we’ve had this momentum pushing the focus away from weight and instead focusing on, one, making sure people are healthy, but then also making sure that we don’t have this really psychologically damaging emphasis on people being skinny, skinny, skinny at all costs.

And what happens when we have more people talking about these medications, taking these medications, is that we have the focus being put squarely back on weight. And this is something that people who are taking these medications are wrestling with in real time. As they’re taking a medication that has potentially profound impacts on their health, they’re also doing this kind of intellectual gymnastics and thinking about what it means.

And so I’ve really been interested in these questions, and because these drugs are so widespread there has been no shortage of finding people to talk to who are on these medications. And I talked to two women in particular who I think really illustrate what it’s like to grapple with these challenges. And for both of them, they described these drugs as being life changing, but in fact vastly different ways.

We’ll be right back.

So, Dani, right before the break, you were talking about how many people you have spoken with who are on these drugs and are wrestling with what it means to be on these drugs. And you said that two women in particular stood out to you. So tell us about these women.

So the first one, her name is Wendy Gant.

She’s in her 50s. She lives in North Carolina. She works as a mental health counselor.

And like so many people, she found out about these drugs on TikTok. And they really appealed to her because she had been struggling with weight for essentially her entire life.

So she remembers going on her first diet when she was around 10 years old, and her parents —

They actually paid her to try to lose weight.

And she spent a lot of her life going through pretty much every diet you ever heard of. And when she becomes an adult, this goes from being a mental preoccupation to a medical problem.

And the doctor basically says for the benefit of her health, she needs to lose a significant amount of weight. And she’s really frustrated with this, because she’s tried diet and exercise, all the sorts of standard medical advice to lose weight, and it hasn’t worked for her. And then she’s scrolling through TikTok one night.

And she sees people talking about Mounjaro which, like Ozempic, is a medication that is approved for diabetes but can induce weight loss.

And so she’s really attached to this idea of a medication that can solve this problem for her. Now there’s an option.

And what she starts to think is why don’t I seek this out for myself?

And she sees people talking about a certain telehealth company that can offer them really fast prescriptions.

And within 24 hours, she gets a prescription for Mounjaro.

And then pretty much as soon as she takes that first injection, she feels different.

She told me that it was like this switch just went off in her brain.

What exactly is she describing as happened to her relationship with food when she starts taking this drug?

So something people bring up to me a lot is this concept of food noise, this constant low level chatter in the back of your brain that’s like, what am I going to eat next? What’s my snack? When’s breakfast? When’s all this? And for her, all of that just shut off.

She didn’t have that sort of rumination in her brain anymore.

It reminds me a little bit of how people who take anti-anxiety medication describe the noise of doubt and worry in their heads, the volume of that just suddenly going down. And by the way, I’m one of those people. I take Lexapro, so that’s a familiar concept. She’s saying that a uninvited guest in her head is going away.

Yeah, I think that’s a really good comparison. And for Wendy, without that sort of constant voice, she was able to listen and adhere to some of the guidance that doctors have been giving her for her entire life.

So she’s more able to exercise. She’s able to make those healthy food choices.

And what actually happens to her weight when she’s on this medication?

So she loses a ton of weight.

She loses about 20 percent of her body weight.

She feels better.

So this was like a case study in why this new class of drugs is so popular right now. Wendy is somebody who struggled with weight literally her entire life, and from what she says, this is the first treatment that has made a measurable difference for her, her weight, her health.

But I’m curious how Wendy feels about these larger, as you call them, intellectual gymnastic questions about self-acceptance and body positivity, and what it means to now have a drug that solves this problem for her in a way that never existed before. Is she grappling with any of that?

So for Wendy, this is the simple part.

Before she had this medication, that was when things were complicated, all of the mental churning of figuring out what to eat, and all of the self-blame her entire life, that was when things got really thorny. But once she was able to access this medication, then it was really the best case scenario for her. The weight was a medical problem. Her doctor had warned her about it, and she had a really effective solution.

But that’s definitely not the case for everyone I talked to about these medications. And for the second woman I spoke with, things got a lot messier.

So tell us about the second woman you spoke with.

So her name is Renata Lavach-Savy.

She’s in her mid-30s, she lives in New Jersey, and at first her story looks pretty similar to Wendy’s.

She’s someone who has desperately tried to lose weight for a lot of her life.

She felt like she was going crazy because she was putting in all this effort and not seeing any results. And so she went to her endocrinologist, and she — got diagnosed with PCOS.

It’s a hormonal condition, and it makes it really difficult to lose weight. If you’re overweight with PCOS, you can have some pretty serious health complications. And so after she gets this diagnosis, she goes to see a nutritionist, and she ends up with someone who specializes in intuitive eating.

Which is?

It’s this philosophy of focusing on foods that make you feel better.

And so she still is keeping an eye on her health, but she stops dieting, and she stops moralizing food as good or bad.

And she says that she reaches this really healthy place with food, with her body. She’s at peace, and that’s something that’s come with a lot of work for her.

But then she goes to a doctor’s appointment.

Her doctor says, look, there’s a drug called Ozempic, and it can help you lose weight.

So unlike Wendy, Renata is not somebody who is seeking out these drugs. She takes the advice of her doctor who is the one who raises it seriously, and decides to go on it.

Exactly. And she feels the effects of these drugs almost immediately.

She had this sense of this is in my system now, and I have to ride this out, whatever it is. And so eventually she feels a little bit better. She digests her dinner, but that nausea stays with her, this low level queasiness that never really goes away.

But what exactly is happening here? I remember you describing these drugs function as slowing down the digestive system. So is that what happens here? Basically, she ate a meal and it just took a really long time to digest?

Yeah, I mean, this is pretty much par for the course with these medications. It takes longer for food to leave your stomach, and so a lot of people have nausea, especially when they’re first starting to take these medications.

But for Renata, it’s really severe. Her house got messy because she was worried if she bent over to pick something off the floor, she would throw up on the spot.

So what she ends up doing is actually setting a bunch of alarms to try to remind herself when to eat.

So given all of this — sounds awful — does she stop taking this drug?

No, and even when she feels really fatigued, even when she starts having really low energy, she keeps taking the medication.

It was a sunk cost —

So she kept seeing her nutritionist.

She was sleeping over 10 hours and still feeling really tired. And the nutritionist basically said that Renata might be malnourished.

Essentially, this medicine is making her eat so little that she’s not getting enough nourishment.

Exactly. She has so little appetite that she’s just not consuming enough nutrients.

This really throws her for a loop, because for her whole life she’s basically been told that, if anything, she’s overnourished. She’s overweight, and now she’s on this medication to do something about that, and she’s not getting enough nutrients.

And I want to be clear that malnourishment is really rare. We’re talking about an extreme outcome. There are side effects that happen more commonly with these medications. Novo Nordisk, the company that makes Ozempic, tends to cite nausea, and diarrhea, vomiting, all those icky things. But these are the sort of risk and benefit trade offs that people make when they’re deciding to take the medication or deciding if they want to stay on it. Are the side effects worth the results?

And so Renata just plans to bring this up with her doctor at her next checkup, but she expects that her doctor is going to say, stay the course and continue.

And for her, it’s a worst case scenario because she goes off the medication, she actually starts gaining some of the weight she lost back, and this entire relationship with food that she has come to such a delicate equilibrium about, it has gotten super complicated over the course of taking this medication.

Well, just explain that. What do you mean?

So because she had to go through all this effort to remind herself to eat, she was thinking about food all the time.

And she had done so much work to get to a place where she didn’t have that sort of mental negotiation.

So, Dani, we are left with two very different accounts of what it’s like to be on these new drugs in their earliest days. But what seems undeniable is that whether these drugs work, as they seem to have for Wendy, or whether they have not worked and had terrible side effects, as they did with Renata, that these drugs are going to be changing our relationship to weight, both medically and culturally.

Yeah. I think they speak to a really monumental shift. Because for so long we’ve viewed obesity as a sort of moral failing. I think a lot of our culture speaks to this idea of thinness is a virtue. It is something to strive for. And if someone has excess weight, that is their fault.

And what these medications do is they basically offer an acknowledgment of this is a chronic condition. This is a disease. And what do we treat diseases with? Medication.

And so from one perspective, these medications are a way to take morality out of the equation.

Right. Because as with mental health, the availability of a treatment says to the world this is out of any one person’s control, and it requires a medical intervention.

Exactly. But on the other hand, you have this other thorny issue of if you can treat obesity with a medication, and everyone knows you have that option, let’s say in theory, then what happens when you elect not to take a medication like this? What happens when you don’t want to deal with the side effects, or you can’t tolerate them, and you’re left in a larger body in a world where increasingly that is becoming almost an option?

And so I asked both of these women if having this medication becoming more and more available, does it emphasize these expectations around being thin? Does it undermine the progress that fat positivity has made?

For Wendy, she’s not really worried about the stigma around weight getting worse.

To her, the real problem would be someone who has struggled with their weight not having an option to access treatment now that there is one that’s finally available.

But for Renata, she’s very worried about the stigma this creates.

She is worried that what happened to her, that this peace she worked so hard to create with her body and with her relationship to food, that’s going to get disrupted on a larger scale. And what Renata saw firsthand is these medications, they don’t work for everyone. It’s more complicated. There are side effects. There are other considerations. But if people don’t understand that, maybe there will be a new layer of stigma around being in a larger body.

And what you’re describing, and what Renata and Wendy are describing, are ultimately questions of psychology and culture, and they’re going to play out over a long period of time, but my sense is that the companies that make these drugs are focused on the huge market that now exists for them regardless of how they are going to fundamentally, as you said, monumentally change our expectations and our conversation around weight.

Yeah, the pharma industry is barreling forward with this. There are dozens of these drugs that are in development. There are pill forms of Ozempic on the horizon. There are experimental drugs that are even more powerful.

I mean, it’s like the entire goalpost for what researchers and doctors consider to be successful weight loss, that has all shifted. And what doctors have told me is what we’re seeing now is the kind of weight loss that they wouldn’t have dreamed of 10 years ago. Now that’s a given.

And so more of these drugs are going to be approved pretty soon for weight management, specifically. And these medications are being studied beyond weight loss. There’s data that’s trickling out about whether they’re protective against cardiovascular issues, whether these medications can treat addictions.

And I don’t think we’re going to be able to put the genie back in the bottle after this. It’s only going to go broader from here.

Well, Dani, thank you very much. We appreciate it.

Thanks for having me.

We’ll be right back.

Here’s what else you need to know today. In a closely watched impeachment trial, the controversial attorney general of Texas, Ken Paxton, was acquitted by fellow Republicans over the weekend. The trial was a test of Republican Party loyalty and whether in the hyper partisan era of Donald Trump Republican lawmakers would be willing to use the impeachment process to oust one of their own from office.

Paxton, a Trump ally, was impeached in May by the Republican-controlled Texas House over allegations that he repeatedly abused his office to help a Texas real estate investor, who in turn allegedly paid for Paxton’s home to be remodeled and for Paxton’s mistress to get a job.

But on Saturday, Republicans in the Texas Senate narrowly acquitted Paxton amid intense pressure from national conservatives, including threats to run primary challenges against any Republican senator who supported Paxton’s impeachment.

Today’s episode was produced by Nina Feldman and Alex Stern, with help from Luke Vander Ploeg and Shannon Lin. It was edited by Lexie Diao, fact checked by Susan Lee, contains original music by Marion Lozano, Rowan Niemisto, Diane Wong, and Elisheba Ittoop, and was engineered by Alyssa Moxley.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for “The Daily.” I’m Michael Barbaro. See you tomorrow.