During his opening monologue at this month’s Oscars, the late-night host Jimmy Kimmel joked about Ozempic, a weight-loss drug that is rumored to be in wide circulation in Hollywood: “When I look around this room, I can’t help but wonder, ‘Is Ozempic right for me?’ ” Developed to fight diabetes, Ozempic and similar drugs are now being deployed far beyond the medical uses for which they were designed—as a tool to control blood sugar for those with diabetes. Lots of people looking to lose ten or fifteen pounds are taking the drug as well. What are the consequences?
The New Yorker staff writer Jia Tolentino reported on Ozempic in this week’s issue, examining the drug’s benefits for those who need it and its impact on those who don’t. Tolentino, who has written about changing beauty standards in the age of Instagram, now considers how Ozempic alters and exacerbates biases about fatness, thinness, and various methods of losing weight. She recently spoke with me for The New Yorker Radio Hour about her reporting on Ozempic, including her efforts to acquire the drug by mail. Our conversation has been edited for length and clarity.
Let’s start with the drug itself. What is it supposed to be used for, and what is it actually being used for?
Ozempic is part of this relatively new class of drugs called GLP-1 receptor agonists. They have existed in some form since 2005, so they’re not totally new, but they are fairly new. Ozempic 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 Wegovy in 2021.
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 GLP-1 receptor agonists, the reason that they help people lose weight is because they replicate a hormone that our body produces naturally, called glucagon-like peptide 1, and this hormone—to oversimplify it, just a little bit—our body produces it after we eat. It lowers our blood sugar, it kind of balances our blood sugar, 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, quite simply—they can’t eat as much. One doctor that I spoke to compared it to a turkey dinner in a pen.
More on Ozempic
Read Jia Tolentino on how the drug could change attitudes about being fat or thin.
[Laughs.] But how come I never heard of it a year ago, and now I hear of little else?
One of the things that has made the Ozempic conversation a little bit confusing and misdirected is that the most prominent users are celebrities who don’t ostensibly need it. We all heard about it, probably for the first time, through reports of celebrities that had suddenly lost, like, forty pounds and were posting bikini pics, but saying that it was just because they worked out a lot. It became this big thing in the popular consciousness because of how skinny all these celebrities were suddenly getting, and how people were talking about it: [that] 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 misrepresentation of what the drug actually entails—and, certainly, as you were noting, what it’s actually meant for.
So Ozempic is not something you can take as a pill—it’s an injection?
No, despite all those jokes of “Everyone’s doing Ozempic in the bathroom at the Oscars.” There is a version of a drug like this that can be taken via pill, but [most versions are] a weekly injection. And, crucially, these are drugs that were designed and intended for lifetime use. Obesity and Type 2 diabetes—they’re considered chronic conditions. [The drugs] were designed for, effectively, weekly injections for the rest of your life, to control your weight or your blood sugar. I think that signifies that they’re not meant for casual use. [Users are] 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 significant enough that—
So, if you’re ten or fifteen 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 help do the trick, how would you counsel someone after the reporting you’ve done?
A lot of friends have asked me, in reporting this piece. [Laughs.] The thing is, also, it’s quite easy to get this drug.
Consider me one of your friends on this. [Laughs.]
Yeah, I’ve noticed from your text messages, you seem to be quite interested.
Exactly, because I’m sick of the gym, and I want to eat a bagel once in a while.
Well, the thing about this—you might not be able to eat a bagel. There are wild side effects that you get from messing with your most fundamental metabolic processes. A few people vomit and get diarrhea so bad it sends them to the E.R. It’s not this casual thing.
From Ozempic you can get that?
Yeah. 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 Ozempic, and, very specifically, if you eat anything fatty or highly caloric. You will get physically ill. So it’s not the kind of thing where you get a shot and you eat as much as you want forever. You’ll actually get quite sick if you do that. But what I would tell my friends is that there is no large-scale safety data [for people who don’t medically qualify for prescriptions]. These drugs have not been tested in large numbers in people who do not have obesity or Type 2 diabetes. Another, maybe more pragmatic thing is that clinical trials show—as these drugs were intended for lifetime use—that, once you stop using them, the weight does come back on. You’re supposed to get blood work every three months to make sure that your kidneys and pancreas and gallbladder haven’t failed you. Something that came up so often, people would be, like, Should I take it? Is it good or bad? It’s like any technology: it’s very complicated. For some people, this drug might save their lives, and for others it just does not make sense to me to use in any casual way.
You write about the Kardashians in your piece. How did they get to be part of this story?
I think it is 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 the weathervanes of how the winds of the beauty standard are blowing. And they are rumored to have been early adopters. Certainly that has not been confirmed, but 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 is going on?
But isn’t that crazily unhealthy in all manner of speaking, whether medically or psychologically? It just sounds very dangerous.
One of the things that initially piqued my interest in this phenomenon of this drug being misused as a vanity tool was that I was a preteen adolescent in the era of 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. It was normal to do extremely disordered things to your body because you wanted to be skinny.
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 body diversity and health at every size, 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, and a lot of the language around it still revolves around wellness. These factors are very confusing right now, and that was part of why I wanted to write about this.
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?
One thing about these drugs is that they are still really expensive, and out of pocket they can cost upwards of a thousand dollars 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 Wegovy pen. But to get these drugs covered by insurance is a bit of a hurdle. Insurance companies don’t like to cover it because, again, it’s expensive. There are stories all over the Internet. People will just—their insurance plan will just suddenly stop covering it. 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 can be instantly available to someone that has a thousand dollars to pay out of pocket every month just because they want to look skinnier in photos.
You did an experiment where you tried to get Ozempic from two different compounding pharmacies. How difficult was it to get them?
It was terribly easy to get. Well, I wasn’t getting name-brand Ozempic. I was getting semaglutide, which is the key ingredient in Ozempic, and it was compounded, [so 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 as cheaply and under the table as possible. I wanted to see how easy that actually was, so I made an account on this telehealth Web site: put in my real height and then a weight that gave me a B.M.I. of thirty, which is the clinical cutoff for what’s considered obese. Within sixty minutes, I got a D.M. full of emojis back from a nurse practitioner that was—she was dying to give me semaglutide, and could give it to me at a great price. I had kind of assumed that I might have a Zoom call, or I might have to provide some sort of documentation that I was actually my height and weight. No such thing. I placed the order for this pharmacy in Florida, got this cardboard box two days later, full of syringes. I can literally show it to you right now. It’s on my desk. It was alarming how easy it was to get. And then I figured, Let me see if I can get it without lying about my weight. I tried another clinic, with an office in New York, and I entered my real weight. And I’m not overweight; I’m pretty small. I just said, “I had a baby in 2020, and I want to lose fifteen pounds,” and they were, like, “Amazing. We can get you enrolled right away.” I was, like, “Damn, O.K. Do I have to go see the doctor? Do I need to do blood work?” Because, ostensibly, I should be doing all these things. There are plenty of places that are prescribing responsibly to the people that meet the criteria—but it was shockingly easy to get as someone who doesn’t.
Let’s forget for a second about people who want to lose ten 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?
Something that seems clearly important is that weight is not a one-to-one signal of whether you’re healthy or not. There have been plenty of studies that show that people of 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. There are other criteria, like level of [physical activity] 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.
You were asking, what is the sane way to think about these drugs within the extremely complicated landscape of body politics? 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 very drastically and rather quickly—I hope it doesn’t close down the discourse about all of that, about health being possible at every size. And also, for people who are actually dealing with serious weight-related health problems, I hope that there is not a stigma against them using these drugs. There’s a certain amount of stigma that they’re taking a quote-unquote shortcut. I think that that framing is based on an idea of thinness as a moral state you’re supposed to struggle for, a Protestant-work-ethic idea that thinness is the state of salvation that you’re supposed to crawl on your hands and knees towards. For plenty of thin people, they’re just thin, and life just works that way. There’s no reason why people should not use this tool if they have a medical reason to and they think it’s a good idea.
What I glean from your piece is that the doctors and medical professionals that you talked to think that the ideal direction here is that [Ozempic] will still be used for the people who need it. But this business of it as a fad is highly dangerous, and they hope that it’ll 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, 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: 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 [in your blood]—it’s not an easy miracle. It’s not casual. It’s pretty serious. It’s significant, significant technology.
Now, I hope this is obvious, but we are not saying you should lie about your medical information. If you’re thinking about getting semaglutide in any form, you should talk to a doctor—a real doctor. Jia, thank you very much.
Thank you. ♦
Sourse: newyorker.com
