Welcome back to the second half of our Ozempic series ;

In last week’s edition we explored the promising potential of GLP-1 receptor agonist drugs (like Ozempic, Wegovy, and Mounjaro) for treating diabetes, neurodegenerative disease, and addiction. But as with any medication, especially one so hyped, it's crucial to examine the less glamorous aspects.

If you’re yet to read the first part of this series, we do recommend having a quick look. It gives some helpful background on what GLP-1 agonists are, how they work on the brain and body, and how they could be helping to reduce neurodegenerative disease (such as Alzheimer’s disease) and even addiction…

Basically, the TLDR of it all is; Ozempic, Wegovy, Saxenda, Mounjaro are the brand names for types of glucagon-like peptide-1 (GLP-1) receptor agonist drugs. These GLP-1 agonists are compounds which work by mimicking a natural gut hormone that regulates appetite and blood sugar. Initially, these drugs were developed to treat type 2 diabetes, however clinicians soon realised that patients were losing weight in a way that old-school diet drugs (such as the 90s craze of phentermine) had long tried to do, but couldn’t pull off without some pretty intense side effects.

Since then, Novo Nordisk, the Danish company that manufactures Ozempic (for type 2 diabetes) and Wegovy (for weight loss) has claimed a larger market value than the entire Danish economy (Source: Forbes).

However, if something sounds too good to be true, it usually is… right?

With all of the hype around GLP-1 agonists being a “cure” for obesity, we wanted to jump into the journals and find out:

Are these drugs truly a "cure" for obesity, or are we overlooking potential consequences? Keep reading as we uncover the implications for body image, drug misuse, and long-term health.

There aren’t many pharmaceuticals that have catapulted into public consciousness in the way that Ozempic has. Ozempic's meteoric rise to fame is partly fuelled by its association with ultra-slim celebrities, who seem to have transformed their bodies overnight, sparking red carpet discourse about changing faces and bodies.

Now of course, Hollywood celebrities are not necessarily the barometer for health for the rest of us (we are looking at you Gwyneth Paltrow!). However, there are definitely psychosocial impacts on body-image that filter down, whether we consciously recognise it or not. Many of us probably look back on the media landscape of the early 2000s with horror at the way that women’s bodies were so openly discussed in tabloids - but without the benefit of hindsight, it’s hard to know if history is repeating itself through the Ozempic discourse of the 2020s. While there is yet to be any specific research into the body-image impacts of Ozempic, some scientists and academics are debating whether Ozempic is promoting an unhealthy ‘thin-ideal’.

First, we want to clarify that there is a huge difference between thinness and health.

While obesity can be linked to worse health outcomes, many obese people live perfectly healthy lives. In the promotion of these drugs as a ‘cure’ for obesity, some scholars are wondering if this will increase weight stigma and fatphobia, and reinforce the negative view that people in larger bodies are inherently unhealthy (Source: The Conversation).

Similarly, some scholars argue that the social acceptance of GLP-1 agonist use for weight loss may further reinforce toxic body-image beliefs. Young women are the highest-risk category for eating disorders, and a constant social-media bombardment of unrealistically thin bodies may be promoting disordered eating behaviours (Source: Healthline). Even among people who have lost weight, a recent study has shown that people who did so by using GLP-1 agonist drugs received stronger negative evaluations and higher egocentric evaluations (i.e. the person was egotistical) from the participants surveyed (Source: International Journal of Obesity). This highlights the complexity of weight stigma, and the ever-shifting goalposts for societal weight standards.

While one small-scale study did find that semaglutide may reduce emotional eating behaviours that sometimes underpin binge-eating disorders (Source: Journal of Physiology and Behaviour), there is no evidence that clearly supports Ozempic’s safety for those with other eating disorders (such as anorexia nervosa or bulimia). It’s worth noting that a recent Australian study highlighted the prevalence of eating disorders amongst people with higher BMIs (Source: Journal of Eating Disorders, Nature). The Australian Journal of General Practitioners flagged that eating disorders are often “incorrectly and stereotypically” associated with low body weight, and that practitioners should exercise caution when prescribing GLP-1 agonists (Source: Australian Journal of General Practice).

It’s key for all of us to keep a critical eye on the discourse around Ozempic. For practitioners, ensuring that well-rounded protocols are in place for prescribing these drugs may be one way to safeguard people who seek out GLP-1 agonists for excessive weight loss.

There is also a huge difference between the recommended use of these drugs by a doctor (which in Australia is limited to people with type 2 diabetes) and the ease of access that has allowed people with healthy BMIs to access these drugs for off-label purposes.

According to researchers from the University of Sydney, some doctors are prescribing these drugs for off-label purposes such as weight loss (Source: The Conversation). Telehealth providers have also been utilising a loophole in which pharmacists are able to create an identical compound due to limited access of the TGA approved drugs (Source: ABC).

While the benefits are widely reported, most medications will have some form of side-effect. Ozempic and similar drugs are no different, with some studies finding that between 48 and 89% of people who took semaglutide reported side-effects (Source: JAMA Network Open, New England Journal of Medicine). Gastrointestinal problems like nausea, vomiting, diarrhoea, and constipation are the most frequent side effects of semaglutide. Additionally, it might raise the chance of pancreatitis, kidney failure, and medullary thyroid carcinoma, particularly in individuals with a family history of this type of cancer (Source: JAMA).

As discussed above, the rapid weight loss associated with GLP-1 agonists often promoted in media, may foster unrealistic body image expectations which could lead to dissatisfaction even after significant weight loss, and pressures to conform to a certain body ideal.

Ozempic is not a magic bullet. As these drugs work by mimicking a hormone to make someone feel full, they only work as long as you are taking them. One study found that participants who had lost weight by taking semaglutide (a type of GLP-1 agonist) had regained about two-thirds of the weight they ad lost within a year of stopping use. This makes weight-cycling, or ‘yo-yo’ dieting another concern with extended GLP-1 agonist drug-use.

Further, weight-cycling has been shown to have negative health effects in women in a 2022 study (Source: ). Similar studies have shown that rapid weight loss from semaglutide or other methods may also lead to gallbladder disease.

Essentially, these drugs are not a long-term solution. When we consider this, combined with recent concerns about availability, the concerns for what happens after Ozempic become more pronounced.

In 2023, the Therapeutic Goods Administration of Australia (the TGA) raised the alarm about a shortage of semaglutide due to a significant uptick in off-label usage. This meant that even people who had been prescribed semaglutide for type 2 diabetes were no longer able to get it (Source: TGA).

As always, more research will be needed to capture the many complex interactions these drugs will have with our bodies, minds and the way we perceive ourselves and each other.

Scientific research in this space can be a bit more nuanced than a straightforward clinical drug trial, as many factors such as culture, individual body-image beliefs, and mental health are difficult to quantify. However, we believe that knowing how these drugs affect our mental wellness and social world are just as important as the physical effects.

Going forward, we would love to see policies move with this rapidly changing space to support holistic care, such as mental-health support and addressing disordered eating behaviours. Having guidelines in place to support safe prescription practices may also be another policy avenue that could support safe use of this drug.

By keeping a focus on health, and not just aesthetics, we hope that these drugs can benefit the lives of people with a medical need for them. Similarly, keeping a critical gaze on media portrayals of weight can help to evaluate and minimise stigmatising content on social media.

As with any medication, the safest form of use is the one recommended to you by a trusted Doctor.

Hopefully ;

that will keep you busy as you ponder the tangible and intangible side-effects of this potentially game-changing category of drug.

If you still can’t get enough of the Ozempic-zeitgeist, Johann Hari (author of Stolen Focus and Lost Connections) has just released his new book ‘Magic Pill.’

The book was inspired by Hari’s own experience with taking Ozempic, and his journey as he investigates whether this ‘wonder-drug’ can be everything it claims to be. Through speaking to scientists and celebrities, Hari tackles one of the most burning topics of the moment.

For the more audio-inclined MM readers, we also loved Sean Illing’s recent interview with Johann Hari on The Gray Area podcast.

And lastly, notorious essayist Jia Tolentino’s New Yorker essay on Ozempic culture is another highly-recommended read.

We’d love to know if you prefer this format so please take a second to hit the survey below and let us know your thoughts!

As always, we welcome any suggestions on what burning science questions you have, so drop us a line (even just in reply to this email!) and we’ll investigate for you.

💙 The MM Team

REFERENCES

• https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2024

• Da Luz, F. Q., Sainsbury, A., Mannan, H., Touyz, S., Mitchison, D., & Hay, P. (2017). Prevalence of obesity and comorbid eating disorder behaviors in South Australia from 1995 to 2015. International Journal of Obesity, 41(7), 1148–1153. https://doi.org/10.1038/ijo.2017.79

• Ghusn, W., De La Rosa, A., Sacoto, D., Cifuentes, L., Campos, A., Feris, F., Hurtado, M. D., & Acosta, A. (2022). Weight loss outcomes associated with semaglutide treatment for patients with overweight or obesity. JAMA Network Open, 5(9), e2231982. https://doi.org/10.1001/jamanetworkopen.2022.31982

• Nicolau, J., Pujol, A., Tofé, S., Bonet, A., & Gil, A. (2022). Short term effects of semaglutide on emotional eating and other abnormal eating patterns among subjects living with obesity. Physiology & Behavior, 257, 113967. https://doi.org/10.1016/j.physbeh.2022.113967

• Post, S. M., & Persky, S. (2024). The effect of GLP-1 receptor agonist use on negative evaluations of women with higher and lower body weight. International Journal of Obesity. https://doi.org/10.1038/s41366-024-01516-4

• Quittkat, H. L., Hartmann, A. S., Düsing, R., Buhlmann, U., & Vocks, S. (2019). Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00864

• Ralph, A. F., Brennan, L., Byrne, S., Caldwell, B., Farmer, J., Hart, L. M., Heruc, G. A., Maguire, S., Piya, M. K., Quin, J., Trobe, S. K., Wallis, A., Williams-Tchen, A., & Hay, P. (2022). Management of eating disorders for people with higher weight: clinical practice guideline. Journal of Eating Disorders, 10(1). https://doi.org/10.1186/s40337-022-00622-w

• Sharp, G., Girolamo, T., Hay, P., Mitchison, D., Cooper, K., Sumithran, P., & Jebeile, H. (2023). New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders. Australian Journal of General Practice, 52(9), 651–653. https://doi.org/10.31128/ajgp-02-23-6731

• Suran, M. (2023). As Ozempic’s popularity soars, here’s what to know about semaglutide and weight loss. JAMA, 329(19), 1627. https://doi.org/10.1001/jama.2023.2438

• Wilding, J. P., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/nejmoa2032183