And Almost All Deny Using the Weight Loss Drugs That Have Flooded the World
I first heard about Ozempic about a year ago. My sister, a professor of medicine, pointed me to a study published in The Lancet. Over a thousand diabetics from 149 centers in 12 countries were randomly divided into three groups: those who self-injected 2.4 mg of semaglutide (Ozempic is one such drug) once a week for 68 weeks, those who received a lower dose of 1.0 mg, and those who received a placebo. All groups followed a special diet and exercise program. At the end of those 68 weeks, the first group lost over 10 kg on average, and more than a quarter of participants lost over 15% of their starting weight. Diabetics using the placebo lost an average of 3.5 kg over the same period.
This, she says, aligns with her experience with diabetic patients. As a doctor, she sees them often, and most know they need to lose weight. Despite strong motivation, they had previously failed to do so. Then Ozempic appeared—a medication for blood sugar control—and suddenly, almost overnight, they visibly slimmed down. The average figures mask dramatic transformations in many patients.
However, the story of semaglutides doesn’t end there—it’s really just beginning. Obesity is one of the major issues of the modern world, increasingly present in Serbia as well. And even among those who aren’t technically obese, it’s hard to find a woman—or increasingly, a man—who wouldn’t want to lose a few kilos. Minoxidil (a baldness treatment) was once discovered through increased hair growth in patients using it to lower blood pressure. Now we have a diabetes drug that, seemingly safely, has led to unprecedented weight loss. Naturally, this raised the question of whether the same drug could be used to treat obesity—and then for shedding unwanted pounds regardless of diabetes.
Many rushed in that direction. It’s an open secret that Ozempic is widely used in Hollywood. Rumors swirl that several prominent actresses and singers—like Adele, Rebel Wilson, and Mindy Kaling—use Ozempic. Elon Musk recommends it. The Kardashian sisters, though never overweight, have visibly slimmed down. Sudden weight loss is noticeable even in local celebrities. And my mother-in-law’s always plump diabetologist suddenly halved her size. Allegedly, she changed her diet—but I suspect Ozempic. In general, I’m suspicious of anyone who has lost significant weight in the past year or two, especially those who’ve long struggled with their weight. Suspicious, because it’s hard to lose weight, and yet everyone slimmed down at the same time while denying the use of drugs that suddenly became available at that moment.
So how do these drugs help with weight loss? When we eat, our intestines release the hormone GLP-1. Receptors for this hormone are located in the pancreas, stomach, and brain. The chemical structure of Ozempic and other semaglutides enhances the effects of this hormone on these receptors, thereby controlling blood sugar levels, slowing gastric emptying, and creating a feeling of fullness. This way, appetite is reduced—and with it, food intake.
Thus, the effect of semaglutides on weight is primarily indirect, allowing for behavioral change without the constant struggle against hunger. I’ve tried it too, and I can confirm it creates a stunning sense of fullness after a very small meal. It helps you eat less, but to lose weight, you still have to eat less.
Why is it so much easier for some people to stop eating than for others? Are they more disciplined, is food less appealing to them, or do they feel full faster?
The enormous demand has led to a global shortage of semaglutide. Diabetics everywhere—including in our country—complain that they can’t get a drug essential for their condition. It has created the impression that some people’s vanity is endangering the lives of the seriously ill. Inspections now circle local pharmacies, and the drug can no longer be obtained without a doctor’s certificate confirming type 2 diabetes. Through the media, there’s a nonstop campaign portraying Ozempic as a bizarre fad, an untested supplement people inject without reason, just to fit into a smaller swimsuit.
But the situation is more complex. First of all, semaglutides are fairly well-tested. My endocrinologist says they’ve been in circulation for about fifteen years. That’s not long enough to declare them completely safe, but they are far more tested than many supplements—and even some approved medications. For example, in a randomized study involving obese patients from five countries who did not have diabetes, the experimental group self-injected 2.4 mg of semaglutide weekly for 104 weeks. By the end of that period, with relatively few side effects, patients in that group lost an average of 15% of their body weight, compared to 3% in the control group. Similar results have been repeatedly confirmed, and in the U.S., semaglutide has been officially approved for treating obesity—not just in adults without diabetes, but also in obese children over 12 years old.
We are not immune to the global problem of obesity. It’s quite likely that this current drama will soon settle down and that Ozempic and similar drugs—now being rapidly developed by major pharmaceutical companies—will be approved here as well for obesity treatment, not just diabetes. Simply put, the health risks of obesity are immense, and this is a relatively safe and effective way to tackle that major problem.
But treating obesity? Isn’t obesity just the result of greed, laziness, and weak character? “Put down the spoon instead of stabbing yourself with a needle,” bitter readers angrily comment under every news article about Ozempic. There’s an unspoken belief that weight loss only counts if it involves sacrifice—hunger, sweating in the gym, sore muscles. Only that kind of weight loss builds character and justifies our low opinion of overweight people. Thinness must be earned. Ozempic? Please. The fat will just eat more and then inject themselves on top of that. How unhealthy.
Overweight people eat too much—no doubt. But Ozempic helps them eat less; it doesn’t make them lose weight despite overeating. The outrage it provokes shows that semaglutides are not just a revolutionary treatment for obesity but also challenge our understanding of fatness and hunger, and of thinness as an achievement. Why is it so much easier for some people to stop eating than for others? Is their character stronger? Is food less appealing to them? Do they feel full faster? Philosophical questions like Thomas Nagel’s “What is it like to be a bat?” have unexpectedly taken on a practical dimension. Because if one small injection can so profoundly alter someone’s craving for food, what does that say about the origin of that craving and its subjective experience? Do we all feel hunger the same way—with the same intensity and frequency—or do some feel it more and more often? Or—how thin would you be if you were as hungry as I am?
We are witnessing a scientific revolution that’s turning our understanding of a massive health problem on its head—with a real chance to solve it for the first time. The potential of semaglutide to transform lives is enormous. There’s the health aspect, of course, but also the moral one.
And we shouldn’t overlook the many interest groups tied to the traditional view of obesity. Entire industries have grown around this issue—fitness trainers, nutritionists, weight-loss programs, diet foods, body shapers, gastric surgeries. In the coming showdown between semaglutides and bariatric surgeons, we’ll surely hear more about the risks of those popular surgeries. The pharmaceutical industry’s interest in selling semaglutide may serve as a helpful corrective to the status quo—which is neither cheap nor entirely safe.
The revolutionary potential of semaglutide inevitably comes with the fact that there’s still much we don’t know about them. It’s not disputed that their use causes side effects like nausea, constipation, and diarrhea. That’s printed on every box. Yet many users see these effects as part of how the drug works. Overeating leads to nausea, which deters users from food—functioning like aversive therapy used in addiction treatments. Some users even lament not having side effects.
There have also been some rare but more serious consequences—for example, pancreatitis. Testing on rodents found that semaglutide increases the risk of a certain type of thyroid cancer, which was recently confirmed in humans as well. So far, it’s a small increase in an already very small risk. Still, who knows what else might emerge. Common sense suggests you shouldn’t mess with your pancreas unless absolutely necessary. So—not just to slim down a bit, but only when obesity itself already poses a serious health risk. Such people already number in the hundreds of millions.
Finally, no one is quite sure how long semaglutides can be safely used, in what doses, or what happens when you stop taking them. Are they lifelong medications, like those for blood pressure or cholesterol? How can we create even more effective and safer versions of semaglutide? Massive human and material resources are now being directed toward answering these questions.
We are witnessing a scientific revolution that is turning our understanding of a massive health problem on its head—with a real chance of solving it for the first time. The potential of semaglutide to transform lives is enormous. There is, above all, the medical aspect, but also the ethical and cultural one. At a time when obesity is becoming increasingly normalized—when 150-kilogram models are walking fashion runways—a path has suddenly opened toward its elimination. The astronomical profits for pharmaceutical companies go without saying. And then there’s the shift in our understanding of fatness and thinness, and the countless industries built on reducing or erasing fatness as a problem. Some will rise and many will sink in this revolution that is approaching us. Most of us, probably, a few kilos lighter.
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