What Has Changed

• Certainly, many people have lost some amount of weight. A subset of these have had improvements in some health markers, and many undoubtedly feel that their lives have been improved.  Depending on how much weight they have lost, they may also be getting better treatment from others, for example, they may be more likely to get a job, a promotion or a raise, as well as other social benefits.
• Due to the demand for these drugs for weight loss, some people with T2DM have been unable to access their medication to help control blood sugar levels. (See, for example: Ozempic Shortage: Causes, Consequences and Alternatives)
• Novo Nordisk’s profits from the sale of its GLP-1 agonist drugs (Ozempic and Wegovy) have impacted the national economy of its home country, Denmark (see link above). In 2023, the company’s market value exceeded the size of the Danish economy, and it is now the second most valuable publicly held company in Europe.

What Has Not Changed

• Many people have not lost weight, or have lost only a small amount. Even using numbers provided by the manufacturer, one can see that the majority of people do not lose enough weight to make a significant change by diet industry standards. (Reading about specific dieting numbers can be harmful to some, so I will not include them here.  Please go to the bottom of this article for more details, if you would like.)

• The majority of people in larger bodies are not taking these drugs (Montero et al., 2024).  Besides not having a health condition for which they are indicated, some people are not interested in trying to shrink their bodies to arbitrary societal standards, and for others, the price is out of reach. While the GLP-1 agonists seem to be better tolerated than some previous weight-loss medications, there are still people who cannot take them on a continuing basis due to side effects or other conditions, or they just do not lead to the desired weight loss, so they discontinue use.
• In medicine and public health, anti-fat bias continues to harm people.  For those who cannot or do not want to shrink their bodies, the prevalence of anti-fat bias and weight stigma remains.  In fact, it may be getting worse.  As Aubrey Gordon points out in the Maintenance Phase podcast episode on Ozempic (A. Gordon & Hobbes, 2023), doctors now have yet another tool for stigmatizing people in larger bodies: prescription drugs for which informed consent is problematic due to manufacturers and those paid by them controlling the messaging, and the lack of long-term data (see below). This may, in turn, lead to more people avoiding seeking out health care, one of the underlying reasons that people in larger bodies sometimes have worse health outcomes. Dr. Mara Gordon also provides a clinical perspective on what these drugs can and cannot do: My patients think Ozempic is a wonder drug. But it can’t fix fat phobia. (M. Gordon, 2024)
• We have been here before with drugs for weight loss. The most dramatic and harmful example was in the 1990s.  Fen-Phen, a combination of two drugs created a similar reaction in the media and an explosion of use for weight loss (Kolata, 1997). There are multiple parallels with what is happening now with the GLP-1 agonists, including assumptions being made about the drug safety based on previous research for other uses. This time, we can hope for a better outcome than what happened to the thousands of people left with heart and lung damage, causing the FDA to pull the combination from the market in 1999 after just 3 years (Morrow, 1999).

What we do not yet know, and what should be part of informed consent:

• While GLP-1 agonists have been in use for T2DM for nearly 2 decades, long-term impacts of taking the drugs for weight loss cannot be known until they have been in use for longer and more research is completed by people without conflicts of interest. In some cases, the dose for T2DM and weight loss are different, so there are further considerations for additional and longer-term research. Manufacturers are already saying that people will need to stay on the drugs for life in order to maintain the weight loss, even though it has not yet been established whether they will be effective or safe long-term.
• Because of the lack of research on the long-term impacts of taking these drugs, we also do not know the trajectory of weight regain. For other methods of intentional weight loss, the overwhelming long-term outcome is weight regain, sometimes even more than was originally lost (Mann et al., 2007; Tomiyama et al., 2013).  Only time will tell if this also happens with these drugs, but there does seem to be a plateau of weight loss for some people, and for some the start of regain near the end of the study (Chastain, 2022).
• We also do not know what the future research will look like when the funding and messaging are less under the control of those who stand to benefit financially.  Ragen Chastain (2023) and Marquisele Mercedes (2021) have written about misleading messaging and the conflicts of interest in funding.