The Daily - The Ozempic Era of Weight Loss

Episode Date: September 18, 2023

Drugs like Ozempic are revolutionizing the treatment of obesity. The medications, originally used to treat diabetes, keep gaining attention as celebrities and other influencers describe taking them to lose weight quickly.Dani Blum, a reporter for The Times, tells the story behind the drugs and describes some of the ramifications of using them.Guest: Dani Blum, a reporter for Well at The New York Times.Background reading: Ozempic can cause major weight loss. What happens if you stop taking it?Some people taking the drugs can experience such intense lack of appetite that they become malnourished.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.

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. obesity and the way that we think about and talk about weight. Today, my colleague Danny Bloom on the story behind these drugs and the very different experiences of two people who took them. It's Monday, September 18th. 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. There is such a cool weight loss medication in the pipeline that I have to tell you about. It is all over social media. I got my ozempic yesterday. I'm nervous. I'm not going to lie. Another hockey mom, she's on it as well.

She looks fabulous. It's on TikTok. You can't go on YouTube or even watch TV without seeing that really catchy ozempic commercial. Jolo, you look thin. Thank you. Ozempic? Yep. Everybody looks so great.

When I look around this room, I can't help but wonder, is Ozempic right for me? It is absolutely everywhere. And it is so massive that it's something that I am thinking about 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 one in the morning? I think it's pretty simple. So much conversation, so many reels on Instagram that I watch at one 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 sort of 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% of Americans have obesity. And while there's an evolving conversation around the link between health and body size, And while there's an evolving conversation around the link between health and body size, right, 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, right? But you have real momentum, and then Ozempic walks in and just sort of 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 GLP-1s. That stands for glucagon-like peptide 1 receptor agonist. Doesn't roll off the tongue. Exactly. And so GLP-1 medications start rolling out in the U.S. 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. Huh. 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% 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 GLP-1s 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?

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, right? 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, right? 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,

right? 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 Wagovi 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's so much demand for Wagovi. 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 Wagovi. 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, right? 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, you know, 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 like, hey, Elon, you're looking really fit these days.

What's your secret? And he tweets, Wagovi, which, you know, 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 sort of 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, you know, is that we have the focus being put squarely back on weight. being put squarely back on weight. And this is something that people who are taking these medications are sort of 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 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. Wendy? Hello? Hi. Hey.

So the first one, her name is Wendy Gant. So maybe we could just start off with the basics. She's in her 50s. She lives in North Carolina. She works as a mental health counselor. Well, this was last summer. Yeah. 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. I can remember always being a pudgy kid. So she remembers going on her first diet when she was around 10 years old and her parents. first diet when she was around 10 years old. And her parents... I remember they offered to pay me to lose 10 or 20 pounds, whatever it was. They actually paid her to try to lose weight.

I can remember in seventh grade, there was a diet going around where you ate seven grapefruit one day, I think it was, seven boiled eggs the next, and maybe like seven bananas or hot dogs, something stupid. And she's spent a lot of her life going through pretty much every diet you've ever heard of. And when she becomes an adult, this sort of goes from being a mental preoccupation to a medical problem. It was a wake-up call for me two years ago because my cholesterol was just climbing. It was the first time I ever heard that my liver numbers looked irregular. 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 about this, right?

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. Women were talking about their Manjaro journey. You know, that's what they would call them. And she sees people talking about Manjaro, which, like Ozempic, is a medication that is approved for diabetes but can induce weight loss. Their story sounded like my story. And so she's really attached to this idea of a medication that can solve this problem for her,

right? Now there's an option. I was like, heck yeah. This sounds amazing. And what she starts to think is, you know, why don't I seek this out for myself? I filled everything out online. I got assigned a provider.

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 Manjaro. As soon as I got home, I could not get that out of the box fast enough and jab myself. And then pretty much as soon as she takes that first injection, she feels different. I woke up the next morning and my first priority was not going downstairs and making myself a breakfast. You know, that loop of have a good breakfast, have a big breakfast, and then what are you going to have? And to not have that food chatter on loop is really freeing. She told me that it was like the switch just went off in her brain. It was a sense of relief.

And I thought, wow, I don't care about food. And I just went about my day. Wow, I don't care about food. And I just want about my day. What exactly is she describing as happened to her relationship to food when she starts taking this drug? So something people bring up to me a lot is this concept of food noise, right? This like 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. It's the first time in my life that I've ever felt normal. She didn't have that sort of rumination in her brain anymore. I kept saying, this must be what skinny people feel like. This must be how normal people's brains work. And for her, she was like, oh, this is what a healthy relationship to food actually presents as. 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 kind of uninvited guest in her head is going away. Yeah, I think that's a really good comparison. And for Wendy, you know, without that

sort of constant voice, she was able to listen and sort of adhere to some of the guidance that doctors have been giving her for her entire life. I've always tried to make sure, okay, I get this amount of steps, I'm going to move my body, I'm going to do this, I'm going to do that and stay active. But in the past, you know, it didn't have an impact on my weight. And now it does. So she's more able to exercise. She's able to make those healthy food choices. It's not as hard to want to eat vegetables or balance your meals as it was a year ago. And what actually happens to her weight when she's on this medication?

So she loses a ton of weight. Since last year, beginning the medication, I've lost 40 pounds. She loses about 20% of her body weight. My arthritis is way better. My knees don't hurt. My plantar fasciitis in my right foot is gone. She feels better. If this medication just quelled the food noise part for me forever, 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. I think people like me who have struggled for years and years and years and who have never been offered help from a medication like this, you feel really judged. And you also don't always feel like you're believed. 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 I spoke with, things got a lot messier. So tell us about the second woman you spoke with. So her name is Renata Lavaksavi. Hello. How's it going? I'm okay. And she's in her mid-30s.

She lives in New Jersey. And at first, her story looks pretty similar to Wendy's. And I'm one of those type of people who would exercise rigorously, control what I was eating, when I was eating. She's someone who has sort of desperately tried to lose weight for a lot of her life. Either I'm losing my mind or this isn't working, like this is not possible. She sort of 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 stands for polycystic ovarian syndrome.

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. I first sounded so kind of like woo woo and like, oh, I'm going to think about what to eat this first. How is that going to help me with anything? this for me. How is that going to help me with anything? But it really made more sense that it's about taking the time to actually appreciate how your body is feeling before and after eating different types of food. And so she still is keeping an eye on her health, but she stops dieting and she stops moralizing food as good or bad. I had no longer been like weighing myself daily or being obsessive over it, but instead trying to look at other measures of health,

such as how I felt, my energy levels, rather than the number on the scale. 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. Again, I didn't bring it up. I didn't say, hey, doc, I really

need something to help me lose weight. What can I do? Like, she on her own brought up, there's these new medications. Her doctor says, look, there's a drug called Ozempic and it can help you lose weight. Was it willing to take the chance that if this is going to be beneficial for me in some way that maybe I can't see, then I'll give it a shot. 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. I remember that day, I was like, okay, this is it. I'm taking the medication.

This is your last morale. You better have a great big meal. And so I had a nice big dinner, and about 10 minutes afterwards, I took the injection. And within an hour, I felt more bloated and full than I have in my entire life. And I was like, what is happening? What is this? And I just felt so sick, so nauseous. And I just felt so sick, so nauseous. She had this sense of like, 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 sort of like 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, right? 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. Feeling like the food is like right there. Well, you can't see me, but I'm putting my hand to my throat, you know, like right at your throat. But for Renata, it's really severe. Like 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. I definitely had a hard time eating anything that was protein rich because it's harder to digest and therefore made me feel sicker. Yeah. So throughout all of that, was there any point in which you actually had an appetite?

Appetite? I don't know if I ever felt hungry. There were times where I felt less nauseous and eating didn't sound disgusting. If you don't eat for too long, you can actually get nauseous. So what she ends up doing is actually setting a bunch of alarms to try to remind herself when to eat. The morning would be me trying to force myself to eat something to lower my nausea so that later in the day I could have a little more. If I didn't have anything or didn't have enough, then the nausea would just get worse and worse and worse and worse. And then, you know, what's the last thing you want to do when you're nauseous?

Eat, right? So then it becomes like a cycle that you can't break out of. So given all of this, and 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 just became like, I'm putting so much effort into like surviving each week that it felt like the longer you do something, the more invested you become. It was sort of a sunk cost. Well, I'm not going to quit now. So she kept seeing her nutritionist. And I was explaining to her how I was just exhausted.

She was sleeping over 10 hours and still feeling really tired. And the nutritionist basically said that Bernadette 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. All of it felt very bizarre.

I'm still overweight. And I only had lost eight pounds in four months. Even after taking this medicine, somehow now I'm both overweight and now nourished. Like, how does that work? This really throws her for a loop because for her whole life, she's basically been told that,

if anything, she's overnourished, right? She's overweight and now she's on this medication to do something about that, and she's not getting enough nutrients. It was just hard to reconcile that with how I know I look. And I want to be clear that malnourishment is really rare, right? Like, 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. But no, her reaction was, this is appalling. This is clearly not a good fit for you. Let's stop this medicine immediately. And for her, it's sort of 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's 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.

Every day, all day long. What am I getting in my next meal? Do I have the food? Can I prepare it now? What am I going to buy? If I go somewhere, will they have something I can eat, right? It became having to be obsessed with food in order to survive, in order to be able to eat enough food to live every day. And she had done so much work to get

to a place where she didn't have that sort of mental negotiation. And I made a lot of psychological mental progress on how I valued myself being independent of my weight, trying to separate the focus of food as being something that nourishes me and provides me with the energy I need versus good and bad, not looking at the scale. I had done a lot of work mentally to get away from that type of toxic environment that's so focused on weight, equal, and beauty. And it felt as if by starting the Ozempic as if I was kind of being untrue to that, like, and now I'm taking a shortcut to lose weight because apparently I do care about weight. You know, like, it felt like I was undoing a lot of the mental work I had been doing

to de-emphasize weight. 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, right, we've viewed obesity as a sort of moral failing. I think a lot of our culture speaks to this idea of, you know, 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 acknowledgement of like, 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.

out of any one person's control and it requires a medical intervention. Exactly. But on the other hand, you sort of have this other thorny issue of like, if you can treat obesity with a medication and everyone knows you have that option, right? 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 sort of emphasize these expectations around being thin? Does it undermine the progress that fat positivity has made?

That's an interesting perspective. For Wendy, she's not really worried about the stigma around weight getting worse. worried about the stigma around weight getting worse. What my hope is, is that medical professionals who are the ones on the front lines with individuals, that they can be more educated about what all the options are so that a person can make a decision based on informed consent, whether you want to take the meds or you don't want to take a med. 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. Not everyone who is psychotic wants to take an antipsychotic drug. Not everyone who wants to be in recovery wants to be an abstinence.

You know, typically there's a reason why someone makes the choices they make. But for Renata, she's very worried about the stigma this creates. I just hope that people don't view it as, why are you still fat when everybody else is just taking Ozempic and losing the weight? That's something I think about, like whether it will cause people to be even more judgmental of others. She's worried that what happened to her, that this piece 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. 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 goalposts 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. We'll be right back. 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 Lexi Diao, fact-checked by Susan Lee, contains original music by Marion Lozano, Rowan Emisto, Diane Wong, and Alisha Ba'itu, and was engineered by Alyssa Moxley. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly.

That's it for The Daily. I'm Michael Bilboro. See you tomorrow.