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The science and scandal of the diabetes drug allegedly fuelling the size 0 revival
When Isobel* first heard the rumours that there may be more to Kim Kardashian’s recent weight loss than a dedicated healthy eating and workout routine she was intrigued.
The 37-year-old PR from Swindon had always kept in shape with the guidance of a personal trainer. ‘But time for myself has become more limited since becoming a mum and working for myself,’ she explains, noting that a busy schedule had stifled regular gym visits and encouraged 9pm sweet cravings, leaving her persistently 1.5 stone above her goal.
Could there be a faster, more efficient way? All it took was a simple Google search for ‘Kim Kardashian weight loss drug’ to satisfy her curiosity: Ozempic. Almost as swiftly, Isobel was able to purchase a month’s supply of the type 2 diabetes medication via an online pharmacy for £195 with just an email consultation. Once it had dropped onto her doorstep the only sticking point was self-injecting a 0.25mg dose into her stomach on a weekly basis without leaving a bruise.
The change to Isobel’s hunger levels was immediate. ‘I’m hit by a wave of terrible nausea, that feels just like pregnancy morning sickness,’ she explains of how it effectively quelled her desire to munch on anything sweet in the evening. The effects gradually fade throughout the week before she needs to administer a fresh shot. At the time of writing, she is a solid three pounds down in just a fortnight.
Isobel is not alone in pausing her pursuit of weight loss through traditional means to take a bite of this new rather attractive ‘shortcut’. That Ozempic, and its sister brands Wegovy and Rybelsus, can help you get lean by suppressing appetite has been whispered about in exclusive circles for the past year.
Then, in September, talk show host Andy Cohen broke rank when he tweeted that celebrities were mysteriously ‘showing up 25 pounds lighter’ all of a sudden, and joked: ‘What happens when they stop taking #Ozempic?’
The rumours that it had become Hollywood’s best-kept secret for staying in shape without so much as lifting a dumbbell were made weightier by The Guardian who reported that a number of musicians and actors had told them they ‘personally’ knew high-profile people using it. A much-discussed Variety article from September shed more details: A-listers were ‘quietly singing the drug’s praises’ on the encrypted messaging app Signal, paying $1,500 for a month’s supply, with it now an accepted part of the preparation for red carpet events alongside hair and make-up.
Such is the hush-hush nature of the medication that it remains unknown who among the rich and famous has dabbled – bar, unsurprisingly, Elon Musk who responded to questions on Twitter about his newly slimmed-down physique by crediting ‘fasting’ before adding ‘and Wegovy’.
The words ‘Kim Kardashian’ and ‘Ozempic’ have also been increasingly uttered in the same breath. Per US Vogue, it has been widely speculated that the reality TV star-turned-mogul’s 16-pound weight loss ahead of May’s Met Gala (to, famously, slip into Marilyn Monroe’s dress) was claimed to be enhanced by the drug.
Indeed, the rapid weight loss of Kardashian, and that of her younger sister Khloe, have taken the medication mainstream. When a controversial New York Post article last month noted the ‘comeback’ of the ‘thin, heroin-chic body of the 1990s and early aughts’ it suggested increasing numbers were turning to ‘suddenly trendy diabetes drugs such as Ozempic and Wegovy’. The swell of interest is evident across Reddit forums and TikTok feeds, where on the latter #ozempic has 350 million views and #wegovy has hit 122 million.
This spike in attention is filling the pockets of the medications’ Danish manufacturer Novo Nordisk, who pocketed $3.4bn in 2020 alone, and are projected to make $7.8bn by 2023 – particularly as use of Ozempic in the UK soars. Indeed, while Ozempic and Rybelsus are currently approved this side of the pond to treat type 2 diabetes, Wegovy has only just been given the go ahead for obesity by The National Institute for Health and Care Excellence (NICE). Doctors hope the latter will be available on the NHS from early 2023.
Ozempic, Ryblesus and Wegovy are all brand names for a compound called semaglutide. It is prescribed in various doses and can be in the form of a weekly injection – administered in the stomach, thigh or arm – or a daily oral tablet. Enthusiasm for it in the UK as a weight management tool has risen after a University College London study, published in The New England Journal of Medicine, found a found a third of people who took it for obesity lost more than one-fifth of their total body weight.
But how exactly does the medication that’s being hailed as a ‘gamechanger’, work? A little science lesson. Meet gut hormone GLP-1. ‘When most people eat their levels go up, causing them to feel satisfied,’ says Dr Harvinder Chahal, consultant endocrinologist and lead bariatric physician at Imperial College Healthcare NHS Trust. ‘But patients with type 2 diabetes lack this.’ That’s why semaglutide, which works as a receptor in the intestine, was created in 2012 to help the pancreas release the right amount of insulin.
Doctors soon noticed that as well as improving to blood sugar levels, patients – who were feeling fuller, sooner – also reported weight loss. Indeed, research has shown that obese people also lack satiety-signalling GLP-1 – and so semaglutide was approved by the Food and Drug Administration (FDA) for weight management in 2021, with NICE (the UK’s equivalent) following suit this year.
It’s effectiveness is clear: Dr Chahal points to research that has found a weekly 2.4mg dose of semaglutide can trigger up to a 15 per cent reduction in body weight in the space of six to nine months.
At present, Ozempic and Rybelsus – the latter of which is the only tablet form of semaglutide – will continue to be available on the NHS to treat type 2 diabetes, where prescriptions will remain free for those with the condition. ‘Draft guidance from NICE indicates those with a body mass index (BMI) over 30 with an obesity-related comorbidity – like high blood pressure – will be able to access it through the NHS,’ notes Dr Chahal. For others, it will be available for treating obesity in a private setting for just under £200 per month.
But it’s becoming increasingly clear that people in the UK – including those who aren’t obese – are paying to access the medication under any brand name online. This includes a friend of mine – slightly overweight, thanks to a more sedentary pandemic lifestyle – who was able to order Rybelsus tablets, £300 for three months, by tweaking their details on the form so their BMI fell into the obese range. They have lost two stone in a year and are now continuing to take it for ‘maintenance’.
It was the ease of access to Ozempic that also shocked Isobel, who also wasn’t obese. ‘I couldn’t believe that there wasn’t even a Zoom, phone or face-to-face consultation before they dispensed it,’ she admits. So, what’s going on? ‘They are being issued “off label” to treat obesity,’ explains Abbas Kanani, superintendent pharmacist at Chemist Click UK.
‘This is a term used when a medication is prescribed for any reason other than what is stated on its product license.’ He explains that online weight management services will issue a prescription after the patient has completed a consultation to check whether it’s clinically appropriate. ‘Of course, online, it is easier to be untruthful, as face-to-face providers will have weighing scales and physical oversight of the patient,’ he adds. ‘But to lie is dangerous.’
‘Using Ozempic without prescription is a threat to patient safety’
Indeed, health professionals are worried. ‘It’s a genuine threat to a patient’s safety if they are taking prescription drugs that they have bought online without a prescription from a qualified medical professional,’ says Professor Kamila Hawthorne, chair of the Royal College of General Practitioners, in a recent statement. ‘It’s even more worrying if those drugs are being used for purposes that they are not intended to be used for.’ One of the problems is that, on some sites, it’s not possible to verify the quality of ‘weight loss injections’ offered at the click of a button.
Not being under medical guidance, warns Dr Chahal, opens you up to complications or interactions with certain medicines. He adds that there are strict dosage guidelines because the strength needs to be gradually increased, and – if in the instance that a patient still doesn’t lose weight – it’s important to investigate what other hormonal problem could be going on, like thyroid issues, PCOS or excess cortisol.
The array of side effects are one of the reasons why it’s important to be issued the right dose and be monitored by a doctor or pharmacist. These can include nausea, cramping, diarrhoea, acid reflux, vomiting and constipation, as well as – less commonly – hair loss, heartburn and swelling at the site of injection. There is also a slight increased risk of pancreatitis, hypoglycemia and thyroid cancer, and it’s important to stay hydrated to avoid kidney issues.
Of course, for the medication to receive NICE and FDA approval it would have been rigorously tested for safety. However, while Dr Ahmet Ergin, endocrinologist and founder of the diabetes and lifestyle channel SugarMD, has not seen major complications in patients, he notes that the drug is relatively new. ‘There’s no way of saying long-term risks, unless we use the medications for 20 years and then look back retrospectively and find problems,’ he explains.
Indeed, other seemingly miracle weight loss solutions have left a bitter taste. In the past six decades there have been more than two dozen approved, only for some unsavoury side effects to come to light – including heart valve damage, strokes and a fatal lung condition called primary pulmonary hypertension. One of these, an amphetamine-based weight-loss drug, Tenuate Dospan, was linked to short-term ‘anxiety, insomnia and delusions of grandeur’ and long-term psychosis.
The latest alleged iteration of the ‘Kardashian effect’ – which we’ve come to know via lip filler and shapewear – is a global shortage of semaglutide, to the point where some type 2 diabetes sufferers are struggling to get hold of it.
Novo Nordisk has recently announced shortages in the UK and US due to ‘overwhelming demand’. Supplies haven’t been helped, notes Dr Ergin, by the pandemic and that it is ‘a very labor intensive, high-technology medication [to be manufactured]’.
So, shouldn’t those with type 2 diabetes be the medical priority over weight loss? ‘It’s important to treat both,’ says Dr Chahal. ‘Obesity is associated with numerous illnesses, including heart disease, hypertension, stroke, PCOS, sleep apnea, cancer, osteoarthritis, many cancers and, of course, type 2 diabetes.’
In fact, he believes that the drug is ‘revolutionising’ how we think about weight management – particularly given the complexity of slimming down through diet and exercise – arguing that they could help people avoid bariatric surgery, which is offered to those with a BMI over 40 who have an associated comorbidity. It could also help trim the £6.1 billion obesity currently costs the NHS, and £27 billion to wider society.
‘Relying purely on a drug for weight loss will end in failure’
However, doctors say these medications aren’t a cure-all and should be serve only as kick-starters to eating healthy and exercising. ‘I tell all my patients that if after six months you have not changed the way you eat or your activity, you are going to gain weight back,’ explains Dr Joseph Arulandu, who is qualified in internal and obesity medicine.
‘To rely on a drug purely for weight loss is going to end up in failure. It has to be the drug plus lifestyle modifications.’ A study this year published in the journal Diabetes, Obesity and Metabolism found that those on a 2.4mg dose of semaglutide regained two-thirds of the weight they had lost in the first year when their appetite returned to normal after stopping the medication.
So, when prescribed by a professional to people battling diseases including obesity and diabetes, these medications can be powerful. But in the wrong hands..? Let me tell you a tale of caution if you’re thinking of turning to this drug to quickly lose a few pounds this January.
I’m a 30-year-old, with a BMI bang in the normal range, living a fairly fit and healthy lifestyle. I’m also a health and lifestyle writer who has penned thousands of words on how healthy, meaningful weight loss being the kind that’s achieved via a nutritious, balanced diet and regular exercise.
I know that weight loss ‘quick fixes’ are pretty much always a bad idea. Yet the buzz surrounding these new medications piqued my interest – were they different? The future? When my friend managed to slim down so easily, with zero side effects, curiosity – and, let’s be real, vanity – got the better of me.
Despite being largely happy with my figure (a relationship built over time) I wasn’t averse to the coo of acquaintances I hadn’t seen for a while, if I was leaner, exclaiming: ‘You look amazing!’
Which is how I came to pop a Rybelsus tablet one morning with a glass of water – per the packet instructions – 30 minutes before my first meal of the day. A decision I swiftly regretted.
‘When my friend slimmed down, curiosity and vanity got the better of me’
Within an hour I was crippled with nausea like I’d never experienced. I momentarily thought about the Greek yoghurt topped with berries, nuts, chia seeds and honey and found myself running to the toilet to vomit. I continued to rush to the toilet multiple times that day, and it took three days for the nausea to fully subside.
My appetite, strangely, remained dulled for a full week – even with a pre-planned trip to my favourite restaurant. I’ve since read that these medications are theorised to partially work by tricking your brain into thinking that food is gross.
So, it’s fair to say the experience taught me an important lesson – in very visceral fashion – about the importance of only taking prescription medication under the guidance of a healthcare professional, not a (albeit well-meaning) friend.
I guess it’s not black and white; as with many things, the question of these medications’ usefulness depends on context.
I can understand the effectiveness of the medication for those who needed it. What’s more, under medical guidance, my dose would have started smaller and be steadily increased, swerving the nausea and vomiting.
However, I came away with the strong feeling that if A-listers are using medication to get super teeny then there is in some ways a duty for us to know – rather than us mere mortals thinking they’re simply on point with their macros and smashing their PBs in the gym.
Just like the plethora of famous faces insisting that plenty of sleep and facials – not Botox or a facelift – are the reason for their youthful glow, isn’t there something similarly toxic about celebrities failing to come clean about the real reason behind their svelte body transformations?
Additionally, while they might help those who are obese or overweight, I can’t help feeling that these medications are finding an audience among already fairly slim women wanting to shrink even more – I’m also concerned that people might take it too far. According to the NHS, the recommended daily calorie intake for women is 2,000, and the recommended pace for healthy weight loss being just two pounds per week. It begs the question: if semaglutide effectively suppresses your appetite, aren’t these drugs open to abuse?
‘Yes,’ says Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic. ‘For those struggling with disordered eating, pharmaceutical tools can be very damaging. They offer a shortcut to managing weight – instead of learning healthier ways of managing weight and appetite – which can be dangerous, especially for those who are vulnerable to having difficulties with body image and eating.’
There are risks, too, for those – like me – without a history of disordered eating. ‘Something that intervenes in your appetite can facilitate the development of a more disordered relationship with eating,’ continues Dr Touroni. ‘The way we normally regulate eating is through learning different strategies – tuning into our body and its hunger cues, exercise and so on. Once you develop a shortcut like this, in a sense, someone may feel like they no longer need to practice these healthy habits – and so, there’s a risk of a rebound effect.’
She adds: ‘In reality, those who are most likely to be taking these types of medications for weight loss – outside of medical advice, of course – are, by default, likely to be more vulnerable. They are probably already suffering from low self-esteem and body image issues. Their relationship with food is likely to already be an unhealthy one which is why they are choosing to take the medication in the first place. They may be engaging in all sorts of other unhealthy coping mechanisms to manage their weight.’
‘Something that interferes with your normal way of eating can lead to disordered habits’
Dr Chahal agrees. ‘Weight is complex, with physical and mental sides to it,’ he acknowledges. ‘This medication should be used to prevent weight-related illnesses and put patients in a much healthier place. It is a concern if these are being used by those of a healthy BMI to slim down further.’
As always, Dr Touroni says healthy, sustainable long-term weight management via a healthy, balanced diet is ‘always the best approach’. She adds: ‘It is about being attuned to your body while also enjoying food and having a varied diet and about having a sense of what your body needs while also incorporating movement and exercise into your days.’
It’s something that Isobel* is fast realising. ‘This seemed like the easy option to drop a dress size,’ she admits. ‘But the constant nausea is so bad I think I’ll get a personal trainer and lose weight in a slower, but more pleasant, way.’
*Names have been changed to protect identities