Over-hyped and growing more popular by the minute, weight loss drugs are taking America by storm, with an estimated 15.5 million U.S. adults now using them, and drug companies scrambling to meet the ever-increasing demand. Some claim that patients can lose as much as 15% to 25% of their body weight on drugs like Zepbound, Ozempic and Wegovy. And ads for these medications regularly tout the loss of 80 pounds or more. But the new weight loss drugs are also raising a slew of growing concerns—from safety to availability to cost.
Although it is common for people to be prescribed these drugs for high blood pressure and diabetes, the U.S. Food and Drug Administration also now approves them for obesity (defined as a body mass index of 30 or greater), and many are approved for patients as young as 12. However, a growing number of people who may not technically be obese are also appropriating them as quick-fix cosmetic solutions.
Four in 10 Americans have obesity, a condition that is tied to other serious health problems, such as high blood pressure, diabetes, heart disease and a myriad of other associated conditions. The implications of this are not insignificant. Many of the people who died from COVID were obese. In addition to shortened life spans and lost quality of life, obesity and its attendant conditions cost the United States an estimated $173 billion per year in extra health care costs, according to the Centers for Disease Control.
How Current Weight Loss Drugs Work
The new drugs are called GLP-1 RAs (glucagon-like peptide-1 receptor agonists). They work by mimicking a hormone secreted in the gastrointestinal tract that prompts the body to produce more insulin after eating, thus lowering blood sugar. They also slow down digestion and make your brain think you are full and satisfied, so you will eat less. Our body produces GLP-1 on its own, but it is broken down very quickly, so as soon as we stop making it, we don’t feel full anymore. The new weight loss drugs, on the other hand, last an entire week, so you feel sated 24/7.
According to The Wall Street Journal, companies that make the drugs in the GLP-1 family often use phrases such as “long term” and “chronic treatment” for their recommended usage. Many are being prescribed as lifelong drugs, and people with diabetes can be covered by insurance indefinitely.
To give you a sense of how lucrative weight loss drugs have become to the pharmaceutical industry, it should be noted that the market value of Danish company Novo Nordisk, which makes Ozempic, is more than three-quarters the annual GDP of Denmark.
Pros and Cons
These drugs have been used for years in lower dosages to help diabetics control their blood sugar levels. Now repurposed for weight loss, they appear to be just as effective. John G., a 75-year-old retiree from Fredericksburg, Virginia, has been taking Ozempic for more than six months for his Type 2 diabetes. Because of his condition, he is provided the drug through his Medicare Advantage Plan; otherwise, he couldn’t afford it. John has lost nearly 20 pounds on the drug so far. “My experience has been largely positive, and I’ve found Ozempic to be very effective at controlling my diabetes. I’ve had few side effects, except loss of appetite. I do have some concerns that if I go off Ozempic I will gain the weight back.”
These drugs have been shown to have additional benefits as well. For instance, a 2025 study published in Nature Medicine found that compared to more traditional treatments, the use of GLP-1 drugs had a number of brain-related benefits, including a reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders (including Alzheimer’s disease and dementia), coagulation disorders (the inability to form blood clots), cardiometabolic disorders (conditions that can result in heart disease, stroke, etc.), infectious illnesses and several respiratory conditions.
One reason for their success at weight loss may have to do with the drugs’ impact on our gut health. It has long been known that animals and humans with obesity have less microbial diversity in their guts, creating an imbalance of microflora in the small intestine. This affects our ability to extract energy from our food, changes fatty acid metabolism in body fat and the liver, influences gut hormones, and can compromise intestinal barrier integrity (which can lead to problems like leaky gut syndrome). One interesting finding is that these drugs increase microbial diversity, thereby reducing gut imbalances and associated digestive problems.
The Affordability Problem
Celebrities gush over these drugs, and right now they are about the only people who can afford them. Zepbound costs about $1,000 a month, limiting it largely to the wealthy. Tiffany C., from Jacksonville, Florida, took Wegovy a year ago, but then discontinued it after only two shots. “I needed to take weight off before a medical procedure, and I was able to lose it very quickly (about 12 pounds), with no side effects. I was very pleased with that. Although I know Wegovy works, it was just too high out of pocket. I’m about to start Zepbound, and I hope it’s more affordable.”
One problem is that weight loss drugs may not be covered by many health plans, and Medicare will only pay for the cost of obesity screening, not the cost of the drugs themselves (a 2003 law prohibits Medicare from covering these drugs for weight loss alone.) All of this has some lawmakers up in arms. There has been a longstanding bill in Congress called TROA (The Treat and Reduce Obesity Act), designed to get Medicare to cover these medications.
While some researchers claim that covering weight loss drugs would hasten Medicare’s bankruptcy—as well as that of many health insurers—others argue that these medications could ultimately save the government close to $250 billion in healthcare costs over the next decade.
Dealing with Side Effects
The new weight loss drugs— injected into the arm, stomach or thigh using a pen-like device—don’t just come with a hefty price tag; they have side effects that some find difficult to tolerate. While for most these symptoms appear to be mild or temporary, they can include nausea, diarrhea, vomiting, constipation and fatigue.
More recent findings suggest that these drugs may also lead to other chronic conditions. For instance, in the previously mentioned Nature Medicine study, it was also reported that GLP-1s are associated with an increased risk of gastrointestinal disorders, hypertension, various inflammatory kidney conditions, eye problems, thyroid cancer, muscle loss, gallbladder disease, arthritic disorders and alterations in blood salt levels, as well as inflammation of the pancreas and drug-induced pancreatitis.
Tamie F., a 54-year-old from Baltimore, was prescribed Mounjaro for diabetes. Although her diabetes has improved, she is ambivalent about the drug. “I was prescribed Mounjaro because my blood sugar went sky high. I don’t know exactly what caused my diabetes, but my weight and eating habits were definitely an issue. However, [the drug] has also caused nausea, diarrhea and upset stomach. I enjoy food less because I don't know what I can eat safely. ‘Safely’ to me means that I won't have an upset stomach or feel nauseous after eating. I'm sad that I don't like the same foods because there are some foods that I miss.”
Tamie’s symptoms were relatively mild. Other patients have developed more dangerous conditions such as stomach paralysis and bowel obstructions. Food can be retained in the stomach for days, which can pose complications for patients in need of anesthesia for surgery. And there are concerning issues for pregnant women, as well. GLP-1 drugs can increase the risk of miscarriage, birth defects and low birth weight. Women of child-bearing age may need to use physical barrier contraceptives while taking these weight loss drugs.
Food as Fuel vs. Food as Fun
But it also appears that Mounjaro has had a positive impact on Tamie’s eating habits. “I can't eat what I used to —which could be a good thing because I'm not eating as many sweets and ‘garbagy’ foods. I hope that I can listen to my body now and not overeat just because there is food in front of me.”
Dr. Carolynn Francavilla Brown with the American Medical Association has seen a phenomenon similar to Tamie’s with her patients. They begin to follow a more conventional three-meal-a-day eating routine, snack less and eat smaller portions. Basically, food becomes more what it was intended to be—fuel. As Francavilla Brown says, “They just don’t think about food as much.”
At the same time, Stephen Powis, a national medical director with the U.K.’s National Health Service, has expressed concern that these drugs are being inappropriately used—as a quick fix for losing a few pounds or to get “beach-body” ready. And, according to a BBC investigation, there is a black market emerging for these drugs, with GLP-1 medications now showing up as an adjunct “therapy” in hair salons and spas.
The Ozempic Personality
Typically, weight loss makes you feel better about yourself, but that’s not always the case for those on GLP-1 drugs. According to Healthline, social media outlets are lighting up with reports of the so-called “Ozempic personality,” which includes increased feelings of anxiety, lowered mood, decreased libido and a lack of interest in previously enjoyed activities (an indicator of depression). It’s been suggested that this may be because the GLP-1 drugs are turning down dopamine receptors, our reward center in the brain. However, some doctors counter that patients feel this way simply because they are no longer rewarding themselves with food, a source of comfort for many people, particularly those who were previously overeating.
Along with Ozempic personality, there is “Ozempic face,” which is basically a skinnier face that highlights one’s advancing age (wrinkles). Moreover, anyone who was previously obese will most likely not have a beach body after they lose the pounds. As Bradley Olson candidly shares in his ongoing weight loss chronicle in The Wall Street Journal, “The mirror exposes a bit of turkey neck due to the slack from my newly skeletal face, flaps of cellulite-scarred skin around my thighs, and a midsection that at times resembles a deflated bouncy house.”
Rebounding
As with insomnia and anti-anxiety medications, there is the likelihood that once you go off the drug, you will once again experience the problem you thought you had fixed, and with renewed vigor. In the case of the new weight loss drugs, you are likely to plateau after about a year to 18 months on the drug, then gain much of the weight back (as much as two-thirds) when you go off it. And this is why many doctors insist that the drug be taken continuously, as with any other chronic disease, such as high blood pressure.
If you do want to discontinue the drug, it is recommended that you not stop cold turkey, but take a tapered approach and use appetite suppressants as a bridge to disuse. Moreover, people who end up gaining much of their lost weight back face another potential problem: dramatic weight fluctuations—losing it, then gaining it back—increasing the risk of heart disease and diabetes. With the over-emphasis on thinness in our culture, particularly directed at women, it should not be a surprise that although obesity affects men and women about equally, it is women who are more likely to take these drugs. Many who take these drugs begin with good intentions, but then find themselves more and more fixated on their weight as they continue. Are the drugs perhaps contributing to eating disorders?
Quick Fix or Slippery Slope?
According to a Pew Research survey, about two-thirds of those surveyed say willpower alone is not enough for people who are trying to lose weight and keep it off. In turn, media hype and ubiquitous advertising have perhaps made many Americans overly optimistic about the efficacy of weight loss drugs and are choosing them as an easy remedy. Although doctors are careful to warn that the drugs must be taken in conjunction with lifestyle changes, like diet and exercise, the fact is that many people are simply using them as a short-term fix.
Tiffany C. falls into that category, but she doesn’t want to be on any weight loss drug for long. “I don’t want to take anything long term because of possible future side effects. I’m looking to lose 25 pounds and then will probably stop taking it again. I diet and exercise as well. I’ve done fasting. So, it’s not a substitution. It’s more to augment what I’m already doing. Whether it’s a procedure or a drug, it’s just a tool and assist for me.”
More doctors today dispute the age-old “eat less, move more” equation, noting that metabolic fluctuations (how many calories we burn in a day) actually drop as we lose weight. The more we exercise or restrict calories, the more our metabolism compensates by storing fat. Not only does our metabolism go down, but our appetite goes up. Many people begin to feel hungrier and less full when they lose weight. Francavilla Brown notes that this is because we are biologically programmed to keep weight on—a genetic echo from our prehistoric ancestors who often had to go for long periods of time with little or no food. “Those are real challenges, and the reason why most people are not going to have long-term success without medication or surgery.”
And many other factors can make weight loss feel like a pie in the sky—metabolic disorders, endocrine issues, stress, age, travel, inadequate sleep, heredity (there are more than 400 genes linked to obesity and weight gain), hormonal changes and other medications, to name just a few. Some doctors even believe that each person has a “weight set point,” and our brains, hormones and metabolism make adjustments in order to maintain that weight. But genes are not destiny—many other things can affect that set point in one direction or another.
Willpower Is Not Enough
It has often been observed that Europeans tend to be thinner than Americans, and much has been made of the so-called Mediterranean diet as the reason why people in Europe are seemingly so effortlessly svelte. However, there are several other factors besides diet that might account for this difference, and people in some countries like Great Britain and Italy are beginning to experience a surge in obesity as well.
Europeans tend to eat more fresh produce and smaller portions, and snub the car for walking and cycling (many cities in Europe, like Madrid and Florence, are pedestrian-friendly). But another critical difference is the quality of the food in their grocery stores. The European Union takes a more precautionary approach to food safety than the U.S., with laws against putting certain additives and preservatives in their foods. Their products also generally do not contain as much salt and sugar as American foods do. In other words, the American food industry seems more focused on convenience and ramping up taste than health. The vast number of fast food restaurants in the United States also speaks to the country’s obsession with easy, cheap, mood-escalating foods that people don’t have to prepare themselves or spend much time thinking about. (There’s a reason they are called Happy Meals.)
There are a few grocery store chains, like Florida-based Publix, that offer products with a “made without” icon to help consumers choose more wisely, but they are the exception rather than the norm. The grim reality is that the U. S. food industry is often working against its citizens rather than for them, particularly when it comes to weight loss and health in general.
Cooking healthy—with loads of fresh, organic produce, whole grains, lean proteins, healthy fats and probiotics—takes time, thought and planning. In America’s fast-paced, self-indulgent, over-extended culture, taking the time to eat right may just be too inconvenient. We’d prefer to have our cake and eat it too.
Based in Northern Virginia, Lyndi Schrecengost is a freelance writer specializing in health and wellness.