Weight loss drugs Ozempic and Wegovy are changing how patients view their obesity

On a seaside in San Sebastian, Spain, Aditi Juneja strutted round within the beige sand carrying a crimson bikini high with colourful bottoms, her mop of curly hair blowing within the breeze. A detailed good friend and journey companion trailed behind snapping photographs.
Within the years earlier than the Spain journey, Juneja, 32, a lawyer, had placed on 50 kilos. She known as it the “Fascist 50” — a lot of it gained through the Trump presidency, when her work handled the period’s democracy abuses.
Identified with scientific obesity, she had come to embrace her bigger physique measurement. She’d been steeping herself in literature on fats acceptance and studying in regards to the “Well being at Each Dimension” motion, which seeks to demedicalize obesity and promote an understanding that physique measurement isn’t essentially correlated with well being. On that seaside day, she remembers eager to doc how far she’d come, “to have a good time this stunning physique.”
However across the similar time, she was additionally coming to phrases with well being points associated to her weight. “I used to be experiencing the bodily results of being in a heavier physique,” she says. First there have been ache and mobility points: Her again was often going out, and she was steadily rolling over her ankles.
Then she discovered that her levels of cholesterol had soared to 10 occasions the traditional vary. It was the results of a genetic predisposition and needed to be handled by ldl cholesterol medicine, her physician informed her, however weight loss might assist, too. Juneja was additionally rising involved about how her weight would heighten her danger of Kind 2 diabetes, for which she has a robust household historical past, and doubtlessly complicate a future being pregnant.
When her physician broached medicine to deal with the obesity — reminiscent of semaglutide, presently offered by Novo Nordisk beneath the model names Wegovy and Ozempic — Juneja refused. The fats acceptance literature she’d been finding out opposed weight loss as a way to well being. Utilizing an obesity drug additionally felt like an admission that her physique was one thing to be ashamed about at a second when she’d come to embrace it.
The brand new class of obesity drugs — known as “GLP-1-based,” since they comprise artificial variations of the human hormone glucagon-like peptide-1 — are thought-about essentially the most highly effective ever marketed for weight loss. Because the US Meals and Drug Administration accepted Wegovy for patients with obesity in 2021, buzz on social media and in Hollywood’s gossip mills has erupted, serving to drive a surge in recognition that’s contributed to ongoing provide shortages. Whereas celebrities and billionaires reminiscent of Elon Musk and Michael Rubin reward the load loss results of those drugs, common patients, together with these with Kind 2 diabetes, wrestle with entry, elevating questions on who will actually profit from remedy.
However there’s one other pressure that’s emerged within the GLP-1 story: The medicines have turn out to be a lightning rod in an obesity dialog that’s more and more binary — swinging between fats acceptance and fatphobia.
“It looks like it’s important to be like, ‘I like being fats, that is my fats physique,’ or, ‘Fats individuals are evil,’” Juneja informed me.
Whereas many clinicians and researchers hail GLP-1-based remedy as a “breakthrough,” and one deemed secure and efficient by FDA, critics query its security and usefulness. They argue the drugs unnecessarily medicalize obesity and dispute that it’s an sickness in want of remedy in any respect. Additionally they say the medicines perpetuate a harmful weight loss plan tradition that idealizes thinness and weight loss in any respect prices.
On the similar time, most of the patients presently on remedy inform a narrative that appears to fall someplace between “miracle” and “ineffective” weight loss plan drugs. Regardless of all of the TikTok movies decrying obesity medicine as the simple means out, progress isn’t all the time easy. Navigating uncomfortable side effects, dosing, weight plateaus, and entry points are irritating options of many patients’ journeys. Patients additionally informed me it’s arduous to know if and when to return off the drugs, or {that a} wholesome finish aim has been reached. A minority don’t reply to the drugs in any respect.
One factor they’d in frequent: wanting medical assist to drop some pounds, regardless of the cultural dialog round fats acceptance. Even Juneja, who ultimately began utilizing the GLP-1-based drug tirzepatide, offered as Mounjaro by Eli Lilly, argues that the medicines are a part of a extra nuanced story, one society must internalize. Quite than viewing obesity as the results of private failing or emotional points, simply reversed with weight loss plan and train, patients like Juneja say they’re starting to see it as medical researchers lengthy have: as a situation that arises from advanced interactions between our biology and our environments. Like different advanced diseases, reminiscent of diabetes, this implies it might additionally profit from medical remedy.
And a few patients, together with those that settle for their bigger our bodies, might wish to strive obesity medicine for assist dropping pounds. “You could be wholesome at each measurement,” Juneja summed up. However “I used to be not wholesome on the measurement that I used to be.”
On GLP-1-based drugs, it’s simpler to eat fewer energy
At first, Juneja took the ldl cholesterol medication prescribed by her physician however resisted the obesity remedy. She hadn’t but put within the time to actually attempt to enhance her well being by means of life-style modifications alone, she thought. So for the yr after her physician first steered semaglutide, Juneja targeted on consuming healthfully — extra protein and greens, fewer snacks — and exercising 5 days per week, pondering these measures alone could be sufficient.
A yr later, her ldl cholesterol had improved on her cholesterol-lowering drugs however her ranges have been nonetheless too excessive, and the ache and mobility points hadn’t absolutely resolved both. She had additionally misplaced “zero weight,” she recollects, and remained “very a lot involved in regards to the diabetes and the being pregnant factor,” referring to the truth that pregnancies with obesity are related to a better danger of problems, reminiscent of preeclampsia and gestational diabetes, in addition to a better danger of bias from well being care staff.
In September 2022, after Juneja returned to New York Metropolis from Spain, she stuffed her first prescription for tirzepatide, which was accepted for diabetes in 2022 and is now getting used off-label for obesity. “I now not felt responsible about exploring medicine help as an possibility for weight loss,” she says.
Immediately, Juneja observed it was all of a sudden simpler to eat fewer energy. Her starvation between meals eased, and she felt fuller sooner at any time when she did eat. The load additionally began dropping off — roughly two kilos per week, she mentioned, to the tune of 37 kilos by January 29, after 5 months on remedy.
GLP-1-based drugs “weren’t initially developed for weight loss,” Daniel Drucker, a scientist and endocrinologist on the College of Toronto who helped uncover GLP-1, says. As a substitute, they have been utilized in patients with Kind 2 diabetes, to assist handle their blood sugar, and solely in these scientific trials did researchers see how many patients have been additionally dropping pounds.
Researchers nonetheless don’t know the exact mechanism by which the drugs work, however they imagine it has to do with mimicking the actions of hormones and their influence on the mind. Hormones are the physique’s touring messengers: Manufactured in a single space, they transfer to a different to ship messages by means of receptors. The intestine makes dozens of hormones, together with GLP-1.
After we eat, GLP-1 is unleashed primarily within the intestine (along with the mind stem) and stimulates the pancreas to make extra insulin, decreasing blood sugar and sending a sign to the mind that we’ve had sufficient meals, which then curbs urge for food.
Drugs like semaglutide and tirzepatide comprise an artificial model of our native GLP-1, and seem like secure. There’s greater than a decade of security knowledge on the consequences of the medicines in individuals with diabetes, many who additionally had obesity. “We’ve been finding out [GLP-1] in animals for 30 years and in people for greater than 18 years,” Drucker, who has consulted with Novo Nordisk, says.
Thus far, each semaglutide and tirzepatide have led to weight loss outcomes rivaling bariatric surgical procedure — with out the necessity for an operation. In scientific trials lasting greater than a yr, patients lose as much as 20 % of their physique weight on tirzepatide and 15 % on semaglutide. Many patients additionally see their fasting glucose or insulin ranges enhance and their blood stress go down.
The following technology of GLP-1-based obesity drugs seems to be much more promising, Drucker says.
Although gastrointestinal uncomfortable side effects — nausea, diarrhea — are frequent, Juneja didn’t expertise any throughout her first 4 months on tirzepatide. Issues have been bettering. Her again ache went away, and she might transfer round with extra ease. Her levels of cholesterol lastly absolutely normalized, prompting her physician to lift the chance that she might cut back her reliance on ldl cholesterol medicine. And the load loss got here with an surprising psychological well being profit: It modified how she considered her obesity, decreasing the disgrace she felt about not having the ability to management her physique measurement.
“I noticed that it wasn’t my fault that I couldn’t drop some pounds regardless of making tons of life-style modifications,” she says. “I can see how a lot hormones are part of it now.”
She added: “Being on these medicines, I used to be like, ‘Jesus Christ, I didn’t must have any guilt round this. I didn’t must have any massive emotions round it.’”
Easing the meals stress
If anybody has tried weight-reduction plan and train for weight loss, it’s Tracey Yukich. Whereas she was a candidate on the truth TV weight loss contest The Greatest Loser, she needed to be airlifted to a hospital to be handled for rhabdomyolysis, a life-threatening situation typically attributable to overexercising. Nonetheless, by the tip of the season, which aired in 2009, she had managed to lose 118 kilos. And she or he stored numerous the load off years after her Hollywood stint — by exercising often (she’s run the Boston Marathon thrice) and consuming effectively.
By 2016, Yukich’s wrestle modified. Irrespective of how arduous she tried, the load piled on. “I’d revolve my whole day round my caloric consumption, and after I did splurge or have a traditional meal, I gained weight simply and quickly,” she recollects.
In 2021, Yukich determined she wanted medical assist. She had come to “despise weight loss plan tradition” which “has consumed a lot of my life,” she says, and as a substitute of extra calorie reducing and train, she sought the care of an obesity physician in Boston. The physician advisable semaglutide — Ozempic — which Yukich began taking that Could. The drug helped her lose greater than 30 kilos, she says. And, as Juneja skilled, it additionally took away the disgrace she felt asking for assist and the blame she was inserting on herself about her weight acquire.
“It’s taken me a yr to get that weight off” on semaglutide, Yukich says. “I’m nonetheless exercising the way in which I used to be a yr in the past. I’m nonetheless consuming the identical as I used to be a yr in the past. The one factor I’ve finished in another way is take prescription medicine. Does that not show medication is required for those that are overweight? That they need assistance? I can’t consider every other proof.”
On semaglutide, Yukich skilled some dizziness and a worsening of current constipation, however each uncomfortable side effects resolved. Along with weight loss, the drug’s different main impact was that her stress round meals eased.
Abruptly, she was now not fearful about whether or not she’d made the precise decisions in her final meal, or what she’d be consuming subsequent. “My day didn’t revolve round what I used to be going to have for meals,” she says.
Clinicians who’ve labored with patients with obesity shared an identical view: Individuals on these drugs don’t simply shed kilos, they shed food-related anxieties, too.
“There’s great psychological well being advantages to now not stressing round meals, to now not feeling such as you’re uncontrolled round meals, and to now not feeling like there’s one thing damaged and flawed with you that stops you from making these wholesome decisions you’d prefer to make,” says Yoni Freedhoff, an obesity physician primarily based in Ottawa who has additionally consulted with Novo Nordisk, which has employed many main diabetes and obesity medical doctors and scientists as consultants. His patients are telling him this discount in stress “is as invaluable as the load loss,” he says.
“For the primary time in lots of of those patients’ lives, they’ve a extra impartial feeling towards meals,” Michelle Cardel, affiliate director for the Middle for Integrative Cardiovascular and Metabolic Ailments on the College of Florida who heads analysis at Weight Watchers, noticed. GLP-1-based drugs “cut back the chatter in their mind; they quiet obsessive meals ideas.”
Critics fear the drugs will solely reinforce weight stigma
However not everyone embraces the brand new obesity medicines.
A few of the most vocal opposition has come from Well being at Each Dimension and weight-neutral well being advocates, who criticize how the drugs medicalize obesity.
They level to the longstanding debate about whether or not obesity is in and of itself a illness state and argue that physique measurement isn’t an excellent well being metric. Some of obesity’s well being penalties can also be attributable to stigma and discrimination, together with on the a part of well being care suppliers who under-treat patients with obesity, attributing medical points to extra weight even after they produce other causes. The scenario is particularly dangerous for individuals of coloration, who even have greater charges of obesity within the US and are much less prone to be precisely recognized by physique mass index, or BMI — the software that’s most steadily deployed to gauge obesity and its dangers.
“The thought of different well being points being ‘obesity-associated’ is scientifically questionable, since weight biking [also known as yo-yo dieting], weight stigma, and well being care inequalities are all correlated with the identical well being points to which being greater weight is correlated,” defined Ragen Chastain, a affected person advocate and author targeted on weight stigma and weight-neutral well being, who, like a lot of her friends, believes weight loss shouldn’t be used as a medical intervention. As a substitute, she’d like well being care suppliers to “cease calculating BMIs, cease pathologizing greater weight our bodies, cease prescribing weight loss diets/drugs/surgical procedures, and give fats individuals the interventions we’d give skinny individuals with the identical signs,” as she summed up on her weblog.
This pushback has gained traction in a second when weight discrimination has been holding agency or worsening — even whereas discrimination primarily based on different components, reminiscent of race or intercourse, has been declining, and obesity charges have been rising. Within the US, obesity impacts 42 % of the grownup inhabitants and 20 % of youngsters and adolescents. Globally, the World Well being Group estimates greater than 1 billion individuals have obesity, together with youngsters. There are legions who’ve struggled with their weight and share a historical past of failed weight loss makes an attempt.
Alongside the cultural motion, there’s a rising pile of scientific proof from obesity and diabetes researchers exhibiting that the well being dangers of extra fats are harder to untangle than the general public has been led to imagine.
Some individuals develop problems linked to obesity, reminiscent of Kind 2 diabetes, earlier than reaching scientific obesity, whereas others handle to keep away from obesity’s metabolic dangers, together with “metabolic syndrome” — a cluster of situations that usually happen collectively, together with hypertension, excessive blood sugar, heart problems, and excessive ldl cholesterol.
These insights have led to the “private fats threshold” speculation — that everyone has a distinct level at which fats heightens the chance of Kind 2 diabetes, and that time isn’t all the time correlated with a excessive BMI. A associated strand of analysis explores “metabolically wholesome obesity,” an idea that’s been closely debated since it might take many years for obesity’s problems to floor. Individuals who appear “metabolically wholesome” early in life will not be sooner or later, or they could develop obesity’s non-metabolic problems, which embrace sleep apnea and mobility issues.
Moreover questions in regards to the true well being prices of obesity, critics additionally categorical concern that the revealed GLP-1 weight loss scientific trials up to now have solely adopted up with individuals for as much as two years and patients are inclined to maintain off a lot of the weight solely so long as they keep on remedy, which means in the event that they wish to keep their new physique weight, they most likely have to remain on the drugs for all times.
Even the obesity clinicians and researchers who view the drugs as a serious step ahead acknowledge uncertainty. Whereas it’s true that drugs containing artificial GLP-1 alone, reminiscent of semaglutide, have been used for years in diabetes patients, among the newer compounds — reminiscent of tirzepatide, which options each GLP-1 and an artificial model of one other related hormone known as GIP — haven’t. “After we add something, it’s a really applicable query to ask, ‘Are you going to take something away from the security of GLP-1 alone or possibly ideally add one thing to the security,’” Drucker factors out. “We can not assume that [additional drug ingredients] have a impartial or useful impact.”
Nonetheless, like a lot of his friends, Drucker says he’s puzzled — and involved — by how individuals deal with obesity in another way from different illnesses, and downplay “the dangers of leaving it untreated.” Of the long-term use of the drugs, he says, “I might provide you with an inventory of tons of of power illnesses that remit when remedy is discontinued — all types of diabetes, hypertension, coronary heart illness, atherosclerosis, arthritis. But by some means, we maintain obesity remedy to a better normal and ‘complain’ that power remedy is important.”
Tony Goldstone, an Imperial School London endocrinology clinician-researcher who treats patients with obesity and has beforehand monitored the security knowledge in GLP-1-based drug trials for Novo Nordisk, shared an identical view. “So we shouldn’t develop therapies for obesity, as a result of there’s a danger that it would get abused by Hollywood celebrities who wish to lose a bit little bit of weight?” he requested. “I imply, that isn’t how medication works.”
Goldstone and others identified that there’s a mountain of proof demonstrating that, as physique weight will increase, individuals’s well being dangers do, too, together with issues that may’t be defined by discrimination alone, reminiscent of sleep apnea and most cancers. Weight loss has additionally repeatedly been proven to enhance well being outcomes — in all the things from rodent analysis to long-term managed human research of bariatric surgical procedure.
Samuel Klein, the director of the Middle for Human Diet at Washington College in St. Louis, who researches metabolically wholesome obesity, famous that many weight loss research embrace life-style modifications, like weight loss plan or train, so it’s troublesome to separate out the advantages of the load loss itself from the advantages of the opposite modifications — some extent these skeptical of treating obesity as a illness make, too. “But it surely’s most unlikely” that weight loss isn’t the “main contributor” to well being enhancements, he added, pointing to analysis that exhibits the extra weight individuals lose, the extra well being advantages accrue.
Even with the unknowns, Klein says, individuals “must get their heads out of the sand. We all know very a lot that even reasonable weight loss can forestall and enhance obesity related-diseases. It improves medical well being, high quality of life, and the flexibility to be bodily energetic and work together in actions with household and associates.”
As researchers attempt to untangle how all this works, and patients’ conceptions evolve, society’s “warped concept” about obesity stays stubbornly in place, journalist Evette Dionne, creator of a“fats liberation” memoir, wrote just lately. “It’s objectively an excellent transfer to unlink the concept of ethical advantage from fatness. Nevertheless, in these makes an attempt to complicate our cultural understanding of fatness, the treatment stays the identical: drop some pounds slightly than changing the methods by which our society interacts with and treats fats individuals.”
Caught in the course of the debates are patients who wish to drop some pounds for myriad well being and private causes, which can don’t have anything to do with how they give the impression of being.
These causes can span medical situations, reminiscent of diabetes, to easily eager to play a sport or with their youngsters on the playground, to not feeling out of breath when bringing within the groceries, Marian Tanofsky-Kraff, a clinician-researcher on the Uniformed Providers College in Maryland, says. However, she provides, “A lot of my patients have informed me their need to drop some pounds because of causes apart from look is by some means slowing the fats acceptance motion and they really feel invalidated and responsible.”
Juneja has come to her nuanced view by reconciling her embrace of physique positivity with taking the drugs. Acceptance isn’t resignation; individuals can love and settle for their our bodies whereas additionally wanting the well being advantages that include weight loss, she says.
“Whereas I agree that there’s an obsession with thinness in our tradition, a few of us do have well being challenges that dropping pounds helps with … which is difficult to do with simply weight loss plan and train,” Juneja informed me. “And it’s such a present to have the ability to get forward of issues like diabetes.”
Yukich sees the drugs as one thing completely other than the weight loss plan tradition she was so steeped in. “What I search is a wholesome me and whereas I’ll by no means be 132 kilos weighing in on the Greatest Loser stage once more, I’m the healthiest model of myself as we speak and am extra completely satisfied than I ever have been.”
The bumpy highway for patients
The multifaceted scientific-cultural second the GLP-1-based medicines have entered into has an extra layer of complexity: Treating obesity as a power illness with what consultants deem a secure and highly effective weight-loss medication is new — and could be troublesome. Even when the drugs themselves proceed to be as promising as they presently appear, this variation scales up the medical remedy of obesity, bringing it into the realm of all of the frequent situations marred by the inequalities inherent to the American well being system.
I’ve talked to many individuals on obesity medicine, and the vary of tales I’ve heard is beautiful. There are individuals who report unbelievable progress and name the drugs life-changing. For others, uncomfortable side effects have been unmanageable or weight loss on the drugs didn’t meet their expectations. Most individuals felt the drugs have been useful but in addition much less of an “straightforward means out” of weight issues than a completely new maze to navigate.
These patients within the center — together with Yukich and Juneja — have needed to change or add medicines after their weight plateaued removed from their aim on the highest doses, or they reported interruptions to their entry because of changing insurance coverage and coupon insurance policies and different affordability points — or all the above.
After Yukich shed 33 kilos on her routine of Ozempic plus weight loss plan and train, her weight plateaued, 25 kilos shy of her aim weight. Her physician steered she change from Ozempic to the higher-dose model of semaglutide, Wegovy. However her insurer, Blue Cross Blue Protect, wouldn’t cowl Wegovy. Yukich was capable of entry tirzepatide however needed to cease it after a month as a result of it had the other of the specified impact: Her cravings elevated, and she gained 10 kilos. This January, after she wrote to her insurer twice a month requesting protection, she lastly bought the approval for Wegovy.
In her first two weeks on the drug, her weight began dropping once more. “I hope to succeed in my aim, and then slowly taper off and see how I handle with out,” she says.
Juneja has confronted related disruptions — and now she’s questioning whether or not to proceed with the drug in any respect. After her insurer, UnitedHealthcare, rejected her preliminary requests to have tirzepatide lined for obesity, she bought entry to the drug with a coupon from its producer, Eli Lilly, for $25 monthly — a fraction of the roughly $1,000 she would have needed to pay out of pocket.
Then, final December, Juneja discovered that Eli Lilly’s coupon coverage modified, to solely supply the low cost to individuals who have already got Kind 2 diabetes. So she’s been paying out of pocket for a month whereas ready to see if UnitedHealthcare may cowl one other GLP-1-based drug. Thus far, all of her prior authorization makes an attempt have been rejected. Due to the prices, and diarrhea that surfaced throughout month 5 on tirzepatide — which she’s not sure is linked to the drug — she’s considering stopping, simply 14 kilos in need of her aim weight.
If she does give up, she’s hoping she will be able to keep her present weight loss along with her common weight loss plan and train routine, however she is aware of there’s a danger her weight may creep again up, together with the mobility, ache, and ldl cholesterol points and different well being dangers. And she or he’s unsure how involved to be.
“Even when I lose the following 14 kilos and I’m now not overweight, I’m merely obese, does that really cease me from having Kind 2 diabetes?” she informed me.
What’s extra, she’d solely ever deliberate to be on the drug for a yr — she had been informed by her prescribing physician that the drugs would reset her physique’s “set level,” in order that she’d have the ability to keep a decrease weight with out medicine. As we speak, she feels she was misled. “I’d’ve by no means gone on [weight loss drugs] if I believed I’d should be on them ceaselessly.”
Aside from the confusion over her personal case, she’s questioning in regards to the potential societal results of the brand new medicines, and how the gaps in GLP-1 entry will play out in a rustic the place states with among the highest charges of obesity even have among the lowest charges of medical health insurance protection.
“I fear that due to the price — and the advertising — it’s going to perpetuate us having individuals who are wealthy and skinny, and individuals who are poor and fats, and it’s not going to alter the tradition or assist individuals that almost all want it,” Juneja says. “So whereas it’ll make a distinction for people who can entry it, our means to alter population-level obesity continues to be decided by the flexibility to entry wholesome meals, entry well being care, have the time to consider your well being. And all of that isn’t modified by these drugs. It’s precisely the place we have been earlier than.”
Clarification, February 14, 5:30 pm ET: Up to date to make clear the quantity of weight Tracey Yukich misplaced with Ozempic.