The Rise and Rise of Ozempic and other GLP-1 Drugs

Dip your toe over the southern border and turn on a TV and you will soon be inundated with commercials for prescription drugs (think Jardiance, Shingrix, and Skyrizi for a start). With their catchy tunes, moving social scenarios, and vibrant outdoor scenes they make a seductive soup for us to swim in during pauses in our news, drama, and soap opera programming. We Canadians will have seen the uptick of such ads on our social media feeds. Although in the USA, there are currently seven drugs which have been approved for weight management, one of the most prominent is Ozempic, a drug that started its life as an aid to diabetics and has taken a sharp turn toward weight loss and possibly much more.

Set to the 1975 tune Magic, by the band Pilot, the catchy Ozempic pitch has helped to transform a diabetes drug into a much sought after medicine for the obese, the overweight, and the “I want my selfies to look sexier” crowd for the ways that it has, unexpectedly, been observed to impede food cravings thereby provoking significant weight loss. As the author of Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight Loss Drugs (2024) Johann Hari revealed in an interview with Steven Bartlett on his podcast The Diary of a CEO, it was after attending a post-Covid, Hollywood party that a friend let him know that he was wrong to assume that the slender figures of all assembled were due to their dedication to Pilates and weight training during the pandemic. By the way, we are not quite sure if it was brave or foolish for Hari (who has a history of heart disease and other weight-related illnesses in his family) to take one of these drugs as a part of the research for his book.

Obesity Canada explains that, “Obesity is a progressive chronic disease, similar to diabetes or high blood pressure, which is characterized by abnormal or excessive fat accumulation that may impair health.” According to Forbes Health, data from 2017 and 2020 reveals that 41.9% of American adults are obese. Sadly, in a 2023 article in the Obesity: A Research Journal, Holly Loft et al reported that this number jumped to 49.6% in 2017-2018 for African Americans 20 years of age or older. Canadians are not doing so great either. While we (unsurprisingly) could not find current statistics for obesity among black Canadians, a recent 2021 article in the Canadian Journal of Diabetes by Rukia M. Swaleh and Catherine Yu revealed that in Ontario, 8.5% of black people have diabetes compared to 4.2% of white people. In fact, a 2017 report from the World Obesity Federation predicted that one-third of Canadian adults will be obese or overweight by 2025 (some 10 million people). While most people now readily acknowledge that obesity is a disease with life-threatening side effects, it is also obvious that we should be as informed as possible when opting to take a drug that many experts believe is not a temporary fix, but a life-time commitment. That’s right, once started, the weight loss that patients achieve will be reversed (if other steps are not taken) if the patient ceases to take these medications. On the upside, Hari explained that the average person will lose about 15% of their body weight within a year, and with the new generation of these prescriptions, the figure rises to 24%. As Hari described, after a couple of days on the drug, he awoke (atypically) without his usual hunger pangs and within a week his appetite had decline by about 80%. While his pre-drug daily calorie intake was 3,200, it was subsequently drastically reduced to 1,800. Sounds pretty good, right? Yes, but for the squeamish or needle averse, your first hurdle will be the delivery system. As yet, these medications are not available in pill form, but are typically self-delivered through a weekly injection in the stomach.

So, what’s the problem, you ask? Well, there are quite a few, actually. There is much speculation and seemingly no settled scientific consensus on precisely how these drugs work or even where they are working in our bodies (the brain and/or the gut). But as we know from recent research on the microbiome, the gut is the brain! Although it is known that these drugs seem to simulate an artificial copy of the hormone Glucagon-like Peptide-1 (GLP-1), there are competing theories about how they get this done. By the way, GLP-1 which is found in the gut and throughout the brain, is what signals our brains to stop eating. About those competing theories, Hari explains, while some scientists believe that the drugs dampen the “reward system” of the brain, others believe they reset our preferences, and still others that they dial up our “satiety system”. He also warns that besides offering potential benefits with regard to addiction, they also clearly introduce drawbacks related to depression.

Made by the Danish company Nova Nordisk, Ozempic and similar drugs have been in the headlines recently due to high profile celebrities like Oprah Winfrey and Whoopie Goldberg bravely admitting their use of it or another in the GLP-1 family of drugs. We say bravely because for many – think Hollywood and social media influencer culture – although these drugs are an open secret, they are still a “secret”. The famous, wannabe famous, and self-defined-fabulous who pursue celebrity through body image are fond of discussing how changes in exercise and diet got them to their ideal weights, and not so much their investments in bariatric and plastic surgeries, or prescription drug use.

Oprah Winfrey, one of the most famous celebrities to honestly share her decades-long weight loss struggles with the public, dove into the discussion with an interesting ABC prime time special Shame, Blame, and the Weight Loss Revolution (March 2024). Winfrey, a woman guided by intention, revealed that she was driven by the desire to stop the shaming and blaming (both of ourselves and others) that occurs around the topic of obesity. Recalling her own painful struggles with weight loss, Winfrey then interviewed a range of people including doctors (specialized in the treatment of obesity), patients (afflicted by it), and executives from Novo Nordisk and Eli Lilly (two of the pharmaceutical companies that make this category of drug). The two medical doctors, Scott Butsch (Cleveland Clinic) and Amanda Velazquez (Cedar Sinai), perhaps unsurprisingly advocated for their use for their obese patients who have experienced life-changing and life-saving weight loss. But they also made their roles as medical consultants for pharmaceutical companies seem downright altruistic (when prompted by Winfrey to disclose these ties and the relevance). Indeed, it was Winfrey and her team who used a slide to explicitly state in writing that “consulting” means that both doctors accept financial remuneration in the form of research funding, the implication being that their opinions are not untainted by bias. Alongside the testimonials about how the drugs saved and improved the lives of the formerly obese guests were the medical experts and drug company executives who seemed to play down the risks of the possible long term health impacts of taking such drugs in perpetuity, impacts which cannot possibly be known for a set of drugs that are less than twenty years old.

But there are louder voices challenging the orthodoxy that these drugs are an easy fix or consequence-free option. In the recent April 19, 2024 interview on Real Time with Bill Maher, the fitness and nutrition expert Jillian Michaels of TV’s The Biggest Loser fame and her current podcast Keeping it Real, described the drugs as a “devil’s bargain” since, in her expert opinion, “diet and exercise are the only way to maintain a healthy weight”. Drawing on scientific research, Michaels argued that 50% of the people who take this class of drug suffer from nausea, vomiting, diarrhea, pancreatitis, kidney failure, thyroid tumors, and vision and muscle loss. We can add to that list constipation, hair loss, and suicidal ideation. Although Michaels claimed that the drugs are being tested on kids as young as 6 years old, Winfrey’s special confirmed that they have been approved as an obesity medication for children over the age of 12 by the American Academy of Pediatrics. Indeed, one of Winfrey’s interview subjects was a brave young girl named Maggie whose parents authorized her to take the drug after watching her grow to 300 lbs. by the age of 11 and being warned that, Maggie, pre-diabetic and suffering from fatty liver disease, would likely grow to 500 lbs. by the age of 16. Maggie, now a teenager, has since lost 108 lbs., joined the cheer squad, and gone to her prom. These seemingly mundane facts are actually not mundane at all since they indicate how Maggie has gotten both the trivial parts and the major milestones of her childhood back since losing the weight.

Brilliantly, Maher and Michaels also addressed the problem of social context, meaning the nature of the foods that are driving us to overeat in the first place. This problem, by the way, did not plague our hunter-gatherer or even our more recent early post-industrial ancestors for whom instant gratification was never readily available and incessantly marketed to them in the form of pre-packaged, just-add-water, toaster-friendly, or microwavable “food like substances” (thank you Dr. Mark Hyman) which are chocked full of salt, sugar, preservatives, and unhealthy fats, deliberately engineered to hack our biochemistry and cause addiction. This is why, as Maher exclaimed, “I don’t keep [that] shit in the house!” Instead, it is clear that although there are a huge number of excellent sources explaining how to feed ourselves healthy, delicious, and longevity-producing foods (like Black Maple Magazine’s very own Self-Care Circle), many of us have not gotten the message.

But the food itself is only a part of the problem. The other part is psychological, since, as Michaels explained, many addictive behaviours regarding food are linked to suffering at the psychological level. If you’ve been paying attention to the stories of sexual abuse survivors, many women report that their childhood abuse led them to “pad” their bodies with extra weight in an often unconscious effort to avoid sexual attention from men. Therefore, solving the obesity problem for most people means doing our best to clean up the food and nutritional landscape of our homes, developing strategies to resist the pervasive pitfalls of the processed and deep fried food environments in which we live, and tackling the mental health issues that lead us to overeat and stuff our pain in the first place.

How the drugs work is that they seem to mimic satiety hormones to make our bodies think we are full and content. But while this may be great for a while, Michaels warns that even for the patients who are blessedly side-effect free, the effectiveness of the drugs will eventually plateau because their bodies will build up a tolerance.

But there are larger social and philosophical questions to ponder. What happens to the pleasure of eating if you’re taking a drug that changes your perception of food and satiety? What becomes of personal sacrifice, will, self-control, and determination when millions of people choose a drug that literally short-circuits their desire to eat? How many people will forgo essential weight bearing and cardio workouts if they can convince themselves they can get the same results without exercise? Furthermore, what does it mean for the aging populations in nations like Canada and the USA when the elderly people who use these drugs and suffer muscle loss require additional healthcare due to the inevitable bone fractures and hip replacements which will surely follow. What happens when people with eating disorders get their hands on these drugs? And what are the long-term impacts on the brain of introducing drugs which mimic hormones that our bodies naturally produce? Since it may take years to answer these questions and for the verdict on these drugs to become settled science, we advise everyone to proceed with an abundance of caution.