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The recent swell of social media excitement about Ozempic and Wegovy have made the injectable weight loss medications household names. The so-called miracle weight-loss drugs have been in high demand and have even faced nationwide shortages.
Ozempic is currently FDA-approved for treating type 2 diabetes, but doctors often prescribe it off-label for weight loss. Wegovy, which is the same drug as Ozempic, is FDA-approved for weight loss.
The excitement over this class of drugs is well-earned. They are glucagon-like peptide-1 agonists or GLP-1s, which mimic the effects of a hormone in the body helping regulate blood sugar and appetite. They’re far more effective for weight loss than other obesity medications.
“They mimic the exact same thing that naturally occurs—or should occur—in the body in that they will increase your feeling of satiety or fullness,” says Dr. Lydia Alexander, chief medical officer for Enara Health and president elect of the Obesity Medicine Association. As a result, your appetite is suppressed, and you eat less.
Monika Smyczek, 40, who started taking Wegovy in the summer of 2021, says it made her forget about food in the most pleasant and benign way possible.
“In a way, it felt like a miracle drug,” she says. “It allowed me to restrict calories in such a way that was sustainable. As someone who has had a fraught relationship with food, it felt really nice not to have to battle with this thing that had always taken up so much of my mind.”
Alexander says these medications are best for people who have a ‘significant’ amount of weight to lose, meaning at least 40 pounds or more, especially if you have at least one comorbidity of obesity such as high blood pressure, cholesterol, or sleep apnea. And the health benefits are significant.
“We know, for instance, that someone with a BMI over 40 or 45 will live eight to ten years less than someone who does not have that BMI, and that is the equivalent of being a smoker,” she says. “So reducing weight long term increases both quality and quantity of life. By treating obesity we’re getting to the root cause of many of the different chronic conditions that primary care providers treat.”
Going off a GLP-1 medication
After the birth of her third child, Liz Baker, 46, lost the weight she’d gained during the pregnancy without much effort. But a few months later, she noticed the scale was slowly starting to creep back up, even though she was still breastfeeding and hadn’t changed any of her eating habits.
“I saw my endocrinologist, and said, ‘Hey, there’s something going on that is not willpower-based here,’” she says.
Her doctor agreed, and prescribed Wegovy. Eight months later, Baker was down 50 pounds. Aside from some early nausea and vomiting, it was smooth sailing. Then suddenly, her insurance informed her they’d no longer cover it.
Wegovy’s average out-of-pocket cost of $1,400 per month meant that it was off the table for Baker financially. She went off the medication.
Over the next six months, she gained back all the weight she’d lost, plus 10 pounds more. In addition, her A1C and fasting glucose levels rose, putting her at risk for diabetes—a problem she hadn’t faced before starting the medication.
“I didn’t know it was going to be such a fast change,” she says. “I had gotten down to my ideal weight and size and was very comfortable and happy with where I was. And then, boom. My appetite and cravings went bonkers for a little while. I was just hungry all the time. I craved sugar constantly.”
Finally she and her doctor were able to get her on Mounjaro, a combination GLP-1/glucose-dependent insulinotropic polypeptide (GIP) medication the FDA approved in 2022 for managing glycemic control for people with type 2 diabetes.
So far she’s down 18 pounds. Mounjaro isn’t yet approved for weight loss treatment, but Baker’s insurance is covering it—for now—because of her prediabetic blood sugar levels.
High cost also forced Smyczek to give up her “miracle drug.” She’d rearranged her family budget to be able to afford the $800 a month “special pricing,” but once that ran out, the price shot up to $1,400.
“For a hot second, I thought, ‘Okay, what do I have to do to afford this drug? Do I need to work another job?’” she says. “And then I realized it was time to explore what else might work.”
After gaining back 25 of the 40 pounds she’d lost on Wegovy, Smyczek said she tried not to feel too disappointed in herself.
“I’m trying to be kind to myself,” she says. “The problem is, without the drug, it’s like you haven’t necessarily built the skills you need, and you also haven’t learned how to deal with the hunger or the cravings or the stuff that will inevitably come back.”
A long-term medical condition, not a personal failing
GLP-1 medications typically aren’t prescribed for cosmetic or aesthetic purposes, or for a quick fix, says Dr. Amanda Velazquez, director of obesity medicine in the department of surgery and acting assistant professor of surgery and medicine at Cedar Sinai.
They’re considered long-term medications for obesity, much like treatments you’d take to manage blood pressure, high cholesterol, or diabetes.
“Obesity is a disease where the body is going to work against you long term for life,” she says. “So to keep those biological pressures from working against you, we need the drug on board. Once you take the drug away, one should expect weight regain.”
A 2022 study that studied what happens after you stop taking Wegovy found that people regained two-thirds of the weight they’d lost on the drug.
“The goal always with these medications is to partner it with healthy behaviors, and it helps patients to be able to more easily adhere to those healthy behaviors because it’s helping the physiology to work in conjunction,” says Velazquez. “However, if you take the drug away and the physiology goes back to trying to make you feel hungrier, reduce your metabolism, and sabotage your efforts, it’s going to be very difficult to sustain that weight loss.”
Monika admits she struggles with the idea that she’d need to take a drug for the rest of her life to maintain a healthy weight, but that she’s trying to “mentally get there.”
“The thing that I struggle with is that diet culture has completely permeated my worldview,” she says. “Diet culture does not approach obesity as a chronic condition. So even while understanding that this is a drug that should be taken long term to treat obesity, I still feel like that message is just: Lose weight by whatever means necessary. But then what? What happens after?”
Baker, who already takes several other long-term medications such as thyroid treatment, sees it in more straightforward and practical terms.
“Among other things, I know that this weight thing is something chemically messed up and it’s not something that I can willpower out of,” she says. “If I have to take something for the rest of my life to help me manage it and keep me out of type two diabetes, I can deal with that.”
