'I woke in the night screaming': The truth about Ozempic and weight loss injections 

Is our understanding of metabolism and appetite out of date and from the past? And could a popular, growing class of drugs for obesity and diabetes help us see that they are are biological facts, not moral choices? 

If you thought Ozempic was everywhere in 2023, it’s set to get bigger, writes Kate Demolder. Picture: Mario Tama/Getty Images

• This article is part of our Best of 2024 collection. It was originally published in January. Find more stories like this here.

Word of a wonder drug travelled quickly. “Everyone is suddenly showing up 25 pounds lighter,” Andy Cohen, the TV producer who created the  Real Housewives franchise, tweeted in September. “What happens when they stop taking #Ozempic?????”

Celebrities have generally denied the accusations. “It’s hard to outrun rumours,” Real Housewife of Beverly Hills’ Kyle Richards — whose recent drop in weight has garnered wry questioning — says in the show’s latest season. “But luckily I’m in better shape than ever.”

Except for some.

“Like a year ago, I tried it,” comedian Amy Schumer revealed recently on Watch What Happens Live, also with Andy Cohen, before admitting that she was “so sick” on it, that she couldn’t play with her son. While the actress didn’t name anyone specific, she did criticise people who have lied about taking it. “Everyone has been lying saying: ‘Oh smaller portions,’” she said. “Shut the fuck up. You are on Ozempic or one of those things or you got work done. Just stop.”

And if you thought the drug was everywhere in 2023, it’s set to get bigger. Trend forecasters are predicting an Ozempic ‘ripple effect’, with claims that snack-makers and fast-food chains will offer smaller portions and more nutritious ingredients that match the preference changes with Ozempic.

Ozempic, which is manufactured by Novo Nordisk, is part of an expanding class of drugs called GLP-1 receptor agonists, which have dramatically altered the treatment of diabetes and obesity. First approved by the HSE in 2018 for the treatment of Type 2 diabetes — a condition that accounts for 87.9% of the total Irish diabetes population, according to medicalindependent.ie — its name is now shorthand for the entire category of weight-loss injections, including Wegovy, which has the same active ingredient as Ozempic but comes with a higher maximum dose. 

These drugs mimic a hormone called glucagon-like peptide-1, which stimulates insulin production and suppresses the production of glucagon, which raises blood sugar. The body naturally releases GLP-1 after a meal, and the hormone travels to the brain, triggering the feeling of fullness. GLP-1 drugs effectively inject a sense of satiety, and also slow the rate at which food empties the stomach and leaves the body. Patients generally report a freedom from cravings and an inability to overeat without feeling ill.

“I can’t eat like I used to,” Siobhán*, who was prescribed Ozempic due to an eight-stone weight gain over two years, shares. “There are also varying side effects at the start, nausea and diarrhoea and horrific wind. [But] it has elevated my confidence — I’m starting to feel comfortable in my own skin again.”

More than 60% of the country is classed as overweight or obese, according to the HSE — and, according to the World Health Organization, obesity in Ireland has reached epidemic levels as of 2022 — with an estimated 225,800 given a diagnosis of Type 2 diabetes. Both conditions involve metabolic dysfunction: Type 2 diabetes is characterised by a resistance to insulin, a trait that tends to develop as a person gains fat mass; insulin resistance leads to high blood sugar, which increases the risk of stroke, heart disease, nerve damage, and more. Obesity is correlated with, among other things, higher rates of cancer, sleep apnoea, and liver disease. For people living with these risks, these new medications can be a godsend.

“It has completely changed my life,” Siobhán continues. “I have lost five stone in a year, it has elevated my confidence and I’m starting to feel comfortable in my own skin again.” When asked if she would recommend it based on her own experience, she replied: “Absolutely.” 

There are, however, complications. 

Initial side effects (diarrhoea, vomiting, constipation, dizziness, nausea) can be gruesome enough to send people to A&E, and patients can also experience hair loss, a result that is caused by rapid weight loss rather than by the drug itself. In rare cases, patients might develop renal failure, pancreatitis, or intestinal obstruction. That, of course, is if the medication one is taking is correct — seizures of fake medication claiming to contain semaglutide have shot up in Ireland from 32 units in 2022 to 254 between January and September alone last year. And, GLP-1 drugs are expensive, around €140-€200 a month in Ireland for those without medical cards or those not entitled to the Drugs Payment Scheme.

Professor Carel le Roux, Obesity Physician, St Vincent’s Hospital

“What we know is that more than a million people in Ireland have the disease of obesity,” Dr Carel le Roux, Metabolic Medicine consultant at St Vincent’s Hospital and leading expert in metabolism and obesity says. “This million people are going to live, on average, about six years less than the people that don’t have the disease.

“So there’s a huge number of people that would benefit from the treatment. Unfortunately, the medication is not reimbursed for people with the disease of obesity. And also it’s not available for everybody that can even pay for it themselves.” 

By the 1980s, BMI had become the standard method of assessing a person’s health via their weight — a system that was formed based on European men’s measurements, meaning its limitations on monitoring women’s weight are many. Today, BMI remains one of the main criteria to gauge whether a patient can be prescribed semaglutide. 

Dr Eva Orsmond MD, MPH heads up three clinics across Ireland, each dedicated to health-focused weight loss. One of her clients, Anna*, recently presented to one of Dr Eva’s clinics to discuss her experience with semaglutide injections at another clinic. “I was told I fit the criteria because I was pre-diabetic,” she says. “Even though I have diverticulitis, which affects my bowel. 

It took away the urge to eat, yet I found myself so constipated that I woke up in the night screaming. 

"When my bowel consultant found out I was prescribed this, he was very annoyed. And when I went back to the GP who prescribed me, they told me the research they had until the point they had prescribed me, which was just a few weeks before, said my bowel wouldn’t be affected, but now they know better.” 

“Research shows it slows down the bowel, so I’m very concerned about doctors pushing a drug on patients that don’t need it,” says Dr Eva. “She might have filled the criteria for weight loss, but she was not suitable for the drug, and was given it anyway. That’s a concern.” 

Dr Eva’s main concern, however, is the way in which patients experience weight loss with the drug. “It’s about health,” she says. “[With Ozempic] people don’t lose the weight because they learn to eat better. They lose it because they feel so sick that they learned to eat nothing.”

The desire to achieve thinness by any means necessary remains an almost foundational tenet of female socialisation. When I was a child, in the heroin-chic 90s and early aughts, pro-anorexia websites soared online while celebrities in magazines insisted they ate a handful of seeds for lunch. In the early aughts, influencers such as the Kardashians shucked Flat Tummy Co. teas — laxatives — to impressionable viewers. Young women today are bombarded with a constant stream of comparative body politics. 

Dr Eva Orsmond

"We have now identified a new entity that we call a cultural desire for thinness, which is not the same as the disease of obesity,” Dr le Roux shares. “So what that means is some people have the disease of obesity and also have a cultural desire for thinness, but there are people who don’t have the disease of obesity, that have a cultural desire for thinness. And it turns out that these medications will be positively harmful if we use them for people who do not have the disease. And the reason is that if you take this medication and you stop it, the disease will relapse. So if you take this medication, you will lose weight — but the minute you stop it, exactly the same thing will happen to you that happened every time you were on a diet; you will gain all the weight back and you will be heavier after the treatment than you were before. So, if you do take it, please take it for the disease of obesity,” he pleads. 

It’s going to make you live longer. It’s going to make you look better, but you have to take it for the rest of your life.

The cultural fear of fat plays a role in the negative outcomes associated with it. Doctors frequently misdiagnose, undertreat, or shame fat people, who then accumulate reasons to distrust medical care. Obesity also correlates with poverty; the general attitude toward fat people allows an aversion to poor people to be expressed as a moral concern. 

“Obesity is a disease that does not discriminate,” Dr le Roux continues. “It’s a fallacy to imagine that obesity is a disease of one social class. What is true is that patients who are of lower income, suffer the complications of the disease more often. So what we are seeing is that if you have a lower income, and you don’t have the ability, for example, to get the treatments, especially for the complications of the disease, then you are at much higher risk of, for example, dying earlier, and having a poor quality of life.”

At the end of our call, Dr le Roux alerts me to a new medical paper which states that the use of semaglutide on obese patients has now been shown to reduce the risk of heart attacks by 20%. 

“The future is incredibly bright,” he says. “This medication that we’re talking about, it’s a good medication, but we’re going to get double the benefits in two or three years from now. So it’s going to change the landscape dramatically and not only double the benefit for weight loss but also double the health benefits. It completely changes the ball game. Because now we are not using this medication to make people lose weight, we’re using it to make patients gain health.”

This article was first published on January 13, 2024