3 reasons why I am pessimistic that Ozempic is the solution to obesity
Being obese is unhealthy. There are some deranged people who think that doctors should not say that, or that it is evidence of fat-phobia, but they are incorrect. It is objectively unhealthy to be obese and overweight. There is nothing wrong with saying the sun rises in the east.
Recently, Noah Smith who writes a popular economics blog said this. In this post I will give 3 reasons why, as an evidence based physician, I am more pessimistic about Ozempic.
There is some chance that as time goes on some adverse effect of ozempic will be discovered. This can happen when a drug is administered to young people for years on end even if not known at product launch. This doesn’t have to be a big signal (OR 1.1 or maybe even 1.05). And it doesn’t have to be the worst thing in the world. Just something people really don’t want to experience, and at some modestly elevated rate. And if that is found, the entire enthusiasm for the product will die.
We still don’t know how well long term weight loss will work in the average user. If 1000 average obese Americans take the drug for 2, 5, 10 years, how many will stick with the drug, and not self discontinue due to GI side effects? How many will rebound their weight after stopping? My team currently has a research project to investigate the real world discontinuation rate and compare it to diet and exercise.
What does it say as a society that the food we produce and serve, and the portions we offer are of such poor quality that we fatten a generation of people, and then have to invented a drug to remove desire to combat our own policies and culture. At some point, I think people crave root cause solutions
If I had to bet, I bet real world results will leave a lot to be desired. There will be a lot of discontinuation. Some safety signal will arise, and those are the two biggest reasons that this injection won’t be a solution to obesity.
Already my local newspaper has front page banner ads that say, "Have you taken Ozempic, Wegovy, Rybelsus, or Mounjaro and been hospitalized for gastroparesis, stomach paralysis, or gastric blockage?" That alone would scare me off! If the side effects are so bad that lawyers are already seeking litigants, it seems like things are bound to go south for the vanity weight-loss crowd.
This is a very complex issue, for which, as with most complex issues, there is no silver bullet or single thing that fixes it. I do think these drugs have a place if they are dosed appropriately ( many problems may be attributed to a dose that is too high for the patient), and combined with an eating and movement/exercise/muscle building plan that is closely monitored by a trained professional. More drug is not better and there are no quick fixes, as we humans tend to fall prey to those ideas. Low doses and going slowly with increasing dose, and backing off the dose that creates side effects may be solutions for some.
I highly recommend readers check out Dr. Tyna Moore’s website and podcasts. She has a lot of very good information on these peptides as well as other topics. She is a fan of microdosing GLP-1s and using them as part of a comprehensive plan, not as a mono therapy.