In his recent book Magic Pill, Johann Hari assesses the benefits and risks of GLP-1 drugs such as Ozempic and Mounjaro that are used for weight loss and diabetes control. Since January 2023, Hari has been injecting himself with Ozempic, one of the best-selling GLP-1 drugs, and he has indeed lost weight. Although Hari has not suffered any serious side-effect, many of those taking the drugs have, including a loss of interest in pleasurable things (a condition called “anhedonia”) — not just food (as intended), but also other forms of pleasure, including music and intimacy.
There are other known risks. The makers of these drugs acknowledge that there exists an increase in thyroid cancer, but since thyroid cancer is relatively uncommon, they insist that the benefits of weight loss and diabetes control can outweigh the risk. There is also the possibility of long-term side-effects that cannot be predicted at this time, though the drug-makers note that this class of drugs has been used in the treatment of diabetes for at least 20 years.
Another common side-effect is what is called “Ozempic face”: changes in the appearance, texture, and sometimes coloring of the facial skin resulting from rapid weight loss, and sagging in the skin elsewhere as well. In response to these changes, dermatologists are marketing a large number of new treatments, along with older treatments such as tummy tuck and face lift. So those who have found GLP-1 drugs effective may have to deal with the resulting skin-care issues.
Among those who are skeptical regarding GLP-1 drugs is RFK Jr., who in the past “has criticized reliance on the weight-loss drug Ozempic, raising concerns about government funding for it and other GLP-1 drugs and advocating for methods that ‘address the root causes of obesity in America instead.’” Yet, as Health and Human Services secretary, RFK Jr. has said that the administration is debating whether to allow Medicare and Medicaid to cover some or all of the cost of GLP-1 drugs for those who have tried other treatments for obesity. At a current price of over one thousand dollars per month, that would amount to an annual cost for seniors of approximately $60 billion, not counting those younger patients covered by private insurance. Paying for GLP-1s would do nothing to “address the root causes of obesity,” but clearly, there will be public pressure for government to do so.
What is certain is that GLP-1 drugs actually work, with patients on average reportedly losing 10 to 15% of their body weight over the course of a year. Along with this loss of weight, there can be other potential benefits, including lower blood sugar, lower blood pressure, less fatty liver disease, improved cardiovascular health, and delayed diabetic nephropathy. An observational study published this year also found that, while obesity in itself has for a long time been linked to higher cancer risk, “GLP1-RAs had a direct effect on reducing obesity-related cancer beyond weight loss, with a 41% lower relative risk compared to bariatric surgery.” If confirmed by other researchers, this anti-cancer effect may be an important consideration for those taking the drugs.
What is also certain is that these drugs are already very widely prescribed and that, in just 12 to 18 months, an estimated 40% of the U.S. population will be taking them. That would amount to 103 million adults in the USA alone. It is also true that GLP-1 drugs are being marketed aggressively, though precise figures for marketing the drugs are not readily available.
As Hari writes, “the stakes in dealing with the obesity crisis are very high — millions of people will live or die, depending on whether we get this right” (252). But, as Hari admits, one cannot know in advance whether we are “getting this right”: The widespread use of GLP-1 drugs points to a major transformation in both the physical and psychological state of our population but with potential long-term side-effects unknown at this time. And there are potential side-effects, as the drug-makers themselves readily admit, just as there are potential benefits, several of them important.
It is tempting to believe that just taking an injection or a pill (reportedly available next year) can ameliorate obesity without fundamental changes in diet or exercise. But if our diet and exercise behavior is unhealthy to begin with, where does this leave us?
I am not a medical doctor (though I possess a doctorate), so I refrain from suggesting that anyone use or not use this new class of drugs. For myself, I would hesitate to begin using GLP-1 drugs, which apparently must be continued for a lifetime to avoid regaining weight. Surely, in many cases, there are other ways to control one’s weight and to prevent type-2 diabetes. For myself, these options include daily exercise, a plant-based low-fat diet, and both short-term and long-term fasting (with medical supervision).
Simply shifting to a whole-food diet might be effective in many cases, but only a small percentage of Americans follows this healthy diet on a regular basis. As Hari puts it, “for forty years we have been eating food that systematically undermines our satiety” (48). Processed food is not intended to keep us slim; it is designed to promote more consumption, resulting in weight gain. “If this transformation in our food supply had not happened,” Hari believes, “the market for weight-loss drugs would be confined to a tiny number of people” (48–49). By treating the problem with drugs, we “neglect what is causing the problem in the first place” (49).
That may well be true, but the problem is that it is easier to obtain an injection or, beginning next year, a pill than it is to make big changes in diet and exercise. Soon, a large percentage of our population will be relying on GLP-1 drugs. I’m tempted to say we’ve seen this show before, with a number of different weight loss crazes in the past — everything from Dr. Atkins diets from the 1970s and 1980s to fen-phen drugs in the early 1990s to bariatric surgery still popular today. Granted, GLP-1 drugs operate in an entirely new manner, and they have been shown to be effective at losing weight.
One would like to believe that the new class of weight loss drugs will benefit tens of millions of users, but no one can say for sure whether the benefits outweigh the risks.
Jeffrey Folks is the author of many books and articles on American culture including Heartland of the Imagination (2011).
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