I have covered Ozempic and similar drugs since 2022.
In the past two years, Ozempic has become synonymous with weight loss. When celebrities slimmed down, the tabloids wondered if they took drugs. Activists argue that the drug enforces old norms about body image – people still want to be thin. Ozempic was weight loss; weight loss was Ozempic. It’s like Kleenex or Scotch tape: totemic.
Technically, while Ozempic is a diabetes drug, people can, and do, take it for weight loss.
But these drugs – and others in their class, such as Wegovy, Mounjaro and Zepbound – are much more. Scientists believe that the drug will revolutionize several fields of medicine, such as cardiology and endocrinology. Researchers are also conducting dozens of trials to see if it can help with Alzheimer’s, liver disease, polycystic ovary syndrome and even skin conditions. If the trial proves successful, the drug could add years to life, save billions in medical costs and divide public health into a before and after era. The researchers who studied the drug told me that they felt like the scientists who first discovered antibiotics.
These are very high hopes, and not everything will happen. But we have seen the impact in the real world. In March, the Food and Drug Administration said doctors can use Wegovy to reduce the risk of heart problems. Last month, a trial showed that compounds in Ozempic reduce the risk of complications from chronic kidney disease. And last week, two trials found that tirzepatide, the substance in Mounjaro and Zepbound, can improve sleep apnea symptoms.
The idea that a single drug could target multiple diseases could be a very good idea. These drugs, called GLP-1s (glucagon-like peptide 1 receptor agonists), have even confused the scientists who studied them. When I asked the researchers how Ozempic can help with cognitive problems and non-alcoholic fatty liver disease and opioid addiction, they give the same answer: We don’t know!
But we have early clues about where the drug might take us — and what it means. In today’s newsletter, I will explain.
Fight inflammation
Some researchers think Ozempic and drugs like it may have medicinal powers: reducing inflammation in the body.
Inflammation is an important part of the body’s defense system. When we sense a threat, such as that caused by a pathogen, our cells can help fight off the intruder. But chronic inflammation leads to heart disease, lung disease, diabetes and many other major diseases. If the new obesity drug actually reduces inflammation, this could explain its effects on a variety of diseases.
There are still limitations. Not everyone responds to GLP-1. Even slimming down will hit the floor, usually after losing about 15 percent of your body weight. And these drugs have side effects (nausea, vomiting, diarrhea and constipation) and rare but serious risks: People can develop gallstones and an inflamed pancreas; they can eat less and become malnourished; and, more generally, they can lose muscle mass.
Limit the urge
We know that these drugs target the areas of the brain that regulate appetite. But there are questions about what drugs do to the mind. I have interviewed dozens of people who took these drugs who said they had lost all interest in alcohol.
Could these drugs block other compulsive behaviors, by creating an “eating disorder”? Studies in rats show that GLP-1 reduces cocaine cravings. Scientists are researching whether these drugs may be able to reduce gambling and smoking addiction.
Great experiment
Ozempic and drugs like it are considered “lifetime drugs” – that is, people are supposed to stay on them forever. They are like statins or blood pressure drugs. If you stop taking them, they stop working.
But this class of drugs has been around for less than 20 years. Ozempic itself has been on the market for only six. We don’t know what happens after a lifetime of using these drugs. Researchers point to examples of drugs we used to think were miracles, especially fen-phen. It is also very effective for weight loss. Then doctors realized it was damaging the heart and stopped prescribing it.
It will take years, more trials and more data to determine the drug’s potential. We are years away from solid evidence supporting its use in treating Alzheimer’s disease, for example. There’s a chance they won’t do what scientists want them to do.
Sometimes researchers tell us that we are living through great Ozempic experiments.
Hundreds of thousands of people around the world take GLP-1. That number will increase as it is approved for other uses. It may be years or generations before they realize their hidden limitations – or their powers.
For more
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We know where the new weight-loss drugs come from – but not why they work.
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These drugs are very expensive. One state stopped covering some this year.
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