Over the summer I was lucky enough to be invited to a 60th birthday party where the after-dinner entertainment was a private performance by one of the UK’s biggest male pop stars. However, more surprising than the actual spectacle was how incredible said star looked. He was a mere shadow of his former self, prancing around the stage in a silver suit. His secret? Semaglutide, or Ozempic as it’s called, a new diet drug that seemingly everyone (but everyone, honey, 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 licensed) in both the US and the UK to treat obesity. In research conducted by its billionaire manufacturer, Danish pharmaceutical company Novo Nordisk, patients lost an average of 17 percent of their total body weight over 68 weeks. This compares to five to nine percent for “old school” anti-obesity drugs such as metformin.
Ozempic is only available in the UK on the NHS if you have type 2 diabetes, and you can get it 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 at line). through various weight loss programs. It is sometimes taken in tablet form, but more commonly taken as an injection.
Originally developed to treat type 2 diabetes, semaglutide is used off-label. It has been billed as a new diet drug that apparently everyone is taking.
Unsurprisingly, Hollywood has known about Ozempic for much longer than we have: Variety recently joked that the drug deserved its own acceptance speech at the Emmys, since many stars on the podium had obviously been taking it. Elon Musk praised its more powerful sister drug, Wegovy, on Twitter; It is widely rumored that Kim Kardashian used semaglutide to lose 16 pounds so she could wear Marilyn Monroe’s dress for the Met Ball. 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, with a backlash against influencers and celebrities hoarding supplies ahead of desperate diabetes patients. Unsurprisingly, Big Pharma has come up with an alternative: tirzepatide (brand name Mounjaro), made by Eli Lilly, but it has not yet been approved by the US Food and Drug Administration for weight loss.
Novo Nordisk has issued a statement to say its supplies will be replenished by the end of the year, but it has not eased anxiety. At least two middle-aged friends of mine who started using it in September are getting nervous about being caught out before the holidays. As one private London GP told me: “It’s like the HRT panic last spring.”
So what exactly is this drug? Semaglutide belongs to a class called GLP-1 agonists, which not only regulate blood sugar but, as was discovered about a decade ago, also mimic the gut hormones that regulate our appetite, which tell the brain when we have hungry or we are full. Of course, there are side effects: acid reflux, nausea, exacerbation of IBS symptoms and fatigue (but much less than with previous GLP-1 agonists like Saxenda), as well as pancreatitis, gallstones and, at very high doses, has caused thyroid tumors in rats. Meanwhile, when you stop using it the effect disappears immediately and in some cases it won’t work at all.
“I would describe semaglutide as an example of very smart science,” says leading consultant 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. This is because the human body favors weight gain, so when you lose weight the body will do anything to get back to its highest BMI. The heavier you are, the harder it will be to lose weight. If a patient hasn’t progressed in three months, I’ll take it off.’
The banker’s wife, Laura, a native New Yorker in her 50s who had bounced back and forth between decades, started using it in January. “The Paleo diet, 5:2, CBT, NLP, boot camps, diet delivery services – I’ve tried them all,” he says from the family home in Hampshire, “and I’ve always responded to the yo-yo.” After my last annual checkup, I seriously thought about giving up. Then my doctor recommended semaglutide.
After just a month, he noticed that his clothes had become baggier. From that moment on the weight began to drop. ‘The strange thing was that I wasn’t eating anything different. I simply couldn’t physically eat again and the idea of eating pudding after a full meal had lost its appeal.’ Three months later, he is two kilos lighter (although he sometimes suffers from heartburn if he eats too late at night or drinks alcohol) and when we spoke in the autumn, he was looking forward to losing another kilo by Christmas.
‘There’s an annoying voice telling me it’s risky and lazy to take a weight loss drug, and I’m worried it will all build up again if I stop taking it. But if so, I will seriously consider taking it indefinitely.”
Private London GP Dr Martin Galy has been prescribing semaglutide for about a year to clients who are unable to lose the weight they gained during menopause. It has also been observed to have a transformative effect on much younger women suffering from polycystic ovary syndrome. “People who suffer from PCOS are difficult to treat 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 solution. Commenting on a study on semaglutide published in The New England Journal of Medicine in 2021, he says: “The challenge after weight loss is preventing weight regain,” he wrote. It may be helpful in the short term, but “public health measures that encourage behavioral changes, such as regular physical activity and moderation of dietary energy intake, are still needed.”
That said, given our rising national obesity statistics and the escalation of accompanying health problems, such as heart failure, cancer, and obstructive sleep apnea clogging hospital beds, we’re going to need something. Semaglutide may be the rich people’s drug today, but could it be approved for more widespread use? Only time will tell.