Beyond Ozempic: How weight loss drugs could change the world

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When Lily Steiner started taking a new drug for her diabetes, she was not expecting weight loss.

Steiner went on her first diet at age seven, and struggled with her weight all her life. Seven years ago, at age 60, she was done with the diet treadmill and quit weighing herself. But then her doctor put her on Ozempic six months ago, and it completely changed how she looked at food.

Lily Steiner, 67, says taking Ozempic for her diabetes has been a game changer for her weight.Credit: Simon Schluter

“For the first time in my life, I understood what it meant to not want to eat something, and to want to stop halfway through a dish that I really liked,” Steiner says.

“I used to really like cakes and certain creamy things, but that doesn’t appeal to me now. It’s not that I’m able to say ‘I’m not going to have dessert’, but I don’t even feel like it.”

Steiner, from Melbourne, is not sure how many kilograms she has shed, but she has dropped several dress sizes starting from a size 24 in the past six months, and she has felt well along the way.

Ozempic does not work this way for everyone. Many people experience debilitating side effects such as frequent nausea, vomiting and diarrhoea, or can’t get hold of it because of shortages or cost.

But Steiner’s story is not unusual, and it represents the promise of a whole class of medications that were developed for diabetes and were then found to have significant benefits for weight loss. Ozempic is the best known, but not the first and it won’t be the last.

Imagine a world in the near future where safe, effective weight loss drugs are widespread and larger bodies are unusual. Is this a vision to be cheered or feared?

The implications would be broad and deep for the whole of society. What would it mean for public health, for business, for our body image and for interpersonal relationships?

There has been overwhelming demand for Ozempic because of its weight-loss effects.Credit: Monique Westermann

This future is not a certainty. The drugs are not effective for everyone, they are unaffordable for most people without a government or insurance subsidy, and there might be unknown, long-term side effects.

But nor is it a mere hypothetical. The signs are promising so far – the drugs seem to work and are generally safe if taken correctly. As research and development continues apace, they are likely to become better and cheaper.

One of the earliest examples of this new breed of medicine was liraglutide (sold as Saxenda), which was approved by the Therapeutic Goods Administration for weight loss in 2015.

The TGA has also approved semaglutide in various forms, including Ozempic for diabetes management and Wegovy, a higher-dose version made by the same company for weight loss.

In October, the TGA approved tirzepatide (sold as Mounjaro) for diabetes. It’s approved for weight loss in the United States.

There is a bewildering array of similar drugs coming down the line. A recent article in The Atlantic says a new, oral form of semaglutide works about as well as Ozempic or Wegovy, which are both injectables. There’s another pill containing a drug called orforglipron, plus research on compounds called survodutide, retatrutide, pemvidutide, lotiglipron, and danuglipron.

Dr Matt Vickers, clinical director of telehealth provider Eucalyptus, says the broad group of drugs is known as GLP-1s. They mimic “incretins” – gut peptides that are secreted after nutrient intake to send a signal to the brain that you are full, and stimulate insulin production.

Ozempic is subsidised for diabetes through the Pharmaceutical Benefits Scheme, but most of the other GLP-1 drugs are not and cost Australian consumers hundreds of dollars a month. The manufacturer is yet to make Wegovy available in Australia but has applied a second time to have it listed on the PBS for severe obesity and is awaiting a decision this month.

There is an acute shortage of Ozempic that the manufacturer says will continue throughout 2024. The TGA blames viral TikTok videos that promoted the drug for general weight loss.

Since Wegovy is unavailable in Australia, many doctors prescribe Ozempic as a treatment for obesity, especially for patients with insulin resistance, a precursor to diabetes.

This off-label use is legal but controversial because the shortages have left many diabetic patients unable to fill their prescriptions.

Vickers, whose company often prescribes Ozempic and Saxenda through its telehealth platforms, argues the off-label use for obesity management is safe and helps prevent diabetes.

“Patients who have struggled with their weight for a long time, and may be suffering from many other chronic conditions related to their weight, are no less deserving of access to medications that could improve their lives than others,” he says.

“Patients who are diabetic have access to quite a large range of medications under the PBS in Australia, so it’s not taking away the sole medication that’s available to them.”

The supply issues probably will be fixed eventually. What then?

Business threats and opportunities

Already, investors have shorted fast-moving consumer goods stocks, such as doughnut chains, and healthcare stocks that treat the symptoms of obesity, such as ResMed, which makes machines for sleep apnoea.

Weight loss businesses such as WeightWatchers have shifted to offering Ozempic and other medications. Business analysts have crunched the numbers on how much fuel airlines could save if every passenger were a few kilograms lighter.

And the company that makes Ozempic and Wegovy, Novo Nordisk, now has a market capitalisation that exceeds the gross domestic product of its host country, Denmark.

Adjustment could be dramatic for the food industry, which has for decades been complicit in expanding our waistlines by deploying science to create the tastiest, most-moreish snack foods, and catering to our growing appetites by supersizing portions.

Suzee Brain, director of business consultancy Titanium Food, says consumers will still eat out to socialise, but restaurateurs and cafe owners need to cater for customers on weight loss medication just as they have vegan and gluten-free options on the menu.

That might mean offering a steak in small, medium and large portions, and offering premium options.

“Early anecdotal evidence we’re getting back from the States is that [people on weight loss drugs] still go out and spend the same amount of money in restaurants even if they’re not eating as much, because they’ll start trading up,” Brain says. “They’ll take a caviar bump, they’ll take a premium sashimi, they’ll drink better wine but less of it.”

Physical and mental health

The Food for Health Alliance, formerly the Obesity Policy Coalition, advocates strategies to prevent so many people becoming overweight or obese in the first place, such as restricting the food marketing that children see.

The organisation’s executive manager, Jane Martin, acknowledges that effective treatment options are also important, as long as governments don’t feel that they’re off the hook for prevention.

“We need both prevention and treatment, and I want to particularly protect the health of our children,” Martin says. “It’s unacceptable to have 25 per cent of four-year-olds above a healthy weight.”

Martin says equity of access to treatment is important since obesity is already a disease that disproportionately affects poor people.

If there is a significant reduction in people being overweight or obese, she says, the public health benefits will be enormous.

Body positivity advocates often say that you can’t look at someone’s size to determine whether they are healthy, and Martin agrees that is true for individuals.

But at a population level, she says, it is clear that body weight is a risk factor for many chronic diseases including type-2 diabetes; cardiovascular disease; 13 different cancers including bowel and breast cancer; dementia; depression and anxiety; and skeletal problems.

Analysis by the Australian Institute of Health and Welfare in 2022 found overweight issues and obesity contributed $4.3 billion to health spending, making them the top risk factor, ahead of tobacco and alcohol.

Yet, eating disorder experts are worried about weight loss drugs. Natalie Spicer, the head of clinical and support services at the Butterfly Foundation, says people with such disorders are attracted to weight loss drugs, and it is essential that doctors screen for this.

“They can worsen harmful thoughts or behaviours for those with eating disorders or contribute to an eating disorder developing for someone who is already quite vulnerable,” Spicer says. She says the common drug side effects of nausea and vomiting can trigger bulimia nervosa, and the fact the drugs suppress appetite is problematic for people prone to anorexia nervosa.

The Victorian and NSW poisons information centres have taken more than 200 calls between them in the past year related to people who have overdosed on Ozempic or Saxenda, including a small proportion who admitted they deliberately took a higher dose to boost weight loss efforts.

Former celebrity publicist Roxy Jacenko wound up in hospital from an Ozempic overdose.Credit: Edwina Pickles

Former celebrity publicist Roxy Jacenko turned to Ozempic in February to try to lose the weight she gained during cancer treatment. When she couldn’t find it in Sydney, she paid $2500 for a driver to collect it from the NSW South Coast – then inadvertently took three times the normal dose and landed in hospital for three nights.

“[It was] the most stupid thing I could have done,” she says. “I’ve never been so sick. I thought this could be it, I could die.”

The body positivity movement

Helen Bird, the Butterfly Foundation’s manager of education services, fears that if losing weight with the new drugs becomes the norm, it could reverse decades of progress on body positivity and size acceptance.

“Unfortunately, I think it will contribute to the weight stigma that exists in society,” Bird says.

She says society already tells people in larger bodies that “the worst thing anyone can be is fat” and a “magic pill” for weight loss would add to the perception that bigger bodies are always unhealthy and a matter of personal responsibility.

When body image activist Taryn Brumfitt, the 2023 Australian of the Year, spoke at the National Press Club in Canberra recently, she refused to answer a question about what she thought of weight loss drugs such as Ozempic.

Australian of the Year Taryn Brumfitt addressing the National Press Club of Australia in late October.Credit: Alex Ellinghausen

In a later interview with this masthead, Brumfitt says her main concern is that journalists should stop giving the drugs free publicity. While it might be appropriate for media coverage to refer to “semaglutide drugs” or more generically, “weight loss drugs”, she believes journalists should avoid using the brand names.

“This is a conversation between medical professionals and their patients, on a one [on] one basis, that needs to fully consider all of the research evidence and the side effects – it’s not something we want people to read a news article about and think, ‘Oh, I might try that!’ ” Brumfitt says.

She also calls for journalists to avoid glamorising weight loss drugs, and writing articles promoting unsafe dieting practices such as one that referred to laxatives as “budget Ozempic”.

While respectful of these concerns, this masthead has chosen to name the drugs to aid clarity and understanding for readers.

Identity and relationships

Body image is at the core of personal identity, but weight loss can also affect relationships.

Relationships Australia NSW chief executive Elisabeth Shaw says people who lose weight often get compliments, but sometimes it can feel backhanded.

Within a friendship group or family, or even between partners, some people might feel happy for the person who has chosen to lose weight, while others might feel jealous or judged for their own size.

“There might be other family members who feel forced on the diet or … they can take it as implied criticism,” Shaw says. “[Weight loss] is a behaviour and a set of circumstances that reverberates on every level through the people with whom we share our lives.”

For Lily Steiner, this is yet to be a concern. She is single and her friends and family have either not noticed or not commented on her weight loss. Steiner believes it’s because “she’s still a large girl” and it will change in time if the weight loss continues.

She says she was never consumed with self-hatred and did not let her weight hold her back in life.

Even so, her weight loss on Ozempic has changed her self-perception, mainly because she now realises that her weight gain as a younger woman was not her fault.

“It was brain chemistry all along,” she says.

Butterfly National Helpline 1800 ED HOPE

With Andrew Hornery

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