Ozempic will not end obesity: the risks beyond the hype

Many people have claimed that medicines such as Ozempic could "end obesity" by curbing the appetites and shrinking the waistlines of millions worldwide.

Yet beyond the hype, that claim is not only false; it may also cause harm. Prioritising weight rather than health is a hallmark of diet culture, which presents the pursuit of thinness as more important than other elements of physical and cultural wellbeing.

The excitement surrounding Ozempic is not based solely on health and medicine: it also draws on ideas linked to fat stigma and fat phobia. In turn, this can sustain fears about fatness and fat people, alongside behaviours that damage those living in larger bodies.

Ozempic is not the first 'miracle' weight-loss drug

This is not the first occasion on which weight-loss medicines have been presented as world-changing. Ozempic and the wider family of GLP-1-mimicking medicines are simply the latest additions to a lengthy history of weight-loss drugs.

Every one of them appeared promising initially. However, none has fulfilled the hype over the longer term, and some have been removed from the market because of serious side effects.

Although science advances gradually, diet culture also traps us in a recurring search for the next miracle cure. Consequently, medicines such as Ozempic may fail to produce the outcomes people anticipate, perpetuating a pattern of hope followed by shame.

Ozempic does not work identically for everybody

Discussions of results from Ozempic studies commonly highlight average - or mean - outcomes, or the highest - or peak - outcomes. A study may, for instance, report that people using the medicine lost an average of 10.9% of their body weight, while some lost more than 20% and others lost less than 5%.

Less often discussed is the fact that responses differ considerably. Some people are "non-responders". In other words, not everyone loses as much weight as the average figure, while some do not lose any weight at all. For certain people, adverse effects will outweigh any benefits.

For people taking medicines such as Ozempic, blood sugar is managed more effectively because the drug increases insulin release and lowers levels of another hormone, glucagon.

However, the variation in weight loss is greater than the variation in blood-sugar control. The reason is unclear, though differences in genetics and lifestyles are likely to contribute, as is the greater complexity involved in regulating weight.

Treatment must continue. What could that mean?

Where weight-loss medicines are effective, they work only for as long as they are taken. To maintain weight loss, therefore, people must continue taking them over the long term. One study found that an average weight loss of more than 17% after a year taking Ozempic became an average net weight loss of 5.6% more than two years after treatment ended.

In the short term, side effects of medicines such as Ozempic can include dizziness, nausea, vomiting and other gastrointestinal problems. However, as these are newer medicines, there is simply no evidence yet to show whether side effects become more common as people use them for longer.

We also do not know whether their effectiveness will diminish over time. Known as drug tolerance, this has been documented with other long-term treatments, including antidepressants and chemotherapy.

Biology tells only part of the story

For some people, taking GLP-1-mimicking medicines such as Ozempic may feel validating and empowering. They may believe their biology has been "normalised", much as blood-pressure or cholesterol medicines can bring people back into the "normal" range of measurements.

Biologically, though, obesity is not determined by GLP-1 activity alone. Many other hormones, physical activity and even gut microbes also play a role.

More broadly, obesity is complicated and has many dimensions. It is shaped not only by individual biology and personal choices, but also by social, cultural, political, environmental and economic determinants.

A weight-centred approach overlooks the wider picture

A weight-centred approach implies that if thinness comes first, health will follow. Yet when considering health, changing appetite represents only one part of the picture.

Obesity frequently exists alongside malnutrition. Research attempts to separate their effects statistically, but emphasising the advantages of weight-loss medicines without tackling underlying malnutrition means improved health outcomes are unlikely to be seen in everyone who loses weight.

Obesity is not an issue separate from people

Even when intentions are positive, language celebrating the prospect of "ending the obesity epidemic" can hurt people. Obesity does not exist separately from individuals: people are obese. The celebration and hype around these weight-loss medicines can therefore strengthen damaging fat stigma.

Describing these medicines as a "cure" intensifies a binary understanding of thin versus fat, and healthy versus unhealthy. Neither represents a simple good-or-bad binary outcome. Both weight and health sit on a spectrum.

Ironically, fat people are told to lose weight for their health, while also being shamed for "cheating" or taking shortcuts when they use medication.

Drugs are tools rather than silver bullets

Developing these medicines is a beginning, but they are still costly, and the hype has been followed by shortages. In the end, complex problems cannot be solved through simple answers. This is especially the case where people are involved, and more so still when there is not even agreement about what the problem is.

Many organisations and individuals regard obesity as a disease, believing that this framing encourages people to seek treatment.

Others consider it unnecessary to apply medical labels to body types. They argue that doing so confuses risk factors - things linked with a higher likelihood of illness - with illness itself.

Whatever the position, two points remain true. Drugs can only ever be tools, and they must be used within a context. Applying these tools ethically requires us to stay aware of whom their use harms along the way.

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Read the other articles in The Conversation's Ozempic series here.

Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, UNSW Sydney

This article is republished from The Conversation under a Creative Commons licence. Read the original article.