August 1, 2023 – Ashley Raibick knows the yo-yo effect of weight reduction. She's tried the massive names: Weight Watchers, Jenny Craig, etc. She loses 10 kilos after which quits the plan, only to see her weight return up.
But a day at her local medical spa — where she gets facials, Botox and fillers — modified every little thing for the 28-year-old hairdresser, who only desired to lose 18 kilos.
During one among her visits, she noticed that the owner of the spa had gotten thinner. When Raibick asked her how she had done it, the owner told her that she was taking semaglutide and explained the method to Raibick. Raibick was convinced. That same day, she got a prescription from a health care provider on the spa and received her first injection.
“Will people think I’m crazy if I do this?” she remembers considering.
At 5'4″ tall, her starting weight before taking the drug was 135 pounds, which according to her body mass index (BMI) would put her in the overweight category but not obese. And she really just wanted to get down to 135 pounds and stop there.
No matter where you get your news, chances are you've heard the name of the drug Raibick was given: Ozempic. It's part of an ever-growing group of drugs called GLP-1 receptor agonists, whose main ingredient is a peptide called semaglutide. Although originally intended to treat type 2 diabetes, Ozempic and its siblings' reputations rose when already-slim celebrities were suspected of using the injectable drugs to get even slimmer.
The FDA Ozempic's cousin Wegovy was approved several years ago for “weight control” in patients with obesity, while Ozempic is currently approved only for treating diabetes. Curious patients who don't meet the criteria can – and do – get off-label prescriptions if they can afford to pay out of pocket, which often amounts to more than $1,400 a month. But is Ozempic worth it, especially if you only need to lose a relatively small amount of weight?
For many, especially those who have been taking the drug for a few months and have lost weight as a result, taking Ozempic has not only helped them lose stubborn weight, but also freed them from the constant internal chatter around food, commonly referred to as “food noise.” But experts don't all agree on whether semaglutide is the right path for those who aren't technically obese – especially not in the long term.
After the first 9 weeks of semaglutide, Raibick had already lost 18 pounds. That's when she decided to post about it on Tick Tockand their videos on GLP-1 have been viewed hundreds of thousands of times.
There is currently no data on how many semaglutide users are using the drug for diabetes and/or obesity and how many are using it off-label solely for weight loss. But the company that makes Ozempic, Novo Nordisk, has reported significant increases in sales and forecasts higher profits for the future.
Raibick knows others like her who have tried the weight-loss drug but aren't as open about their experiences. Some feel stigmatized by having to resort to a weight-loss drug that's supposed to treat obesity, rather than achieving their goals through diet and lifestyle changes alone.
Another reason for the secrecy is the guilt felt by some Ozempic users who took advantage of their financial privileges to obtain a drug that was in serious shortage, making it difficult for some patients who needed the drug to treat diabetes or obesity to get their dose.
This is what Dr. Diana Thiara, medical director of the weight management program at the University of California, San Francisco, has observed on the ground.
“It's one of the depressing things I've seen as a physician,” she said. In her practice, she's seen patients who finally had access to GLP-1s and started losing weight, only to gain it back in the time it took them to find a new prescription that their insurance would cover.
“It's just terrible. There are patients who spend all day calling dozens of pharmacies. I actually have never seen such a situation in my profession,” said Thiara.
Ann, 48, a mother of a teenage girl who works full-time from home, has been taking Ozempic since late January. (Ann is not her real name; she asked us to use a pseudonym so she would feel comfortable speaking publicly about her Ozempic use.) Like Raibick, she has paid for her shots out of pocket. Initially, she would have had to pay $1,400 a month, but she found a pharmacy in Canada that offers the drug for $350. It is sourced worldwide, she said, so her Ozempic packages are sometimes in Czech or another foreign language.
Unlike many other women, Ann never had problems with her weight or her appearance. She was never very athletic, but it was only during the pandemic that she started gaining weight. She noticed the changes in her body when people started to reopen and her clothes no longer fit.
She tried to exercise more and eat healthier. She tried to The Real Housewives of Beverly Hills Actress Teddi Mellencamp controversial Weight loss program, notorious for its incredibly restrictive eating plan and excessive cardio recommendations. Nothing helped until another mother at her daughter's school mentioned that she was taking Ozempic.
Ann also started experiencing hot flashes and stopped having her period. The doctor who prescribed Ozempic confirmed that she was going through perimenopause and that losing weight can be more difficult than ever for women during this stage of life.
Ann, who is 5'7″, started off weighing 79kg (which is taken into account obese) and now weighs 68kg, which is taken into account normal weight in keeping with BMI measurements. She continues to be taking Ozempic but continues to struggle with shame on the thought that she could also be taking the drug away from someone who desperately needs it. And she doesn't know the way long she is going to have to take Ozempic to take care of her weight.
Ann has reason to fret. A study from 2022 found that almost all people regain their lost weight inside a 12 months of stopping Ozempic.
Once Raibick reached her initial goal weight, she felt she could keep going and lose a bit more weight. It wasn't until she hit the 120-pound mark that she decided it was time to stop the semaglutide dose she had been taking.
“I got to the point where my mom said, 'Okay, you're a little too thin.' But I'm just so happy where I am now. I don't worry about fitting into my clothes or a bathing suit,” said Raibick, who has lost about 30 kilos in total since starting the shots.
Eventually she stopped taking the drug altogether, and the cravings and binge eating that semaglutide had suppressed resurfaced. She didn't gain weight that month, she said, but the inner chatter around eating was enough to get her to start out again at a lower dose geared toward weight maintenance.
There can be the problem of unintended effects. Raibick says she has never experienced the overwhelming nausea and digestive problems that so many who take the drug – including Ann – have reported. But Thiara said that along with these more common unintended effects, there are numerous other concerns – reminiscent of the long-term effects on the thyroid and reproductive health, especially in women – that we still don’t know enough about. And only in the near past, CNN reported that some Ozempic users developed gastric paralysis since the drug slows the passage of food through the digestive tract.
Raibick has to pay about $600 a month out of her own pocket for the drug. She is willing to proceed paying these costs only for the peace of mind that the drug gives her. She has no plans to stop taking her semaglutide injections any time soon.
“There's nothing stopping me from looking back at photos from a year from now when I've gained some weight again and thinking that I was way too thin.”
Dan Azagury, MD, a bariatric surgeon and associate professor of surgery at Stanford University School of Medicine, is trying GLP-1 in patients with obesity before considering bariatric surgery. For his group of patients, it's possible that drugs like Ozempic might be a part of their lifelong treatment plan.
“We're not doing it for cosmetic reasons, we're doing it for health reasons,” he said. “I always tell my patients: If you're going to start this medication, you should be OK with taking it forever.”
For doctors specializing in weight management like Thiara, long-term use of Ozempic in healthy-weight patients is the fallacious approach.
“It's not about how people look, it's about their health. If you're of a normal weight or even overweight but don't show signs of increased risk for cardiometabolic disease, … you don't need to take drugs for weight loss,” she said. “This idea of taking drugs for aesthetic reasons is more to do with societal ills that are related to the fact that we value thinness above all else. That's not the goal and it's not safe.”