Over the summer I was lucky enough to be invited to a 60th birthday party where the after-dinner entertainment consisted of a private performance by one of the UK’s leading male pop stars. But what struck me most about the performance was how incredible the star looked. He was a mere shadow of his former self, strutting around the stage in a silver jumpsuit. His secret? Semaglutide, or Ozempic as it’s known, a new slimming drug that seemingly everyone (everyone, darling, including one of the world’s most famous supermodels) is taking.
Originally developed to treat type 2 diabetes, it is used off-label (for a purpose other than that for which it was approved) in both the United States and the United Kingdom to treat obesity. In research conducted by its multibillion-dollar manufacturer, the Danish pharmaceutical company Novo Nordisk, patients lost an average of 17 percent of their total body weight in 68 weeks. This compares with five to nine percent for “old-school” anti-obesity drugs such as metformin.
Ozempic, which is only available on the UK NHS if you have type 2 diabetes, can be obtained through a private doctor, and if you are willing to take it without medical supervision (not recommended by doctors, see panel), you can get it online through various weight loss programmes. It is sometimes taken in tablet form, but more commonly it is taken as an injection.
Semaglutide, which was originally developed to treat type 2 diabetes, is used off-label. It has been promoted as a new diet drug that seemingly everyone is taking.
Unsurprisingly, Hollywood has known about Ozempic for much longer than we have: Variety recently joked that the drug deserved its own Emmy acceptance speech, since so many stars on the podium had obviously been taking it. Elon Musk praised its more potent sister drug, Wegovy, on Twitter; Kim Kardashian is hotly rumored to have used semaglutide to lose 16 pounds so she could fit into Marilyn Monroe’s dress for the Met Gala. On TikTok, the hashtag #ozempic has had more than 285 million views.
Thanks to the hype, there has been a surge in demand, leading to shortages on both sides of the Atlantic, and a backlash against influencers and celebrities hoarding supplies before desperate diabetes patients arrive. Unsurprisingly, Big Pharma has come up with an alternative: tirzepatide (brand name Mounjaro), made by Eli Lilly but not yet approved by the US Food and Drug Administration for weight loss.
Novo Nordisk has issued a statement saying its supplies will be replenished by the end of the year, but that hasn’t calmed anxiety. At least two middle-aged friends of mine who started using it in September are very nervous about running out of supplies before the holidays. As one private GP in London told me: “It’s like the HRT panic last spring.”
What exactly is this drug? Semaglutide belongs to a class of GLP-1 agonists, which not only regulate blood sugar but, as was discovered a decade ago, also mimic the gut hormones that regulate our appetite – the ones that tell the brain when we are hungry or full. Of course, it has side effects: acid reflux, nausea, exacerbation of irritable bowel syndrome symptoms and fatigue (but much less so than with earlier GLP-1 agonists like Saxenda), as well as pancreatitis, gallstones and, at very high doses, it has caused thyroid tumours in rats. Meanwhile, when it is stopped, the effect immediately wears off and in some cases it doesn’t work at all.
“I would describe semaglutide as an example of very clever science,” says leading consultant endocrinologist Dr Efthimia Karra, from her private practice on London’s Harley Street. “But it’s not a panacea for everyone. Around a fifth of users don’t respond to it. This is because the human body favours weight gain, so when you lose weight, your body will do anything to get back to its higher BMI. The heavier you are, the harder it is to lose weight. If a patient hasn’t improved within three months, I take them off.”
Banker’s wife, Laura, a New Yorker in her 50s who had been on the tightrope for decades, started using it in January. “Paleo, 5:2, cognitive behavioural therapy, NLP, bootcamp, diet delivery services – I’ve tried them all,” she says from the family home in Hampshire, “and I’ve always come back on track. After my last annual check-up, I was seriously considering stopping. Then my doctor suggested semaglutide.”
After a month, she noticed that her clothes were fitting looser. From then on, she began to lose weight. “The strange thing was that I didn’t eat anything different. I just couldn’t get seconds any more and the idea of eating dessert after a full meal had lost its appeal.” Three months later, she has lost 12 kilos (although she sometimes suffers from heartburn if she eats too late at night or drinks alcohol) and, when we spoke in the autumn, she was looking forward to losing another kilo before Christmas.
“There’s a voice telling me that taking a weight loss drug is risky and lazy, and I’m worried that all this stuff will build up again if I stop taking it. But if it did, I’d seriously consider taking it indefinitely.”
Dr Martin Galy, a private GP in London, has been prescribing semaglutide for a year to patients who are unable to lose the weight they gained during the menopause. He has also seen it have a transformative effect on much younger women suffering from polycystic ovary syndrome. “People with PCOS are difficult to deal with and you can imagine how body image plays a huge role when it comes to self-esteem.”
But according to Tom Sanders, professor of nutrition and dietetics at King’s College London, it’s not a magic bullet. Commenting on a study of semaglutide published in The New England Journal of Medicine in 2021, he said: “The challenge after weight loss is to avoid regaining it,” he wrote. It may help in the short term, but “public health measures that encourage behavioural changes, such as regular physical activity and moderation of dietary energy intake, are still needed.”
That said, given the rising national obesity statistics and the escalation of accompanying health problems such as heart failure, cancer and obstructive sleep apnea clogging up hospital beds, we’re going to need something. Semaglutide may be the rich man’s drug of choice these days, but could it be approved for more widespread use? Only time will tell.