GLP-1 drugs have been remarkably helpful for my patients, and so many others—but you’d never know that from the media coverage. The big story has been all about body image–obsessed celebrities. Or it’s been fearmongering headlines about “Ozempic face” or “paralyzed stomach”. Because obesity is stigmatized and misunderstood, so are the medicines to treat it.
Naturally, people are nervous and skeptical when they hear about a new “wonder drug,” particularly one that has anything to do with weight loss. The last major Food and Drug Administration (FDA)- approved drugs for weight loss were catastrophic fails. In the 1990s, there was fen-phen (fenfluramine/phentermine), a stimulant drug combination that had to be pulled off the shelves when a study confirmed that one of its components, fenfluramine, caused heart valve damage. Later came orlistat, which became better known for producing bowel incontinence than for weight loss. But unlike fen-phen and orlistat, GLP-1s have been prescribed by doctors for blood sugar management since 2005 and for weight loss for over a decade, establishing a strong track record for both safety and efficacy. The Fen-phen disaster also led to much tougher protocols for the study of drugs before they are released to the public.
Alongside the many medical fails sits the unregulated weight loss industry, which in the US alone is worth more than $20 billion annually—not because it works, but because it doesn’t! Commercial weight loss programs have helped some customers lose weight, but the vast majority of dieters have eventually gained back what they’ve lost and often added more pounds on top of that.
In this bleak reality, the body positivity movement emerged as an important alternative to diet culture. The concept of “Health at Any Size” has exposed weight stigma in medicine, giving people tools to advocate for themselves and forcing doctors to face their own bias. Hopefully, people of all sizes and ages have less shame around what they look like. Still, beneath these welcome improvements in attitudes is some unchanged science. Overwhelmingly, the evidence links obesity to serious health issues down the road The short story is that a body mass index (BMI) over 30 combined with a large midsection indicates an increased future risk for a variety of illnesses. But as I see it, body positivity and GLP-1 drugs are partners in treating obesity, not adversaries.
Millions of people’s health could benefit significantly from GLP-1 drugs—if they aren’t scared away by medical weight stigma, by the skewed information that dominates headlines, by the failures of older weight loss methods, or by the story they heard about their friend’s friend’s friend who took Wegovy and was so nauseated, they vomited for three days straight. Because here’s what the evidence and the collective experience of my patients tells me: The Ozempic revolution changes everything. These drugs finally provide a viable, healthy, and reasonable alternative to all of the above. Their use shouldn’t be seen as destructive to body positivity, but supportive of it. They aren’t another concession to diet culture, but a means to free ourselves from it.
My new book, THE OZEMPIC REVOLUTION combines all the available data with the real-life experiences of patients at my obesity medicine practice, SoWell Health, to help you make an informed decision with your doctor about whether you should pursue medical weight management.
There’s yet another hurdle to reaching the full potential of GLP-1s. These medications are unbelievably effective, but success requires so much more than a prescription. The data illuminates this: Currently, up to 66 percent of people stop taking GLP-1s in less than a year. This means they don’t experience the intended benefit, which is long-term, sustainable weight loss that protects them from disease. We need studies to understand why so many people quit taking GLP-1s before reaping the rewards, but as someone who has had great success treating patients with these meds long-term, I see four major reasons.
First, they have unrealistic expectations: Lacking information, they think the weight will fall off right away. In my book, I offer clear data and vivid descriptions of what every point on the GLP-1 journey looks like, setting users up to stay the course for the long haul.
Second, they need help managing side effects: GLP-1 users need to learn how to eat to prevent the most common side effects (nausea, diarrhea, constipation, and fatigue), particularly in the early months when these uncomfortable side effects are most likely. This book provides a new framework for food choices that manage these issues while supporting optimal health.
Third, they lack social support: So many of my patients get nothing but grief from their family and friends (and even their doctors!) about their decision to use GLP-1s. They need information and the self-belief to feel confident and empowered while taking these drugs—none of which comes with their prescription.
And finally, they can’t afford it: In the United States, these drugs have had a list price of upward of $1,000 a month. (Compare that to $100 to $200 a month in the United Kingdom and Europe.) Many insurance companies—including Medicaid, since 2003—don’t cover weight loss drugs, and some that do claim that the costs will soon force them to limit access and length of coverage. This is a definite challenge, but change is coming. Downward pressure on prices is likely as new GLP-1 drugs reach the market. As well, studies demonstrating the long-term benefits for cardiovascular and metabolic health will change the “affordable” equation dramatically. A 2023 study of more than 17,000 people—yes, sponsored by Ozempic manufacturer Novo Nordisk but double-blinded and carried out by top cardiology researchers—has already shown that taking the GLP-1 semaglutide (marketed as Wegovy) cuts the risk of cardiac complications, such as heart attacks and strokes, by 20 percent. As a result, Medicare users with obesity and an existing cardiovascular condition are now eligible for coverage—offering hope that as wider benefits are proven, insurance coverage will continue to expand.
