Our culture’s obsession with weight has always felt unshakeable. But over the past year, new classes of drugs seem to be changing the way we think and talk about weight, dieting and obesity—for better and for worse. Popular pound-shedding medications including Wegovy, Ozempic, Mounjaro and Zepbound have been all over social media and mainstream headlines in the past few years, and the frenzied interest around these drugs has fueled a research boom that produced impressive results in 2023. These drugs, typically taken as regular injections, are attractive for multiple reasons: they offer not only a seemingly fast and easy way to lose weight but unexpected cardiac benefits as well. But even though the latest research shows immense promise, high costs and poor accessibility of the life-long treatment pose thorny challenges.
Scientific American looks back at what we learned this year about these new drugs and how they are could be changing our relationship to, and understanding of, our weight.
Breakthroughs with a Hunger Hormone
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Novo Nordisk’s diabetes medication Ozempic and weight-loss drug Wegovy are two brand names for an agonist called semaglutide, which binds to specific receptors in the body to trigger the release of the hormone glucagonlike peptide-1 (GLP-1). This promotes insulin production and reduces blood sugar, which originally made semaglutide appealing to diabetes drug developers. And then scientists found the drug also influences appetite; when you eat, GLP-1 levels increase and make you feel “full,” suppressing hunger. A 2021 study found that people taking semaglutide lost an average of 14.9 percent of their initial body weight over 68 weeks, compared with 2.4 percent in those receiving placebo injections. Some researchers have called GLP-1 agonists and similar drugs a “transformative breakthrough” for treating obesity, while others express concerns that they may be “potentially harmful” by worsening social stigma around weight. Researchers also question who will respond best to treatment, factoring in recent findings of possible adverse side effects such as gastrointestinal problems and muscle-mass loss.
Curbing Addiction
Scientists have explored how GLP-1 agonists may have other beneficial side effects that could address additional health conditions beyond obesity and diabetes. Some Ozempic users found that while taking the medication to control their food cravings, other cravings also seemed to subside. These included addictions to nicotine, alcohol and gambling, and even skin picking and other compulsive behaviors. Various research groups are looking into how GLP-1 might impact addiction pathways and whether its mechanism can be tapped to treat addictions to substances such as alcohol, nicotine and opioids. This connection has also revitalized broader discussions about food as an addiction; a functional magnetic resonance imaging study published this year found that consuming certain drugs or processed foods can induce cravings in the same reward areas of the brain. This suggests that overeating and substance dependency may have overlapping neurological processes.
Improving Cardiac Health
In November 2023 Novo Nordisk released clinical trial results that made huge waves: people who took semaglutide for about three years lowered their risk of heart attack, stroke and death from cardiovascular disease by 20 percent. The trial’s participants were considered overweight or had obesity and cardiovascular disease but not diabetes. Those who took semaglutide lost weight, but weight loss alone didn’t seem to explain improvements in the participants’ heart health; some experts think other, still-unknown mechanisms of the GLP-1 agonist may be involved.
Price Problems and Insurance Issues
Semaglutide and similar drugs are in high demand, partly because of social media posts touting their effectiveness and off-label use. But injections of Ozempic, Wegovy or Eli Lilly’s similar drug Mounjaro can cost around $1,000 or more per month. Shortages of these drugs, along with their lofty price tag, have raised questions about accessibility and equity. As Scientific American reported in October, most private insurance companies and federal health programs do not cover weight-loss drugs. Medicare, which primarily provides health care for people aged 65 and older, was specifically prohibited by law in 2003 from covering weight-loss treatments. But in July a bill was reintroduced to the U.S. Congress to allow Medicare to cover weight-loss medications again and is pending further action as of December.
Dangerous DIY Weight-Loss Hacks
Amid the high costs, inconsistent insurance coverage and spotty supply of these drugs, some people have taken drastic measures by using dangerous alternatives. In September reports surfaced that some TikTok users were promoting laxatives as a cheaper, more accessible alternative to weight-loss drugs—and were calling this approach “budget Ozempic.” Some posts claimed that laxatives can help people slim down, despite a lack of evidence that they could help with sustained weight loss. Laxatives are used to treat constipation or clear the bowels before surgery; taking such medications for weight loss could lead to misuse and disordered eating. “A lot of it stems from this society’s pathologic desire for thinness,” says Diana Thiara, an assistant clinical professor of medicine at the University of California, San Francisco. “And obviously, social media has accelerated that.”