Last 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. Even more impressive than the show itself, however, was how incredible the star looked. He was a shadow of his former self, prancing around the stage in a silver catsuit. His secret? Semaglutide, or Ozempic as it’s called, a new slimming drug that everyone – and I mean everyone, including one of the world’s most famous supermodels, apparently – is taking.
Originally developed to treat type 2 diabetes, it is being used off-label (for a purpose other than the one for which it is licensed) in both the US and the UK to treat obesity. In research conducted by its billionaire manufacturer, Denmark-based pharmaceutical company Novo Nordisk, patients lost an average of 17 percent of their total body weight in 68 weeks. This compares to five to nine percent for ‘old-school’ anti-obesity drugs such as Metformin.
Only available in the UK via the NHS if you have type 2 diabetes, Ozempic can be obtained through a private doctor, and if you are prepared to take it without medical supervision – not recommended by doctors (see box) – you can get it online through various weight loss programmes. It is sometimes taken in tablet form, but more often as an injection.
Semaglutide was originally developed to treat type 2 diabetes and is used off-label. It has been marketed as a new diet drug that everyone apparently takes
As expected, Hollywood has known about Ozempic for much longer than we have—Variety magazine recently joked that the drug deserved its own acceptance speech at the Emmys, since so many stars onstage had clearly taken it. Elon Musk raved about its more powerful sister drug, Wegovy, on Twitter; Kim Kardashian, it’s hotly debated, used semaglutide to lose 16 pounds so she could fit into Marilyn Monroe’s Met Ball gown. On TikTok, the hashtag #ozempic has been viewed more than 285 million times.
The hype has fueled demand, leading to shortages on both sides of the Atlantic, with a backlash against influencers and celebrities scooping up supplies for desperate diabetes sufferers. Unsurprisingly, Big Pharma has come up with an alternative – tirzepatide (brand name Mounjaro), produced by Eli Lilly – but it has yet to be approved by the US Food & Drug Administration for weight loss.
Novo Nordisk has issued a statement saying that supplies will be replenished by the end of the year, but it hasn’t allayed fears. At least two middle-aged male friends of mine who started taking it in September are freaking out because they’ll run out before the holidays. As one private GP in London told me: ‘It’s like the HRT panic of last spring.’
So what exactly is this drug? Semaglutide belongs to a class of drugs called GLP-1 agonists, which not only regulate blood sugar levels but, as was discovered about a decade ago, also mimic the gut hormones that regulate our appetite – the hormones that tell the brain when we’re hungry or full. There are side effects, of course: acid reflux, nausea, worsening of IBS symptoms, and fatigue (though much less than with earlier GLP-1 agonists like Saxenda), as well as pancreatitis, gallstones, and, in very high doses, it has caused thyroid tumors in rats. Meanwhile, when you stop taking it, the effect disappears immediately, and in some cases it doesn’t work at all.
‘I would describe semaglutide as an example of very clever science,’ says leading endocrinologist Dr Efthimia Karra from her private practice on Harley Street in London. ‘But it is not a magic bullet for everyone. About a fifth of people who take it don’t respond. This is because the human body promotes weight gain, so if you lose weight, the body will do everything it can to get back to the highest BMI. The heavier you are, the harder it is to lose weight. If a patient hasn’t made any progress in three months, I will take them off it.’
Banker’s wife, Laura, a New York native in her mid-50s who has bounced between decades, started using it in January. “The Paleo diet, 5:2, CBT, NLP, boot camp, diet delivery services—I’ve tried them all,” she says from her parents’ home in Hampshire, “and I always end up going back to where I was. After my last annual checkup, I seriously considered going off it. Then my doctor suggested semaglutide.”
After just a month, she noticed her clothes were looser. From then on, the weight started to fall off. ‘The strange thing was that I couldn’t eat anything else. I just couldn’t physically eat another helping and the idea of pudding after a full meal had lost its appeal.’ Three months later, she’s two stones lighter ‒ although she occasionally 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 stone by Christmas.
“There’s a nagging voice telling me that taking a drug to lose weight is both risky and lazy, and I worry that if I stop taking it, it’ll all pile back up. But if that happens, I’ll seriously consider taking it indefinitely.”
London private GP Dr Martin Galy has been prescribing semaglutide for about a year to clients who are not losing the weight they gained during menopause. He has also seen it have a transformative effect on many younger women suffering from polycystic ovary syndrome. ‘PCOS patients are difficult to treat and you can imagine how important body image is when it comes to self-confidence.’
But according to Tom Sanders, a professor of nutrition and dietetics at King’s College London, it’s not a magic bullet. In a 2021 commentary on a study of semaglutide published in The New England Journal of Medicine, he said: “The challenge after weight loss is to prevent the weight from coming back,” he wrote. It may prove helpful in the short term, but “public health interventions that encourage behavioural 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 associated health conditions like heart failure, cancer, and obstructive sleep apnea filling hospital beds, we need something. Semaglutide may be the drug of choice for rich people today, but could it be approved for wider use? Only time will tell.
