Over the summer I was lucky enough to be invited to a 60th birthday celebration where the after-dinner entertainment was a private performance by one of Britain’s leading male pop stars. But more striking than the actual show was how incredible the star looked. He was a mere shadow of his former self, prancing around the stage in a silver catsuit. His secret? Semaglutide, or Ozempic as it’s called, a new diet drug that everyone – but everyone, honey, including one of the world’s most famous supermodels – is apparently taking.
Originally developed to treat type 2 diabetes, it is used off-label (for a purpose other than that for which it is approved) to treat obesity in both the US and Britain. Research from billionaire manufacturer, Danish pharmaceutical company Novo Nordisk, shows that patients lost an average of 17 percent of their total body weight in 68 weeks. This compares with five to nine percent for ‘old-fashioned’ anti-obesity medications, such as Metformin.
Ozempic is only available in Britain on the NHS if you have type 2 diabetes. You can obtain Ozempic through a private doctor, and if you are willing to use it without medical supervision – not recommended by doctors (see box) – you can obtain it online through various weight loss programs. It is sometimes taken in tablet form, but more often as an injection.
Originally developed to treat type 2 diabetes, Semaglutide is used off-label. It has been branded as a new diet drug that apparently everyone is using
Predictably, Hollywood has known about Ozempic for much longer than we have. Variety magazine recently joked that the drug deserved its own thank you speech at the Emmys, since so many stars on stage had clearly used it. Elon Musk raved on Twitter about its more powerful sister drug, Wegovy; Rumor has it that Kim Kardashian used semaglutide to lose 16 pounds so he could fit into Marilyn Monroe’s dress for the Met Ball. On TikTok, the hashtag #ozempic has been viewed more than 285 million times.
The hype has sent demand soaring, causing shortages on both sides of the Atlantic, with a backlash against influencers and celebrities grabbing supplies ahead of desperate diabetics. Predictably, Big Pharma has come up with an alternative – tirzepatide (brand name Mounjaro), manufactured by Eli Lilly – but it has yet to be approved by the US Food & Drug Administration for weight loss.
Novo Nordisk issued a statement saying that supplies will be replenished by the end of the year, but this has not allayed concerns. At least two middle-aged male friends of mine who started using it in September are confused because they get caught right before the holidays. As one private GP in London remarked to me: ‘It’s like the HRT panic of last spring.’
So what exactly is this drug? Semaglutide belongs to a class called GLP-1 agonists, which not only regulate blood sugar levels but, as discovered about a decade ago, also mimic the gut hormones that regulate our appetite – the hormones that tell the brain when we are hungry or full are. There are of course side effects: acid reflux, nausea, worsening of IBS symptoms and fatigue (but much less than with previous GLP-1 agonists such as Saxenda), as well as pancreatitis, gallstones and, in very high doses, it has caused thyroid tumors in rats . Meanwhile, if you stop using it, the effect disappears immediately and in some cases it does not work at all.
“I would describe semaglutide as an example of very smart science,” says leading endocrinologist Dr Efthimia Karra from her private practice on London’s Harley Street. ‘But it is not a panacea for everyone. About a fifth of users do not respond to it. This is because the human body prefers to gain weight, so if you lose weight, the body will do everything it can to return to the highest BMI. The heavier you are, the harder it is to lose weight. If a patient hasn’t made any progress within three months, I take him off.”
Banker’s wife Laura, a native New Yorker in her mid-50s who had drifted between decades, started using it in January. ‘The Paleo diet, 5:2, CBT, NLP, boot camp, diet delivery services – I’ve tried them all,’ she says from the family home in Hampshire, ‘and I’ve always yo-yoed. After my last annual check-up, I seriously considered giving up. Then my doctor suggested semaglutide.”
After just a month she noticed that her clothes had become looser. From that moment on the weight started to decrease. ‘The strange thing was that I didn’t eat anything else. I just physically couldn’t take any more seconds, and the idea of pudding after a full meal had lost its appeal.’ Three months later she is two stone lighter – although she occasionally suffers from heartburn if she eats or drinks alcohol too late at night – and when we spoke in the autumn she was looking forward to losing another stone by Christmas to lose.
“There’s a nagging voice telling me that taking a drug to lose weight is both risky and lazy, and I’m afraid it will all pile up again if I stop taking it.” But if it does, I will seriously consider taking it indefinitely.”
Private London GP Dr Martin Galy has been prescribing semaglutide for about a year to clients who cannot lose the weight gained during menopause. He has also seen it have a transformative effect on many younger women suffering from polycystic ovary syndrome. ‘PCOS patients are difficult to treat, and as you can imagine, body image plays a very important role when it comes to self-esteem.’
But according to Tom Sanders, professor of nutrition and dietetics at King’s College London, it is not a panacea. Commenting on a study on semaglutide published in 2021 in The New England Journal of Medicine, he says, “The challenge after weight loss is preventing weight gain,” he wrote. It may prove helpful in the short term, but “public health measures that encourage behavior changes, such as regular exercise and moderating dietary energy intake, are still needed.”
That said, given our rising national obesity statistics and the escalation of associated health problems like heart failure, cancer and obstructive sleep apnea clogging hospital beds, we’re going to need something. Semaglutide may be the drug for rich people these days, but could it be approved for broader use? Only time will tell.