Since 1960, the number of U.S. adults who are obese has tripled, and severe obesity has increased by 10 times. Obesity is one of America’s most pressing health issues and has now become a part of our culture. At the heart of this epidemic is the South, with Arkansas, Mississippi, Louisiana and Alabama all in the top five most obese states in the country. Obesity’s rise in the United States has been virtually unstoppable with no real end in sight — until now.
In 2017, Ozempic hit the market for Type 2 diabetics trying to manage their blood sugar. Very quickly, however, patients taking this drug noticed significant weight loss. Ozempic’s potential as an effective way to lose weight with fewer lifestyle changes led to unprecedented popularity among Americans with obesity. The fields of medicine and public health have latched onto the weight loss drug as the solution to America’s obesity epidemic. However, there may be grave consequences if use of Ozempic and drugs like it becomes too widespread.
How did we get here?
Upon its U.S. release in 2017, Ozempic was marketed as a weekly injection to help Type 2 diabetics manage their blood sugar. Since then, more clinical trials have been run and published in 2018, 2020 and 2024. The earliest patients on Ozempic noticed a remarkable trend — significant weight loss without major lifestyle changes. Danish pharmaceutical company Novo Nordisk saw the potential immediately, marketing Ozempic for weight loss as well as diabetes management. It made them impossibly rich.
American pharmaceutical giant Eli Lilly and Company was quick to answer Ozempic’s popularity with its own GLP-1 drug Mounjaro, which was even more effective for weight loss than Novo Nordisk’s. GLP-1 drugs, originally intended for blood sugar management in diabetics, suddenly became unprecedentedly desired among people searching for quick and easy weight loss. The demand in the United States exploded so rapidly that there was soon no Ozempic or Mounjaro available to the very people for whom the medications were designed.
In the U.S. market, these weight-loss drugs are a veritable gold mine. Demand for these drugs is still steep, and pharmaceutical companies are doing whatever they can to distribute as many of them as possible, even if it risks the safety of patients. Novo Nordisk and Eli Lilly expedited their clinical trials and their approval for distribution in the U.S. Leading British pharmaceutical company AstraZeneca is working to have its own line of GLP-1s on the market very soon and will certainly use the expedited clinical trial path.
The result? Quality standards are lower, and the government has a higher incentive to push them through despite concerns.
The Ozempic problem
Unfortunately, GLP-1s are not a one-step, 100%-effective, effortless way to drop those last 10 pounds. It’s important to remember that they were originally made for people already managing a serious disease. The weight loss caused by GLP-1s is rapid, drastic and can fundamentally change the structure of the body.
The weight you lose is not even entirely fat. In fact, fat may not even make up the majority. Up to 50% of the weight lost while on Ozempic and similar drugs is reduction in muscle and bone mass. This raises the question of whether all weight loss is created equal. In the case of GLP-1s, the answer is no. The primary goal of weight loss in diabetes management is fat loss, not just reducing the number you see on the scale. Losing muscle and bone is bad for your health and can increase risk of injury and disease later in life.
Even worse than these conditions, patients using the earlier GLP-1s from the 2000s developed pancreatitis, pancreatic cancer and thyroid cancer. There is pending litigation against Byetta, the first approved GLP-1, for patients who developed these conditions after taking it. Though both mice and rats developed these conditions in clinical trials for Ozempic, Mounjaro, Wegovy and Zepbound, the FDA decided that just a few years of monitoring was conclusive evidence that they did not cause cancer in humans.
Worse still, a study was published in Thyroid journal that concluded that GLP-1 use was not linked to increased risk of thyroid cancer. However, the researchers only followed up with patients three years after they used the drugs. In some patients, they followed up less than two years afterward. It’s worth noting that if we only followed up with smokers three years after they started smoking, we would conclude that smoking does not increase the risk of developing lung cancer.
The future of obesity in America
Today, Alabama ranks seventh in the nation for GLP-1 usage. Obese residents of the state have the choice between staying at an unhealthy weight, undergoing a healthy yet difficult diet and exercise programs, or sacrificing their lean body mass and risking cancer for the “easy” way to lose weight. Considering the exploding popularity of these drugs, it seems many people are choosing the latter. Though obesity in America may be declining, are we simply trading that epidemic for widespread sarcopenia, osteopenia, osteoporosis, pancreatitis, pancreatic cancer and thyroid cancer? Perhaps the hardest question to answer — which is worse?
Between 2020 and 2023, the number of people between 12 and 25 years old who use GLP-1s increased 594%. The number of women between 18 and 25 using GLP-1s increased 659%. It is clear that Novo Nordisk and Eli Lilly are strategically marketing toward adolescents and young adults to boost profits, preying on our need to be skinny over our need to be healthy.
One University of Alabama sorority member said that she knew “over a dozen” sorority girls using Ozempic or another GLP-1 for weight loss.
The fact that members of our generation, students at our own university, are willing to trade their health for medically-induced weight loss elucidates a problem that still persists despite countless campaigns to fight it: Losing weight is more about aesthetics and attraction than it is about health. For many, intrapersonal and societal pressures mean that we see the number on the scale simply as a number that needs to be lowered.
What we’ve learned from the health risks of medical weight loss is that not all pounds should be lost, and we should treat losing weight as an endeavor to become healthier rather than one to become skinnier. In that regard, people without diabetes or obesity-related health conditions should not risk their lives in pursuit of an outdated idea of the skinnier, the healthier. Not all weight loss is created equal.
