You have to hand it to us human beings: we really are willing to go to any lengths in the name of vanity. Injecting, waxing, spraying, tweezing, pummelling. Sign us up! Pain, expense and inconvenience do little (if anything) to dissuade us from the pursuit of the mythical perfect body.
For many, thinness is the ultimate trophy in this forlorn quest. And it is in this goal that fearlessness and foolishness often collide. Weird, possibly (or, very definitely) dangerous diets seem to have been part of the human condition for as long as we’ve had mirrors. Tapeworms, cigarettes, sleeping pills and arsenic are a handful of the methods that have been touted as weight-control ‘miracle’ cures over the centuries. You might scoff, but us modern-day normies are hardly shy of a fad.
But now, it seems, we might finally have the silver bullet: Ozempic. Originally conceived as a treatment for Type 2 diabetes - and still only indicated for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise - the blood-sugar management drug has the side effect of rapid weight loss. ‘From the first hit, the effects were immediate. No hunger, little thirst,’ says one fan who started taking it to shift the weight she had put on in lockdown. ‘The lack of hunger was extraordinary; food literally repelled me. There was a certain smugness watching colleagues dive into a bag of Maltesers while I abstained, or friends tuck in to Sunday roasts while I pushed a Yorkshire pudding around the plate’.
You can go for days without passing or in one day you might go five times
Shortly after its US rollout in 2018, the drug became an open Hollywood secret (drugs? Hollywood? Who’d have thought!). But Ozempic really charged into the popular discourse last year — and the buzz has only grown louder. It was rumoured to be how Kim Kardashian got into the Marilyn Monroe Met Gala dress (firmly denied, she put it down to good ol’ deprivation). Other celebrities have gone on the record: Rosie O’Donnell, Elon Musk and Chelsea Handler have all spoken about taking Ozempic or similar medications. TikTok is fuelling the hype, with #ozempic on over 800 million views at the time of writing. And now it’s gone mainstream. Boots will soon start selling Wegovy (the brand name used by manufacturer Novo Novisk approved for weight management) via online consultation.
Fans might proclaim it to be magic, but there is no witchcraft going on, no painting rotting in the attic. Ozempic and its ilk belong to a class of medications called GLP-1 agonists. The active ingredient is semaglutide, which lowers blood sugar and spurs insulin production. Slowing digestion, it also makes you feel fuller for longer. Now, injectable semaglutide has been approved by the FDA and Nice for weight loss under specific criteria (off-label prescriptions are the way to go if you don’t meet those criteria; Ozempic’s manufacturer, Novo Nordisk, does not endorse off-label prescribing in any way).
‘It is no surprise that a drug like Ozempic has generated so much interest. All of the pivotal clinical trials reported an improvement in blood sugar control and weight loss,’ says Dr Charlotte Gribbin, a clinical aesthetic physician who sees patients at Dr David Jack’s Belgravia clinic. ‘More recent studies have investigated semaglutide solely as a weight-loss medication, with promising results so far,’ she says. ‘These studies determined that the optimal dose is 2.4mg, once weekly, administered as a superficial injection. The weight loss observed in trials ranged from 5 to 14 per cent.’
So, say you can shoulder the cost — around £159.99 per month — and don’t mind injecting yourself (although some semaglutides are available in pill form - not Ozempic - needles are now commonplace in beauty regimes), is it safe? ‘There is no such thing as a safe drug. There are only pros and cons,’ says Dr Gribbin. ‘The benefits always have to be weighed against the risks.’
Semaglutide studies have identified a number of potential side-effects. Most common are ‘gastrointestinal disturbances’, doctor-speak for nausea, vomiting, constipation and diarrhoea. Not exactly fun, but nobody hell-bent on weight loss will be put off by a bit of poop or vomit. One fan of the drug says her experience has been 99 per cent positive: ‘The 1 per cent that is outstanding is because of what it does to your bowels. You can go for days without passing or in one day you might go five times.’ But for another former user, the side-effects made it untenable. ‘I found it to work 100 per cent,’ they tell me. ‘But unfortunately I got all the common listed side-effects that made it very difficult for me to continue long term. I wish I could have stayed on it.’
Among the most alarming potential complications listed on Ozempic’s own website is ‘possible thyroid tumours, including cancer’. It elaborates: ‘In studies with rodents, Ozempic® and medicines that work like Ozempic® caused thyroid tumours, including thyroid cancer.’
I found reading that chilling because I saw it, clocked it, and then still set about trying to get it (which, by the way, involved lying about my BMI — approval currently pending — since I am not eligible and cannot BS my own GP) despite losing someone very, very close to me to cancer and knowing how brutal it is. How can it be that, now in my late 30s, I don’t know better? This hits on something else. Losing or gaining weight isn’t all about the physiological but the psychological, too. We eat — or don’t — for myriad factors other than hunger.
‘Ozempic or other weight-loss medications should be sold only under the strictest possible conditions, and prescribers should be doing thorough physical and mental health checks to make sure their patients are well enough to take them. Any medicine which offers weight-loss or a “quick-fix” solution can really appeal to anyone with an eating disorder, but there’s a very high risk of making them even more unwell,’ warns Tom Quinn, director of external affairs at the eating disorder charity Beat, adding that misusing medication can be an early sign of an eating disorder. Ozempic doesn’t promise to address underlying emotional factors (that, after all, is not what it has been manufactured to address). A former user, a doctor, says that six weeks after they had come off it, emotional eating habits returned. ‘It is important, of course, when starting Ozempic also to start working out and changing your diet,’ they say. But another user tells me, ‘You begin to relearn how to eat. It teaches you to listen to your body and eat only when you are hungry.’
As a millennial I grew up in the heroin chic-to-Zoebot era when a low-BMI and jutting bones were lionised. We’ve moved on since then (at least I thought we had, the casting of bigger models felt more tokenistic in the most recent round of fashion weeks than in a long time) but all those subliminal skinny = superior messages have a lasting impact. I wonder what Great Things I could have achieved had I dedicated a morsel of the thinking time I have spent on how my body looks to worthier pursuits. Extra brain space appeals to me as much as looser jeans.
Certainly the thin operate with a degree of inbuilt privilege. That’s not to say it is innately ‘better’ than being fat (beauty cannot be quantified according to BMI) but thinness does inevitably make life easier. As well as bestowing privilege, it also implies it: the time to work out, the money to eat ‘healthy’ food, the discipline not to clear your plate. It is a social status indicator to many — not just Hollywood, fashion or Tom Wolfe’s ‘social X-rays’ — which begs the question: if anyone can just get a shot, will thin still be in? Will attainable thinness do something to diminish its desirability and exclusivity? Will admitting to taking it be a social faux pas? Is it cheating? I have no idea.
One thing I will hazard a guess at: the side-effect that might put people off is the so-called ‘Ozempic face’, a haggard, hollowed look as a result of losing weight too quickly. It’s the age-old toss-up between body and face. But, of course, there are other injections for that.