My expansive thoughts on Ozempic, a drug I have never taken

If you are like me, a woman over 40 who uses social media, there’s no way you’ve been able to avoid headlines, articles, tweets, podcasts, broadcasts, and conversations about Ozempic and all of its sister medications. So you probably already know this, but just in case: Ozempic is a once-weekly injection used to treat Type 2 diabetes. It can also lower the risk of serious cardiovascular problems. There are several other drugs that work in similar ways that are used for diabetes and/or weightloss with names like Rybelsus, Mounjaro, Wegovy, Saxenda, and Zepbound. But for whatever reason, in headlines and non-medical conversation, the word ‘Ozempic’ is used as shorthand for all of these types of drugs. I’m going to use ‘Ozempic’ as shorthand here as well.

Generalizing here: people who use Ozempic describe how it curbs their appetite, how they eat less food, they desire less food, and their body needs less food. They say that they buy fewer groceries, they dine out less, when they do dine out, they eat smaller portions, and they don’t snack.

Accompanied by the increase in Ozempic use, is an increase in anger toward people who are using Ozempic. Celebrities are criticized for using the drug, people judge their neighbors and co-workers who they suspect are using it. It seems to be one of those “you can’t win” situations. Our culture constantly judges and criticizes people who are overweight and insists that people aren’t worthy of respect, or even proper medical attention, unless they lose weight. And then, when people are losing weight, they’re criticized for “doing it wrong”.

When I was in Palm Springs for Alt Summit, I was running errands and listening to an episode of Science Vs. It’s a podcast that takes a current topic, and asks what does the Science say about this? And then they talk to experts, scientists, etc. and share all their source links. The topic of the episode was Ozempic and whether or not it was safe. The conclusion was that Ozempic was as safe as any other regulated drug, that it wasn’t particularly unsafe at all, and that the objections to it are due to “moral” reasons — feeling like it’s a “cheat” or “shortcut” to weight loss.

I finished the episode as I went into a grocery store — I was picking up a few things to bring back to France, but I was also there to explore what’s new in American grocery stores. When I’m in the U.S., I like to slowly wander up and down each aisle. What are the latest food trends? What are the new flavors of M&Ms or Cheetos? What have I missed out on in the last year? Because the Ozempic podcast was still fresh in my mind, I couldn’t help notice how many products would no longer make it into the grocery carts of someone using Ozempic. There are whole aisles dedicated to specific weight-loss diets — low-carb sections, low-fat sections, high-protein sections, sugar-free sections, keto sections, zero-calorie sections, etc. Beyond those aisles, I noticed more aisles filled with snack products, products specifically marketed to eat between meals.

As I wandered the aisles, observing what was new to me, I had this flash in my brain — a little glimpse of a possible future — where grocery stores are a quarter of the size they are now, because entire categories of foods are no longer of interest to people. A future where our habits around food and attitude toward food is so different we can’t really fathom what it would be like.

I was picking items out, wondering if I could fit two cereal boxes in my suitcase, and my mind went to the airport. I started imagining how different an airport would be if snacking was no longer of interest to people — no snack bag kiosks every few yards. I started thinking about the flights themselves. Even if the flight is short, like really short, there’s still snack service. And then I thought of how in our current culture, it would be odd if I hosted a meeting or gathering and didn’t offer refreshments, but how that culture would go away, if people stopped snacking. People would stop expecting a table of cookies at the PTA meeting if the food was always being ignored and not eaten. The airlines would stop offering bags of pretzels if the flight attendant walked down the aisle and everyone said no thanks.

And they would be saying no thanks not because they are “watching their weight” or feeling “guilty” about having a snack; they’re not being judge-y or self-righteous, they’re just not interested in having a snack.

I don’t think we can comprehend what a shift like that would really be like and how many aspects of our culture and life it would affect. I compare it to not being able to imagine a world without patriarchy. There’s the joke about fish: Two fish are swimming along and a turtle sees them and says, “Hello there, how’s the water today?” And the fish answer, “What’s water?”.

The fish don’t know anything but water, they can’t comprehend a world without water. Water doesn’t need a name, water is just the world, it’s just their reality. In the same way, patriarchy is so pervasive that we’re swimming in it so we don’t really recognize it. We can’t accurately picture what a world would be like if patriarchy didn’t exist. And I don’t think we can picture what a world would look like without our cultural obsession with thinness and fatphobia; we can’t comprehend a world where weight-loss culture doesn’t exist.

All this has been on my mind since that trip to Palm Springs. I’ve been thinking about it, and mulling over the implications. While I was mulling it over, I saw an Instagram post from my wonderful friend Jessica Turner — she used Ozempic, and really wanted it to work for her, but the side effects were so unbearable she had to stop. Since her post, I’ve gone back and forth on whether I should write about this topic, or avoid writing about it, knowing this is a very sensitive subject for people.

And then, last Thursday I had a call. It was an Office Hours call. If you’re unfamiliar with Office Hours, this is where I make myself available for anyone to make an appointment and chat with me about anything they want. It’s often a conversation about a room in someone’s house they are wanting to redesign, or someone who’s coming to France and wants to chat about their itinerary and get advice. But this time was different. The woman who booked the meeting had no questions for me, she just wanted to share about something going on her life, and she wanted to share it with a neutral party, someone not in her immediate circle. I was honored to listen.

I’m not using her name here, but I did get permission to share her story. She said she’s 45, and that she’s been overweight since 4th or 5th grade. She’s tall, 5’10”, and said she can hide her weight well, that people wouldn’t guess she is 250 lbs. She’s fit and healthy — she’s active, her heart is healthy, her cholesterol is great. After years of fighting her weight, and trying every weight loss diet, she’s come to terms with her body and is living and enjoying her life. She’s healthy and happy but she’s also medically considered overweight. About a month ago, she goes in for her annual checkup, and once again, the doctor said everything looks great and she’s in good health. But the doctor also said that because she’s medically overweight, she’s a good candidate for Mounjaro (one of the Ozempic-family drugs).

Her initial thought was why take a risk? If her health is good, why mess with it? And like all of us, she’s heard some really harrowing horror stories about the drug. So she brings up her concerns to the doctor, and the doctor reassures her this a safe drug, and that she suspected it would work for her. So she said yes and tried the drug.

At this point in telling me her story, she got emotional, and had to compose herself for a second before she kept going. She said she’s only been using the drug for 3 weeks, but that it’s been life-changing.

Yes, she’s lost weight — 10 lbs in 3 weeks (which anyone who’s ever tried to lose weight will recognize as really fast weight loss). But that’s not what she wanted to talk about. She mentioned it once and then the weight loss didn’t come up in her story again.

What she wanted to share is how different her brain feels. It’s as if her brain capacity increased by an immeasurable amount. All this brain space, brain power, brain capacity has been opened because she’s not thinking about food or weight-loss or body image. To be clear, she’s keeping up her already good habits — nutrition, weightlifting, activity, etc.. But even with the upkeep, her brain is far more free and available than it felt a few weeks ago. Until taking this drug, she didn’t understand how much of her brain’s resources were dedicated to food and diet — what she’s going to eat next, food to avoid, having a craving, feeling guilty about eating too much, or proud for avoiding a snack, wondering if she’ll fit into an outfit, worried the doctor will bring up weight instead of addressing a medical problem, worried she’s taking up too much space in the world.

She has 3 kids and 2 of them have serious medical issues. She said in the last 3 weeks, with this increased resource of brain power, she’s come up with an incredible new app idea that could really help her daughter, and could also be helpful for patients with Alzheimer’s. It made me wonder: what could she have come up with and accomplished if she had had this drug ten years ago, or as soon as it was available?

She talked about how she knows there are people who approach food-as-fuel and don’t really think about food that much. She said her brain wasn’t like that before, but with the drug, now it is. There are people in the world whose brains are naturally food-as-fuel, and there are people whose brains are not. And our culture is constantly judging them, berating them, and telling them they have to have a food-as-fuel brain. But of course, if they don’t happen to have a food-as-fuel brain, there was no way to get one, or even picture what it was like to have one. But now there is.

She also told me about the price. With her insurance, she’s paying about $200 a month. That’s doable for some people and not doable for other people. And it’s not a standard price. There are people with different insurance who are paying more like $2000 per month for these drugs.

I told her I was so happy for her new brain power, so grateful she’d shared her story, and that I hoped she could ignore the biggest criticism she’s going to get: that people who take the drug may need to use it for the rest of their lives. To which I say: so what? I take daily medication, I will probably be on it for the rest of my life. Lots of people are on life-long daily medication. Big deal. If it’s working, then that’s great, fantastic, wonderful. Why would we be in a hurry to stop using a medication that’s working for us?

So I get off the call and I’m kind of stunned and feeling emotional. I had already been thinking about the impact of these drugs, and then, she brought up all sorts of aspects I hadn’t considered. I know it is still very early in the life of these drugs. And I know it was happenstance and anecdotal that I had this conversation during on Office Hours call, but while my mind will at times jump to worst-case scenarios, it will also sometimes explore what it might look like if it all worked out. And that is what happened after the call.

I want you to imagine something for a minute. Imagine 3 things have become reality: 1) Imagine these drugs are being produced in such high quantities, that they are available to anyone who wants or needs them (for diabetes, for heart health, for weight loss, for any reason). 2) Imagine that these drugs are extremely affordable or even free. And 3) Imagine that variations of these drugs have been developed for every kind of body, so there’s an option that works for anyone, so that people like my friend Jessica can use a variation without experiencing horrible side effects.

To be clear, in this imaginary scenario, no one is being forced to use the drugs, but anyone who wants to has easy access and can afford to take them and find a variation that works for them with little or no side effects. But no one has to use them if they don’t want to.

What does the world look like if those 3 things are true? How many people would choose to take the drugs? What would that mean for our current food culture? Our current grocery shopping culture? Our current restaurant culture? How would it affect retail clothing shops? How would it change our culture around body image? If anyone can be thin, will thinness still be the ideal? Will thinness be replaced by a new beauty ideal that’s always just out of reach? How would it affect what we teach about positive body image? How would it affect eating disorders? What kind of environmental impact would there be if less packaged foods are being produced, shipped, stored, and refrigerated?

And then, far bigger, far more unpredictable: What does it mean if brain power and brain capacity is increased for millions and millions of people, maybe hundreds of millions of people across the world?

After the call, I had another flash where I could glimpse a possible future. I could see a graph showing a big spike in innovation, invention, technological progress, and social progress. A big spike in positive progress and that we’d be able to track to the year that these 3 things became a reality — that these drugs became widely available, that there’s a version that works for everybody, and that they’re affordable.

Then, my mind immediately went to: Any governing body — federal, state, local, even a university — would potentially save a massive amount of money by making these drugs available.

If the government bought out the patent and started making Ozempic available for free, in a simple way, anyone who takes the drug effectively gets an immediate raise, because they are buying and eating less food. Regarding medical savings, we know it helps prevent and reverse diabetes. And there’s also research that these medications work for addiction and alcoholism, and can solve infertility (gift link). There’s even hopeful research they could help with Alzheimer’s and dementia. If we suddenly have a real treatment for addiction or dementia, what kind of cost savings would our medical system see?

I know this is a sensitive topic. I don’t want to pass judgement on anyone who doesn’t want to take these medications. I don’t want to pass judgement on anyone who already takes these medications. I don’t want to pass judgement on anyone who has tried them and didn’t like them. I just want to explore the idea of what the world would look like if these drugs become accessible, affordable and work for anybody. At the moment, that world seems really close, and I don’t think we can comprehend what that will mean.

I admit, I am reserving some judgement for people who seem angry that people are using these drugs for weight loss. 95% of the people who are successfully using these drugs for weight loss are people who have been fighting their weight their whole life, who have tried every possible diet — they’ve restricted calories, they’ve tracked every bite they take, they’ve exercised and lifted weights, and dealt with the lectures and the rude comments and the pervasive fatphobia. They’ve done all of the things. And nothing has ever worked.

Now something is working, and people are still mad at them? Is it only real weight loss if someone is suffering and miserable? It’s as if thin people are angry that they won’t be able to think they’re better than fat people.

Maybe you’ve spent that last decade getting into a good mind space about your body and don’t want to think about this. That’s valid, and I hope you are able to generally avoid Ozempic-related articles like this one. At the same time, you can also be happy for people who haven’t been able to achieve that good mind space, who are still struggling and now have another tool to use. Or maybe you’ve lost significant weight without these drugs and feel like Ozempic somehow devalues your efforts. Instead of feeling like it’s a loss, let’s think about how awesome it would be if someone could accomplish the same outcome with a fraction of the effort, and have all that extra energy, and time, and money to put toward literally anything else. (It’s a similar thought process to student loans — my loans were not forgiven, but I’m happy as can be for anyone who has had their loans forgiven.)

Based on the information I have at this time, my take is that the Ozempic family of drugs seems like a really big deal, a hugely positive scientific breakthrough. I’m excited for anyone who these medications are currently helping. I’m hopeful for more variations so there’s an option that will work for anyone. I’m excited about research into other medical issues these drugs could address. And I’m anxious for these drugs to be produced more quickly so there’s no longer a scarcity mindset around them — related, I would be fine to see government intervention to speed up production.

I like to think I have an understanding of how harmful diet culture has been and still is. I try to stay current on conversations about body image and body positivity, about how to combat fatphobia, about creating accessibility for bodies of all sizes. I sincerely believe that all bodies are beautiful, that we can love and appreciate our bodies, and be confident in our bodies no matter what they look like. None of those are new thoughts to me. What is new to me, is thinking about this issue in terms of how many resources (time, energy, money, brain space) we have dedicated to our diet and food culture, and to our culture of anti-fatness — thinking about it, experiencing it, identifying it, examining it, fighting against it, working around it, working through it, living our whole lives while swimming in it. What would it look like, if we didn’t need to use resources for any of that, ever again?

P.S. — Because I know some of you will be curious: I have not used Ozempic or any drugs in the Ozempic family, but I personally I have no moral issues around them and would not hesitate to try them.

P.S.S. — 3/22 update: After I published this, I heard from an endocrinologist who has prescribed these medications for years. She recently wrote a really helpful post about them explaining the differences between the types of medications and how she approaches managing side effects. I found the post to be calming and measured and informative and want to share it with you.