“I Lost 40 Pounds on Ozempic. But I’m Left With Even More Questions.”, 2023-06-06 ():
…Weight was a chronic issue but, for the most part, not an urgent one: I was always heavier than I wanted to be, but when I put my mind to it, I could shed enough pounds to look better—for a while. They say you always remember your first time, and I will never forget the slap-in-the-face sting of a 10th-grade boyfriend who offered, in response to what I had intended as a joking inquiry, “Everyone knows you could stand to lose a few pounds.” This was the day I became a person who worried about her weight, but his cutting remark wasn’t the last…Over the years, I tried a little hypnosis and a lot of grapefruit. I attempted Scarsdale and SlimFast, counted calories and cut carbs. At college, I packed on the freshman 15, then lost it. I was thin—or thin enough—when I met my husband a dozen years later, and thin enough at our wedding. When children arrived, so did the extra pounds and, like them, stuck around. Weight Watchers, with its sensible, balanced approach to diet, helped peel them off (the pounds, not the kids)—and then, after the scale inevitably crept back up, lose those same pounds again. Setting up shop at the kitchen table for remote work during the pandemic didn’t help…
So, at 63, I was stuck, and unhappy. This time, I just couldn’t seem to get my appetite under control, I told my doctor, Beth Horowitz. A close friend, another patient of hers, had been seriously obese. Since we met nearly 4 decades ago, my friend had tried everything—liquid diets, bariatric surgery, you name it. Nothing worked, or, more accurately, nothing worked for long. But now, with a diabetes drug called Ozempic [semaglutide], my friend had lost 75 pounds, slowly, over the course of more than a year.
…(Calling this an injection overstates things—it’s a teeny, painless pinprick, especially painless if you’ve got the body fat to justify it.) As I write this, I have lost 40 pounds, an astonishing quarter of my body weight. I weigh less than I have since high school—just about what I did when that high school boyfriend made his nasty crack, and while I’d still like to lose a few more, this goal is now in the realm of pure vanity.
My “thin clothes”—the pants that sat untouched in the closet for years, because I couldn’t zip them up—are falling off my body. I have more energy. Hikes that were punishing a few years ago felt easy last summer, without all that extra weight. People comment on the transformation, then pause to make sure—I’m at that age, after all—that there’s nothing life-threatening going on…the risk of gaining back weight was the least of my problems at that point. After all, I had done that before.
…What I also experienced, and what remains, is an unfamiliar feeling: satiety. My relationship with hunger, and therefore with eating, is transformed. I leave food on my plate, untouched and unlamented, and do not look at the food on yours with the same longing: “Are you gonna eat those fries?” I can, it turns out, stop after just a few Thin Mints. And my taste buds appear to have shifted: I would rather have the roasted Brussels sprouts than the burger, which isn’t going to sit all that well in my stomach. The thin women I once watched at dinner parties, as they waved away the dessert plate and plunged into the fresh berries brought instead—I can do that now. I cannot claim to have done this for my health—certainly, appearance was my primary motivation—but the health impact has been impressive. My sleep apnea had been so severe that tests showed I was waking up an alarming 54× every hour; new testing put it in the mild range, and my sleep apnea machine has been stashed in the closet. In November 2020, my LDL cholesterol—the “bad” kind, which raises your risk of heart disease and stroke—was at 146; it was down to 133 by March 2022 and, a year later, to 120. My A1c levels, measuring blood sugar, have fallen from on the cusp of prediabetes to safely in the normal range. My blood pressure is lower, and my C-reactive protein, an indicator of cardiovascular disease, has plummeted.
Then there is the emotional impact, harder to quantify but equally important. I understand the movement for body positivity and fat acceptance, and if you are heavy and content with your weight, that’s terrific. No one should feel externally imposed shame about how they look. But speaking for myself: I am so much happier being thinner. Shopping for clothes is no longer a humiliating ordeal. Ordering dessert does not feel like a contest between gluttony and shame.
…“I think this is the turning point”, said Dr. George A. Bray, a veteran in the field of obesity research. “It’s the equivalent of bariatric surgery, but without the surgery.”…Other physicians—and not just those with hefty consulting contracts from drugmakers—have a different response: relief. Before the new generation of medications, said Dr. David Rind, a primary-care physician in Boston, “All I could ever do was say, ‘Well, I think you should exercise more and diet’, knowing perfectly well that never works. You know, it works in the short run—everybody can lose weight in the short run, and 95% of people regain weight. And so, you know, it is thrilling for me to have something that I could use that lets people lose weight.”
…For specialists in obesity, the current situation carries unsettling echoes of the fen-phen disaster of the mid-1990s, when another promising medication had to be yanked off the market…But for all of fen-phen’s ills, it also brought with it an important insight: that obesity medication could be understood not as a temporary jump-start to weight loss but as a long-term approach. “If you looked at the drugs that had been approved for weight management by the FDA, it all said, ‘for short-term use’, like up to 12 weeks, and people were saying, ‘Oh, well, you know, you could choose these, and it’s going to let you get a jump-start. And then you can learn the right ways to eat. And then you stop them. And you should be able to keep the weight off if you’re really motivated enough.’ And of course, that turned out to be totally wrong”, said Dr. Susan Z. Yanovski, co-director of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. Fen-phen, she said, introduced the idea that “we may need to use these medications in the same way we do medications for other chronic diseases.”
…Scientists, prompted by, of all things, studying the saliva of Gila monsters, developed synthetic, longer-lasting forms of GLP-1, including semaglutide, the scientific name for the medications now being marketed by Novo Nordisk as Ozempic™ & Wegovy™. As Novo Nordisk scientists studied the synthetic GLP-1, they noticed that the rats and mice on which they were testing the drug were losing weight—an enormously beneficial side effect because Type 2 diabetes is associated with being overweight or obese.
…The track record of the new class of anti-obesity medications is far more extensive, and comforting, than that of fen-phen. The most common side effects—nausea, vomiting, constipation and diarrhea—are tolerable for most patients and dissipate with time. The risk of more serious complications—pancreatitis, gallstones, thyroid cancer—appears remote. If anything, the developing evidence is that semaglutide protects cardiovascular health, based on the experience of patients with diabetes and a forthcoming analysis of semaglutide’s effect on those without diabetes. Because semaglutide reduces inflammation, which plays a role in dementia, researchers are studying whether it can slow the progression of those with early Alzheimer’s disease. At the same time, as some experts cautioned me, we don’t know what we don’t know: These new drugs last in the body and act on the brain in far higher concentrations than we have ever experienced.
…Already, the impact is quantifiable—and enormous. Komodo Health, which tracks health-care data, reported in February that in 2022 “more than 5 million prescriptions for Ozempic, Mounjaro, Rybelsus [semaglutide in pill form], or Wegovy were written for weight management, compared with just over 230,000 in 2019—a 2,082% increase.” No surprise: These patients, with no prior history of diabetes, were also overwhelmingly female—81% of those ages 25–44.
Morgan Stanley anticipated the explosion, and how it would be unleashed. “It’s a just a matter of time before the key bottleneck for obesity—the activation of patients to seek treatment and engagement with physicians—is addressed”, its report said. The solution, it suggested, was already in place: using social media to spread the word. “Our analysis shows that social media is already creating a recursive cycle of education, word of mouth and heightened demand for weight-loss drugs”, it noted.
Translation: Instagram and TikTok are already bursting with accounts of miraculously dropping unwanted pounds. “Hollywood’s Secret New Weight Loss Drug Revealed: The Hype and Hazards of Ozempic”, Variety reported in September. Elon Musk tweeted the next month that he had lost weight by fasting—“and Wegovy.”…“Everybody looks so great”, Oscars host Jimmy Kimmel said as he surveyed the audience and riffed off a line from Ozempic’s marketing. “When I look around this room, I can’t help but wonder, ‘Is Ozempic right for me?’”
Kim Kardashian might have used medication to help squeeze into a Marilyn Monroe gown for the [2023] Met gala—she denies it but told Vogue she had lost 16 pounds in 3 weeks. The truth doesn’t matter. Posts speculating on how she did it went viral, along with the query, “Where can I get some?”