Ozempic: The Shot Heard Around the World
"Do you think she’s on it?” one buttery blonde asked her friend between bites of tortellini pomodoro at New York’s Torrisi on a recent weekday evening. “She has to be, she’s so thin,” replied the other buttery blonde. These days there’s only one substance they could be referring to. Ozempic, the semaglutide that has become the unofficial descriptor for an entire class of diabetes drugs turned diet drugs, has become ubiquitous. Ads for it plague your feeds; on TikTok the hashtag #ozempic has nearly 1.5 billion views; articles touting its benefits for people with a host of medical issues, from depression to dementia, regularly roll out; and it’s available (well, when there isn’t a widespread shortage) at your doctor’s office, but also at the cosmetic dermatologist and the strip mall medi-spa and through a long list of telehealth ventures (the approval of Ozempic birthed a VC-backed cottage industry). If you’re not on it, you know someone who is.
Ozempic has upended how we look at food and health, changed how we age and think about aging, challenged us to confront our collective anti-fat bias, and become a financial juggernaut for drug companies. In other words, its wildfire success has implications far beyond the doctor’s office. Here, a look back at the dawn of the Ozempic era and its impact on everything from restaurant etiquette to spa attendance to facelift demand—as told by the doctors, scientists, surgeons, trainers, and social butterflies who have been in the thick (and thin) of it.
A Secret Weapon Revealed
Right now, in millions of fridges across the U.S., there is an Ozempic pen. The drug is an injectable semaglutide, one of a class of medicines known as GLP-1 agonists that mimic an insulin-releasing hormone, thereby lowering blood sugar and reducing appetite. It was first approved in 2017 for the treatment of type 2 diabetes, but according to data compiled by Bloomberg, the number of prescriptions for Ozempic has ballooned more than 5,000 percent since 2018. Last year alone that added up to 20 million prescriptions. And we know those millions of users are not all diabetics.
“These drugs are able to access the brain, and you’re getting a suppression in hunger drive and also appetite,” says Dr. Matthew Hayes, an associate professor of nutritional neuroscience at the University of Pennsylvania Perelman School of Medicine who has spent decades studying the cellular mechanisms governing weight regulation. There’s no question that semaglutides (which also include Wegovy, approved to treat obesity in 2021) work. But how did they so rapidly become the quick fix waistline assist du jour?
“Kim Kardashian wore a dress [to the 2022 Met Ball] that most people didn’t believe she should be able to fit into, and suddenly everybody heard about Ozempic. Now the demand is so great we wind up prescribing whatever is available.” —Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill Cornell Medicine
“In 2014 liraglutide, the first generation GLP-1, was approved for the treatment of obesity, but it resulted in only about 6–7 percent average total weight loss. With the second generation of semaglutides, we started to see about 15 percent average total body weight loss, and for high responders 20–25 percent. In 2021 and ’22 those high responders were very vocal: They were going on Instagram and TikTok, making YouTube channels about their experience, and suddenly there was a lot of interest.” —Dr. Fatima Cody Stanford, obesity medicine physician at Massachusetts General Hospital
“Social media and a few famous people led to its surge in popularity, which feels silly to endocrinologists, because we’ve been using these drugs off-label for weight loss for years. But now the cat’s out of the bag.” —Dr. Caroline Messer, New York–based endocrinologist
Death of the Diet
For those who suffer from what’s called “food noise” (intrusive and persistent thoughts about food), GLP-1’s brain-rewiring mechanism has been a game changer. The deep flaws in diet culture’s traditional calorie counting and willpower thinking have been revealed by the success of Ozempic, and time-honored weight loss institutions have had to pivot accordingly. To wit, WeightWatchers (at which Oprah Winfrey recently abandoned her role, a few months after publicly admitting that she has taken weight loss medications) has added GLP-1s to its roster of treatments. Most reputable doctors and clinics prescribing semaglutides are also referring patients to dietitians to help them develop healthy meal plans so they still get adequate nutrition, but that hasn’t stopped Ozempic from becoming the go-to for those aiming to shed a few pounds before a big event (RIP, juice fast). And none of this means we can all cancel our gym memberships. Thanks to one potential semaglutide side effect—muscle loss—those who take it need to work out more rather than less to maintain their overall physical condition over time.
“The Upper East Side’s favorite game show is Who’s on Ozempic? What I’m seeing is people using it to lose five to 10 pounds. A few friends of mine are openly talking about being on it, and then others you just don’t mention, but everyone knows because they’ve lost a Backstreet Boy.”
—Jill Kargman, New York–based writer and actress
“People will take it for one week, one injection a month, or they’ll do half an injection a week. It’s like the Wild West with how people are dosing themselves, and many seem to be taking it into their own hands.”
—Dr. Melissa Doft, New York plastic surgeon
“For years I’ve been saying, kind of tongue-in-cheek, these people don’t eat anyway, especially if it’s a New York crowd. But what has happened now, primarily with couples for weddings, or the host if it’s some milestone event, they say we’re just gonna do Ozempic for six months. The same way they’re having beauty treatments or facials before an event, Ozempic has become part of the prep.” —Marcy Blum, New York City event planner
“We’re realizing that for the majority of people diets don’t work, because they make you obsessed with calories and you totally ignore your hunger and fullness cues. WeightWatchers worked much better 20–30 years ago, when we lived in a very different food landscape.” —Katherine Balantekin, PhD, RD, assistant professor in the University at Buffalo’s Department of Exercise and Nutrition Sciences
“For people who can’t stop thinking about food, to be able to shut off that noise is a gift. Food is becoming only one important part of their life, as it should be.” —Kim Shapira, L.A.-based celebrity dietitian
“If you have a tremendous amount of weight to lose, I get it: You need to clean up the house before the maintenance. But it’s not in lieu of. In fact, I want you to work out harder, bumping up the protein and training. Because muscle loss doesn’t just dramatically impact how you look but how you age. Your bones are not going to be as strong, and your muscles are not going to be as strong to protect those bones. You are one fall away from a hip fracture.”
—David Kirsch, author and celebrity trainer
The Dawn of Ozempic Face…And Butt
“Ozempic face” is not just an attention-grabbing headline: This wave of shrinking bodies has had aesthetic ripple effects. Cosmetic dermatologists and plastic surgeons have been busier than ever tending to the lax skin that can come with dramatic weight loss—performing more facelifts and injecting more filler, into both faces and deflated derrieres.
“It’s been a boon to my practice,” says celebrity cosmetic dermatologist Paul Jarrod Frank, who coined the term “Ozempic face.”
“I have people coming in who feel as if aging has been accelerated in their face because of rapid weight loss,” says New York dermatologist Dan Belkin, who also sometimes refers patients who come in for body contouring to an internist to discuss taking low-dose Ozempic instead. “Ultimately,” he says, “it’s so much better than CoolSculpting or anything else noninvasive that I have.”
“You walk down Madison Avenue, and you can see the skinny faces. It’s like when Botox first came out, and it was all frozen foreheads, and when filler first came out, and everyone had big cheeks. The people who are using Ozempic to lose only five to 15 pounds are going into what’s called protein deficit, and that’s not just about muscle mass. The largest and most common protein in the body is collagen. You’re losing collagen, you’re thinning your dermis, you’re losing muscle mass, and your skin is hanging on your bones.” —Dr. Paul Jarrod Frank
“I’m on it. My staff is on it. I assume everyone in New York is on it at this point.” —Dr. Dan Belkin
“Rapid weight loss can affect the fat pocket volume on the face, and it ages people faster. There are no creams or potions to make your skin produce fat, especially around the eye area. After two months of Ozempic, people look empty. —Pietro Simone, celebrity aesthetician
“I’m doing a lot more necklifts and facelifts at a much younger age—we’re talking thirties and forties. Once you start losing 20 or 30 pounds, suddenly the neck is looking a little more like jelly. What 40-year-old wants to have a hanging neck?” —Dr. Melissa Doft
“I can spot immediately when someone is on it, because you’re not just losing fat, you’re losing muscle. You have Ozempic ass, or, as my grandmother would say, you have no tochis. You’re losing the tightness and the elasticity and the suppleness of your body.” —David Kirsch
Empty Stomach, Empty Spa
Rumors are swirling that exclusive European spas have been under-booked, as moneyed clients opt for the big O over a week of broth and colonics. At SHA and Canyon Ranch, where the well-heeled have retreated for decades to slim down and detox, the programs have been adjusted for a new generation of visitors who arrive with Ozempic pens to stash in their minifridges. “A significant number of people coming to Canyon Ranch are on semaglutides, so we’ve got to play the game,” says Dr. Stephen C. Brewer, the medical director there. The spas’ goal now: instead of helping guests simply shed pounds (the Ozempic is taking care of that), it’s about addressing stress and helping build a healthy relationship with food and exercise to support them when, and if, they go off the drug.
“About 40 percent of our clients come to SHA for our weight loss program, and in the last two years I’ve seen a lot of Ozempic. It’s a very good medication for the right person, someone who has obesity but also other problems like high blood pressure and cholesterol. It’s not something for Kim Kardashian to use to lose 10 pounds.” —Dr. Anna Baeza, SHA Clinic medical services coordinator
“I think we’re going to see a bunch of people with vitamin depletions because they’re not eating well. They’re literally starving. My biggest concern with semaglutides is that they’re missing the whole health issue and only focusing on the weight. These drugs should be an addition to what you’re already doing, not the first step.” —Dr. Stephen C. Brewer
Dinner Drama
Gyms and spas aren’t the only losers in this new world order. Investors in food companies and food delivery services are reportedly nervous about dipping profits. Liquor companies are even more worried (Ozempic quells the desire for booze as well as banquets), and Nestlé is pivoting to produce supplements specifically for semaglutide users. “At some point I think restaurants are going to start enforcing food minimums, because they’re businesses and, particularly in New York City, it’s really expensive,” Kargman says. “I’ll go out to dinner with people, and instead of ordering an appetizer and main course, they’ll just get a bunch of stuff for the table. Sharing plates masks what you’re really eating, and it’s easier for them to just push food around their plate.”
“People are feeling more confident and are out and about socializing, but it’s still a little taboo to say you’re on it in some circles. When they are out, people on it are eating smaller meals, and also there’s just more socializing at non-meal times.” —Dr. Melissa Doft
“People are drinking less socially, which is partially due to Ozempic, which makes alcohol less appealing. I’m seeing more THC gummies or microdose psilocybin on nights out.” —Dr. Dan Belkin
“I’ve had a couple of dinner parties with people who won’t admit they’re on Ozempic, and I won’t have them back. It’s one thing if someone is battling obesity, but it’s another if someone is essentially trying to be a double zero, and I have them over and go through great effort to have a plethora of foods, and they barely eat. It’s just not fun.” —Jill Kargman
“For weddings they might do a giant fabulous dessert buffet, which no one will touch. It’s more, you know, performative.” —Marcy Blum
Thin Is In. Again.
Has Ozempic shrunk the body neutrality movement, too? It’s a cruel irony that the popularity of drugs touted for their figure-shrinking abilities comes at a time when we’ve been making cultural strides toward an acceptance that bodies come in all shapes and sizes. While excess weight can put you at risk for a host of medical issues, weight alone has been shown to not be an accurate measure of overall health. The same goes for BMI, the limitations of which the AMA addressed in a policy statement last June. “BMI always needs to be considered in the context of body composition, not as a single health marker,” Balantekin says. The worry for many experts is that Ozempic et al. will perpetuate destructive weight stigma and, for those who have suffered from eating disorders in the past, be a constant trigger.
“These drugs are feeding an ongoing conversation about the pervasiveness of diet culture, the desire to manipulate our bodies to look a certain way, and the anti-fat bias that is all around us. And the message is always clear: Thin is better.” —Erin Parks, PhD, clinical psychologist and co-founder of Equip, a virtual eating disorders clinic
“We’re a thin-obsessed culture. Societal ideals of thinness have been around for a long time, and I don’t think the presence or absence of medication is going to affect that.” —Rebecca Puhl, PhD, deputy director of the Rudd Center for Food Policy & Health
“As someone who has lived in a larger body since childhood, I feel like it’s two steps forward, one step back. What worries me in the public psyche is when you have celebrities using it to get thinner, and drug companies like Novo reaching out to body-positive influencers to try to get them on the medication. I’m hoping as the celebrity stuff wears down, the people who really want treatment have access to it, and the people who don’t want to change their body size don’t feel pressured to.” —Brooke Boyarsky Pratt, CEO and co-founder of Knownwell, a weight-inclusive care company that offers hybrid treatment (including semaglutides)
Will We All End Up On It One Day?
Ozempic may be pharma’s version of golden handcuffs: Going off it would be ideal, but it will be a struggle to maintain your new low weight. “Most will regain, and that will happen rather quickly,” says Dr. Stanford. Plus, there’s a rapidly growing list of semaglutides’ ancillary benefits. Studies have shown a reduced risk of heart attack and stroke in people with cardiovascular disease; a 60 percent reduction in the risk of developing type 2 diabetes; and benefits for liver function and, potentially, for dementia. Also, solid preclinical data has been published on semaglutides’ effectiveness in curbing addiction to opioids and alcohol. “We’re starting to think of the GLP-1 system as an emergency brake for behavior,” Dr. Hayes says. It’s no surprise, then, that more drug companies are clamoring to make their own versions, and a pill form is on the way. But what functional and longevity medicine doctor Frank Lipman thinks will really expand semaglutides’ reach is their use as a longevity hack. In his practice he’s microdosing it instead of Metformin.
“I really don’t think we’ve seen the peak yet,” Brewer says.
“This is capitalism, and when something is a trillion-dollar industry, there is going to be competition. The price of semaglutides will eventually be driven down, and it may be something that a large swath of the population is on.”
—Dr. Caroline Messer
“I think more people are going to be microdosing it. I’ve kept it at.25, which is below the lowest dose, and I see more people doing that. It allows you to maintain your weight, and you get the benefits in terms of your glucose and A1C, but you don’t lose a ton of weight quickly, so you don’t see the facial aging.” —Dr. Dan Belkin
“These drugs used at a low dose can have a lot of beneficial effects downstream, not only with your blood sugar and weight but with cardiovascular issues and preventing Alzheimer’s with inflammation. I think in the future they’ll be hot anti-aging drugs.” —Dr. Frank Lipman
“Once you can pop an Ozempic pill, and you don’t have to get syringes and put them in your fridge and inject yourself, it’s going to be really widespread.” —Jill Kargman
“Every venture capitalist and their brother wants to get in on this.” —Dr. Matthew Hayes
This story appears in the May 2024 issue of Town & Country. SUBSCRIBE NOW
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