The New Yorker Radio Hour - Jia Tolentino on the Ozempic Weight-Loss Craze

Episode Date: March 24, 2023

The prescription drug Ozempic was designed to help people with Type 2 diabetes manage their disease, and, under the name Wegovy, to treat obesity. But it has been embraced recently as a tool for weight loss, and many celebrities are rumored to use it in order to shed pounds. Known generically as semaglutide, the drug gives users the feeling of satiation—even to the point of uncomfortable fullness. “One doctor I spoke to compared it to a turkey dinner in a pen,” the staff writer Jia Tolentino tells David Remnick. Tolentino recently reported on the use and misuse of the drug, and what its prominence among celebrities says about our relationship to thinness today. After some years in which body culture seemed to become more accepting, Tolentino fears the drug will wind the clock back to the brutal insistence on thinness of decades past. “Like any technology, it’s very complicated,” she says. “For some people, this drug might save their lives. For others, it does not make sense to be used in any casual way.” New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

This is The New Yorker Radio Hour, a co-production of WNYC Studios and The New Yorker. Welcome to The New Yorker Radio Hour. I'm David Remnick. At the Oscars recently, Jimmy Kimmel had a line about a drug that seems to be coming up a lot these days. You look great. Everybody looks so great. When I look around this room, I can't help but wonder, is Ozempic right for me? To listen to some people talk about Ozempic, you'd think we're a good. walking into a sci-fi future of universally trim bodies all achieved without sweat or tears. And if you turn your brain back on, you'll think it's probably a lot more complicated than that. Staff writer Gia Tolentino has been reporting on the use and misuse of OZempic and what it says

about our relationships to our bodies today. Gia, let's start with the drug itself. Let's start with OZempic. what is it supposed to be used for, and what is it actually being used for? So, OZembek is part of this relatively new class of drugs called GLP1 agonists. They have existed in some form since 2005, so they're not totally new, but they are fairly new. OZempec was first approved in 2017 as a treatment for type 2 diabetes. It's a substance called semaglutide, and the same substance was approved as a treatment for obesity under the name Wagovi in 2012.

So how does it help you lose weight? Because that's what we're hearing about. We're hearing about OZempic as a weight loss drug now. Right. These drugs, these GLP1 agonists, the reason that they help people lose weight is because they replicate a hormone that our body produces naturally, called glucagon-like peptide one. And this hormone, you know, to oversimplify it just a little bit. What it does, our body produces it after we eat. It lowers our blood sugar. It kind of balances our blood sugar, lowers it, and it also produces the feeling of satiation. So it makes you feel full. It makes you feel full, which is one of the reasons people, you know, quite simply, they can't eat as much. It's like one doctor that I spoke to compared it to a turkey dinner in a pen.

But how come I never heard of it a year ago? And then. Now I hear of little else. So one of the things that has made the OZemp conversation a little bit confusing and misdirected is that the most prominent users of it are celebrities who don't ostensibly need it, right? We all heard about it probably for the first time through reports of celebrities that had suddenly lost like 40 pounds and were posting bikini picks, but saying that it was just because they worked out a lot, right? And it kind of became this big thing in the popular consciousness because of how skinny all these celebrities were suddenly getting and how people were talking about there was this sort of miraculous hormone shot that you could get and suddenly you would be skinny, which I think is a pretty significant representation of what, A, what the drug actually entails, and certainly, as you were noting, like, what it's actually meant for.

So a Zempic is not something you can take as a pill, it's an injection? No, despite all those jokes of like everyone's doing OZemphic in the bathroom at the Oscars, it is a, there is a version of a type of drug like this that can be taken via pill, but it is most of them, it's a weekly injection. And kind of crucially, these are drugs that were designed and intended for lifetime use. They, obesity and type 2 diabetes, they're considered chronic conditions. They were designed for, you know, effectively weekly. injections for the rest of your life to control your weight or your blood sugar. And I think that kind of signifies they're not meant for casual use. They're not meant to go on it and go off of it. They're meant for people who are experiencing weight or blood sugar-related health issues. So if you're 10 or 15 pounds overweight and you want to get down to what you think is your ideal weight, however wise or misbegotten that might be, if you think Ozempic is going to do the trip, how would you counsel them after the reporting you've done?

A lot of friends have asked me, you know, in reporting this piece, you know, because the thing is also, it's quite easy to get this tried. Consider me one of your friends on this. Yeah, yeah, yeah. I've noticed from your text messages you seem to be quite interesting. Exactly. Because I'm sick at the gym and I want to eat a bagel once in a while. Exactly, exactly. Well, also the thing about this, you might not be able to eat a bagel. Like, there are wild side effects that you get from messing with your most fundamental metabolic. processes, right? Like, people vomit and get diarrhea so bad, it sends them to the ER. Like, it's not kind of... From Ozzypic, you can get that. Yeah, because you basically, you know how after

bariatric surgery you hear? People really can't eat the same way that they used to, right? They'll get quite sick if they eat any more than a really small amount. The same is true for OZempec. And very specifically, if you eat anything sort of like fatty or, you know, highly caloric, you will get physically ill. So it's not, it's not the kind of thing where you get a shot and you eat. as much as you want forever, like you'll actually get quite sick if you do that. But what I would tell my friends is like, A, it has not, there is no large-scale safety data. These drugs have not been tested in large numbers and people who are not, who do not have obesity or type 2 diabetes. Another maybe more pragmatic thing is that clinical trials show if you, you know, as these drugs

were intended for lifetime use, once you stop using them, the weight does come back on. I mean, you're supposed to get blood work every three months to make sure that your kidney and pancreas and gallblotter haven't failed you and you have to get them removed. You know, like it's not like my, something that came up so often, people would be like, should I take it? Is it good or bad? Exactly. And it was like, it's like any technology. It's very complicated.

For some people, this drug might save their lives. And for others, you know, it just does not make sense to me as, you know, like to use in any casual way. So, you write a lot about the Kardashians in your piece. How did they get to be part of this? story. I think it is kind of an undeniable fact of our contemporary reality that the Kardashians have been, I think I use this phrasing in the piece, they're sort of like the weather veins of how the beauty standard, the winds of the beauty standard are blowing. And I think that one, that they were,

they are rumored to have been early adopters, certainly has not been confirmed, but they were some of the earliest celebrities to just prominently, they had been famous for a certain kind of body, that had become the social media beauty standard. And they had been known for a look that was significantly curvier. And they just started shrinking at some point in the last two years. A lot of other celebrities have also shrunk. And this is when the drug started to seep into the popular consciousness. And people were like, what, you know, what is going on?

But isn't that crazily unhealthy in all manner of speaking, whether medically or psychologically, it just? It just sounds very dangerous. One of the things that initially piqued my interest in this phenomenon of this drug being kind of misused as a vanity tool was that I was a preteen adolescent in the era of like Lindsay Lohan and Paris Hilton and Nicole Richie when everyone was looking very, very skinny. And it had wild psychological effects on girls my age. You know, it was normal to do extremely disordered things to your body. because you want it to be skinny. You look really skinny, I have to tell you.

I mean, you look really skinny. Yeah. You look really skinny. Of all the skinny minis in Hollywood, Nicole Richie could be the most shockingly thin of the mall. Much of that attention is thanks to her new slimmed down look. Lindsay says that's just her unless it isn't. You look good to me. Thank you.

But you know, you have trimmed down. Is that just because you want to get in shape? I'm going up. I want to, you know, I'm learning about eating healthier and working out and just taking care of myself. When you look at you, you look at you. you don't see a model. And as much as I hate and preach about models not having to be stick skinny, we have to face it that we are in the fashion industry.

If you don't fit the clothes, you don't work. In the last couple of decades, it had seemed that the dialogue had developed past that, that there was lots of talk about fat acceptance and, you know, body diversity and health at every size and stuff like that. And that the single-minded desire to be thin as the, only aspirational vision of what a female body could be, that that was just deeply, deeply unhealthy, as you said, physically, psychologically, in every way. And now it's kind of back. You know, it's kind of back. And it's still, a lot of the language around it still revolves around

wellness. And these factors are very confusing right now. And that was part of why I wanted to write about this. So, Gia, with all these people snapping up this drug, supposedly to drop a few pounds, how is that affecting the people who need it for chronic disease? So one thing about these drugs is that they are still really expensive. And out of pocket, they can cost upwards of $1,000 a month. You can get them from compounding pharmacies for cheaper. That's a bit of a complicated issue. You're not getting the exact same thing that comes in the Ozempic pen or the Wigovee pen. But, you know, anyway, but to get to get these drugs covered by insurance is a bit of a hurdle. Insurance companies don't like to cover it because it's, again,

expensive. There are stories all over the internet. People will just, their insurance plan will just suddenly stop covering it, right? And I think that's part of what has made the focus so intense on the celebrity usage of it or the ostensible celebrity usage of it, that it's, you know, can be instantly available to someone that has $1,000 to pay out of pocket every month for, just because they want to look skinnier in photos. Well, you did an experiment where you tried, to get OZempec from two different compounding pharmacies, as you mentioned. How difficult was it to get them? It was terribly easy to get to get. Well, you know, I wasn't getting named around Ozambic. I was getting semi-glutide, which is the ingredient in Ozambic, and it was compounded. It's slightly different. But I did want to see how easy it was to get because a lot of the people who will be taking this drug for vanity purposes will go the route of getting it sort of as cheaply and sort of under. the table as possible. And I wanted to see how easy that actually was. So I made an account on this

telehealth website, put in my real height, and then a weight that gave me a BMI of 30, which is the, you know, the clinical cutoff for what's considered obese. I, within 60 minutes, I got a, I got a DM full of emoji back from a nurse practitioner that was, she was dying to give me semi-glutide and could give it to me at a great price. You know, I had kind of assumed that I might have like a Zoom call or I might have to provide some sort of documentation that that was actually my height and weight, no such thing. You know, I placed the order for this pharmacy in Florida. I got this box, like this cardboard box two days later, full of syringes. I can literally show it to you right now. I mean, it's on my desk. It's, it was alarming how easy it was to get. And then, you know,

I figured I would say, okay, I was like, let me see if I can get it without lying about my weight. And I tried another clinic with an office in New York. And, and, you know, I figured. And, you know, I figured, And I entered my real weight, and I'm not overweight at all. I'm pretty small. And I just said, like, I had a baby in 2020, and I want to lose 15 pounds. And they were like, amazing. We can get you enrolled right away, right? And I was like, damn.

You know, I was like, okay, like, do I have to go see the doctor? Do I need to do blood work? You know, because essentially I should be doing all these things. And there are plenty of places that are prescribing responsibly to the people that meet the criteria. But it was, yeah, it was shockingly easy to get as someone who doesn't. I'm talking with staff writer Gia Tolentino. More in a moment. Well, let's forget for a second about people who want to lose 10 pounds or something like that.

On the much more serious side, we have changed how we think about or talk about fatness and rightly so. At the same time, there's a very high rate of obesity, as you mentioned, which for a lot of people is not healthy. So what is the sane, medically sound way to think about weight loss for people who really do need to lose weight? I think that's something that seems clearly important is that weight is not used as a one-to-one signal of whether you're healthy or not, right? There have been plenty of studies that show that people have a quote-unquote normal weight, a significant amount of them will be metabolically unhealthy, a pretty significant portion of people who are technically overweight or obese will be perfectly metabolically healthy too. There are other criteria like level of fitness and what you eat that are actually much better predictors of whether you're healthy at whatever weight you are. So I think

one of the important things is to separate being overweight and being automatically unhealthy, which is still something that many doctors believe, despite plenty of research that shows otherwise. And so I think, you know, that we were asking, what is the same way to think about these drugs within the extremely complicated landscape of body politics? Like, the first thing I would say is what we hopefully won't see is that the advent of these drugs that can make people lose weight, you know, very drastically and rather quickly, I hope it doesn't close down the discourse about all of that, right? About health being possible at every size, all of that stuff. And then also, I hope, I hope that it opens up, you know, for people who are actually

dealing with serious weight-related health problems, I also hope that there is not a stigma against them using these drugs. You know, there's a certain amount of sort of stigma that's like they're taking a quote-unquote shortcut. And I think that that framing is based in an idea of thinness as something you're a moral state you're supposed to struggle for, like a Protestant work ethic idea that's thinness is the state of salvation that you're supposed to you know crawl in your hands and knees towards and plenty for plenty of thin people they're just thin and life just works that way right and there's no um there's no reason why people should not use this tool if they're if they have a medical if they have a medical reason to and they think it's a good idea so what what i glean

from your piece is that the doctors and medical professionals that you talk to think that the ideal direction here is that it will still be used for people who need it, but this business of it as a fad is highly dangerous, seems to be still growing, and they hope that it'll kind of burn itself out at some point. I think people are hoping that the vanity use case burns itself out. I don't think that it will. I don't personally think that it will, and that is really worrying to me. But I do think that as time goes on, I am hopeful that more and more people will understand, like, it's not a casual thing to mess with your metabolism. It's not a casual thing to change how your pancreas secretes hormones that tell your brain how full you are and how much sugar is it. You know, it's not like an easy miracle.

It's not casual. It's pretty serious. It's a significant, significant technology. Gia Tolentino, thank you very much. Thank you. You can find Gia Tolentino's reporting on OZempec at New Yorker.com. Now, I hope this is obvious, but we are not saying you should lie about your medical information. If you're thinking about getting semi-glutide in any form, you should talk to a doctor, a real doctor.

I'm David Remnick, and that's our program for today. Thanks for joining us. See you next time. The New Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbes of Tune Arts with additional music by Louis Mitchell. This episode was produced by Max Walton, Brita Green, Adam Howard, Kalalia, Avery Keatley, David Krasnow, Jeffrey Masters, Louis Mitchell, and Ingofen and Putabwele, with guidance from Emily Boutin and assistance from Harrison Keith Vine, Michael May, David Gable, and Meher Batia. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.