How Ozempic Changed Everything

In the summer of 2022, a Michigan woman named Sarah (who didn’t want to use her full name) was frustrated. She had gotten engaged, been offered a big promotion at work, and in general felt as if the world was treating her differently: Men opened doors for her; people seemed to spend longer talking to her, and her difficult relationship with her father had even improved. 

So why was she frustrated? In the previous six months, she had lost 70 pounds. To Sarah, that was "exciting but also depressing," writes the author Aimee Donnellan in her new book, "Off the Scales," which chronicles the rise and rise of GLP-1s like Ozempic and Mounjaro. 

In the book Sarah describes how her "ideas at work were the same, the stories she told her now attentive father were the same." But dropping the weight had "lifted some kind of invisible cloak that had obscured her and her talents." For the first time, Sarah was being seen by those around her. The problem, in her view, was that apart from her weight, nothing about her had changed. The fact that people were treating her differently made her mad.

That’s not surprising. The explosion of GLP-1s tends to provoke strong emotions. 

Ozempic and its rivals — Wegovy, Mounjaro, Zepbound and others — have taken the pharmaceutical world by storm in a way no drug has ever done before, says Donellan. "Botox and Viagra, those are the types of things you could probably compare it to," she says. “But I don't think we've ever had a prescription drug that was being used the way it is being used now.” Polling by Gallup indicates that 15% of American adults have used GLP-1s for weight loss. And the drug is working: Since 2022, rates of obesity have fallen from 39.9% of the U.S. population to 36.4%, what Gallup describes as a “statistically meaningful decline.”

Donellan, a financial journalist, first got wind of this revolution during the pandemic. She was asked to write about Novo Nordisk, the first company to commercialize GLP-1 agonists, which trigger the release of insulin and slow digestion. As she did her research, she noticed the company's seemingly sudden success. "Every quarter, their results were way beyond what anyone had expected," she says. The source of these hard-to-miss upticks in profit was Ozempic, a drug that had first been approved by the Food and Drug Administration (FDA) as a treatment for diabetes in 2017, but that was increasingly being identified as an effective treatment for one of the world's fastest-spreading diseases: obesity.

One of the most interesting parts of Donellan's book chronicles the story of Svetlana Mojsov. In the 1980s, Mojsov was working as a scientist when she discovered how the body's natural GLP-1 hormone acted as a trigger to make the pancreas produce insulin. Like so many women, she then found herself pushed out of the history of her own discovery by a series of male colleagues. As it became clear that the drug's creators might be eligible for a Nobel Prize — which can only be awarded to up to three people — Mosjov has fought for her name to be returned to the story. 

Women being pushed aside is "something that happens in many industries, but science seems to have a particularly awful reputation for it," says Donellan.

But perhaps that’s fitting, in a kind of macabre way. GLP-1s started as prescription drugs to treat a range of serious conditions, from sleep apnea to diabetes, but have arguably now crossed over into the beauty industry — a sector with some history of pushing women around. And, as more people's waistbands begin to shrink, the moral and ethical questions around GLP-1s and their use as a weight loss aid, often for people who may not clinically require weight loss, are stacking up. 

One big question of many: If we're saying losing weight is a good thing — and for our collective health, it undoubtedly is — does that render the body positivity movement of the mid-2010s irrelevant? Should people who don't need to lose weight, but merely want to, be given access to these drugs? And who gets to control that, anyway? 

The Persistent sat down with Donnellan to address some of those questions. Our conversation has been edited for length and clarity. 

Why write about this? 

I'm a financial journalist. It was such an interesting business story — but actually, I grew up with a mother who dieted, which meant I was very aware of diets. The talk of losing weight was so important — and that was the biggest thing I was interested in.

You have a daughter. Did writing this book affect your behavior around her? 

I think a lot about my daughter and the example I want to be for her — but I think society might be more powerful than me. I [also] realized that children in a bigger body know early on if their parents have an issue with them being bigger, because it's just not okay in society to be bigger. Parents want them to avoid a future of being commented on.

The thing is, most people [I spoke to] said they look back at pictures of themselves as kids and ask, "What was so bad about the way I looked? I wasn't unhealthy, I just was bigger." 

I think just accepting that your kid is a bit bigger — that's okay. It's not them being unhealthy.

Are GLP-1s a good thing for society? You're very nuanced in the book. 

Ultimately it's very hard to divorce society from the health impact of these [drugs]. The fact is, for a lot of people, these drugs revolutionize their health. They bring down all of the levels that are getting out of control, whether that's cholesterol or blood pressure.

But the prologue is this woman, Sarah, whose life opens up as she's taking these drugs. And that's depressing — that she's somehow more valuable now.  That [attitude] was always there…[but] people in bigger bodies just didn't know it existed. [Like Sarah], they had never experienced what life could be like if they were on the "winning" side of the genetic lottery.

What struck you most about the patients you interviewed? 

Every person I spoke to had been dieting all their lives. They had lost 30 or 50 pounds at a time, then regained that. They had been on every diet you could imagine. So the idea that these people are not trying to be healthy, that they're happy the way they are? That's just not true. And until these drugs came about, there was no real solution for them. 

The other thing that's noticeable is how much people are willing to pay for GLP-1s [when insurance doesn't cover it]. They're spending a lot of money every month, which again gives you the impression that people with obesity have been just so desperate for anything. People are taking on second jobs [to pay for the drugs]. 

Speaking to some of the doctors who prescribed them, I thought this was kind of amazing. I was talking to them about the drugs' side effects, and the doctors would say, "People who are living with obesity will tolerate a lot because they're so desperate."

Speaking of side effects, one of your interviewees, Emily, became very sick from the side effects of GLP-1s. The heartbreaking part is where she concluded that maybe she had everything she wanted before she started losing weight. How difficult was that conversation?

It was very difficult. She was failed by her doctors. She was in [the emergency room] so often, and nobody was saying to her, ‘Hold on, you're taking a drug that affects your gastric system. Maybe we should take you off that for a while.’

Emily's uncle had died of diabetes when she was younger, and she was very worried about where she was headed. So I do get why she continued [to take GLP-1s in spite of the side effects]. She was the absolute extreme example, but people end up with pancreatitis. And some people have lost their sight permanently from taking these drugs. 

[Emily's] is the cautionary tale. But it does highlight the risks: If your cholesterol is through the roof, if you're pre-diabetic, if you are on your way to serious ailments, that is very different to somebody in a healthy body who just wants to lose a bit of weight. 

Hollywood got access to GLP-1s very soon after they were commercialized. What impact has that had?

Women like Oprah Winfrey were examples of people who were "allowed to" be bigger. Others could look to somebody famous and successful to demonstrate that you didn't need to be ultra-thin. [Famous people losing weight on Ozempic] do seem to put that idea aside, and suggest that "no, it's not okay to be multiple different sizes."

But even this discussion is problematic. We're either critiquing women for being bigger or we're critiquing them for wanting to be smaller. I don't think there's any way of getting around that. That's just society, that's where we are — but all of it is toxic. There's no bit of it that's good.

Would you take these drugs? 

If I put on a lot of weight and felt like I couldn't control it, I probably would, if I felt like my health was being impacted.

But I have evolved a bit on this. It's my age [she is in her 40s], and I'm around a lot of perimenopausal women, and weight gain is a big part of that process. About a stone and a half [21 lbs] is the average amount of weight women gain from the beginning of perimenopause to the end, and women just have to accept that. You hear them say it all the time: "I've done everything, I've cut my portions, I work out" — it's just very difficult for them to lose weight. So I do get why GLP-1s would be compelling in that situation.