Ozempic is a Sophisticated Mind/Body Drug 🧠

Why weight loss is almost incidental to Ozempic's effects on emotional & behavioral health

May 06, 2024

ICYMI 👉

At the risk of sounding hyperbolic, there’s something almost magical about Ozempic and its GLP-1 agonist cousins. Sometimes my patients wonder if it’s too good to be true. But as a humble servant of pharmacology, evidence-based medicine, and my patients who struggle with metabolic health, I’m here to tell you that Ozempic is more than meets the eye.

You might stop here and wonder if I’ve lost my marbles. You might assume I’ve drunk the KoolAid of Big Pharma—or that I’m concocting fake versions of Ozempic in a camper van and selling it on the internet. Worse, you might think that I prescribe Ozempic as a “one-and-done” slam dunk for anyone trying to lose weight.

But you’d be wrong.

So, how is it possible that an injectable medication is as magical as it is effective at helping patients lose weight and control their type II diabetes?

timelapse photo of man holding burger — Photo by Pablo Merchán Montes on Unsplash

The short story: It is because Ozempic is more than merely a “weight loss drug.” It treats mental health, specifically by targeting the part of the brain where ruminations about food, eating, and body size fester. Ozempic is a sophisticated mind/body medication that helps people turn the volume down on shame and turn the volume up on their sense of agency in areas where they need it the most.

My patients for whom I’m prescribing Ozempic (and who are taking it for the appropriate FDA-approved reasons such as type II diabetes and obesity) are not only losing weight and improving their diabetes, they are unlocking the very mechanisms that got them there in the first place. Most importantly, they are on a newly-paved, biologically-sound road to self-compassion.

The mental and physical weight of obesity

Having cared for patients for 20-plus years, I think it’s fair to say that most of my patients who have struggled with their weight have experienced some, if not all, of the accompanying challenges:

The shame that accompanies obesity and overweight, conditions that our society inappropriately equates with poor willpower or unworthiness.
The frustration about the gap between the intent to be healthy and the execution of sustainable and improved habits—a chasm that exists specifically not because of the lack of willpower or information on the harms of excess body weight and one that is only exacerbated by diet culture, thinness bias and the constant drum-beat of doctors telling people to “just lose weight.”
An excessive amount of brain space that is occupied with thoughts about weight, food, eating, and the ongoing judgment about body size by others (including medical providers).

As I have feverishly and incessantly argued, health is not defined by a certain body weight or cholesterol level. It’s not about the lab test results at your annual check up. It’s not about pleasing other people or your doctor.

Redefining health

Health is, in fact, about awareness of the totality of our medical data (which, of course, includes body weight, but also includes facts about our genetics, family history, and our life story.) Specifically it includes facts such as: whether or not your mother had substance use issues during your adolescence, you were bullied on the school bus, you are an overachiever and chronic people-pleaser, you have a genetic predisposition to type II diabetes and a family history of obesity and heart disease.

Those facts matter just as much as the lab tests at your doctor’s office.

How so? The facts of our life story—from our genetics and birth order to what kind of household, chaotic or alcoholic or calm or dismissive, we grew up in—directly inform how we think, feel, and behave in our everyday adult lives. They inform how we relate to food, nourish our bodies, and talk to ourselves. These facts inform our exercise and sleep habits, or stress and anxiety barometers, and the way we conceptualize our worthiness in the world.

And for health to improve, we need access to these facts. Of course we need medical evidence—i.e., data and science—too. We need to check your cholesterol panel and lipoprotein (a) and hemoglobin A1c and TSH and metabolic markers—oh yes! However medical evidence doesn’t stop with your BMI and LDL cholesterol readings. It must include the facts of your story. Those facts need to be mined and explored in order to conceptualize health in a more nuanced way—and to address your health in a way that treats you, not just your lab results.

After all, health is mental, physical, and spiritual. It’s a process, not an outcome. And health can only improve as our sense of agency does.

Agency, however, doesn’t come easy. Agency grows only when we’re aware of the facts first, when we accept the facts that we cannot control, then when we shift our energy from focusing on facts we cannot control—e.g., aspects of our past life, or how fast our metabolism is—and move that energy toward effecting change in areas we can control—e.g., fact-checking the stories we tell ourselves, asking for help, redefining health as more than the number on the scale, and then deploying sophisticated pharmacologic agents like Ozempic, especially when Weight Watchers plus self-flagellation hasn’t done the trick.

Back to why Ozempic is magical, almost mystical

In essence, Ozempic is a drug that, when appropriately prescribed to the appropriate person, can elegantly help them more effectively engage in the process of 1) self-awareness 2) acceptance and 3) agency.

And for people struggling with obesity, this path commonly includes an unfair degree of suffering. Suffering (specifically, shame and self-doubt) is part of life, however when the suffering itself becomes its own barrier to better health, it’s time to address it (quite literally) head first.

Even if Ozempic did not elicit weight loss, it would be, to me, the most important pharmacological intervention of our time because of its ability to help people experience a sense of agency. Its pharmacology is so elegant that the mechanism of action alone is worthy of discussion.

How does Ozempic work?

Ozempic has a few mechanisms of action. First, it helps occupy the dopamine receptor in the brain. This helps people feel less compelled to overeat and ruminate about food. In short, it helps turn the volume down on “food noise.” This effect is distinctly and importantly different from quieting hunger; Ozempic helps diminish the amount of brain space that is occupied by thoughts and feelings about eating, food, and the complex relationship with both. Ozempic helps with the emotional aspect around food in a unique and novel way.

In other words, Ozempic not only reduces emotional burden, it liberalizes precious brain space that can be spent thinking about other, more pleasant and relevant things. That reallocation of brain space is the very definition of agency.

Ozempic also helps people better regulate hunger and satiety. It helps slow digestion, which helps people feel more full and, ultimately, lose weight which, for people with weight-related medical problems can be a game-changer. As I’ve written about, regularly experiencing satiety (e.g. the feeling of fullness) is essential for health. First, for the obvious reason that when our brain registers fullness, it means that our body has been appropriately fueled. Second, satiety is essential for emotional and mental health. Experiencing fullness is critical for attention and focus and managing stress and regulating anxiety.

Ozempic helps insulin work more efficiently. When insulin works more efficiently, you process carbohydrates more effectively. For people with insulin resistance—that is, the problem whereby insulin doesn’t work well—Ozempic provides the metabolic “wheel-greasing” that is the opposite of cheating; it’s akin to putting on reading glasses for people who squint looking at a menu.

The upshot

The magic of Ozempic lies not in its proven benefits on metabolic efficiency—or even in its ability to reduce the risk of diabetes, stroke, heart disease and dementia—all of which are stunningly remarkable. Its magic is in its ability to give people a sense of agency they didn’t think was possible.

The caveats

Lest you think I’m trolling for new patients, on the sales team for Ozempic’s manufacturer (Novo Nordisk), or just a total nut job, there are a lot of caveats with Ozempic. It’s not a panacea. To recommend Ozempic to every person with weight problems or emotional distress about body image or eating or with “food noise” would be completely unethical. It would fly in the face of the Hippocratic Oath.

In other words, there are many people for whom Ozempic would do—and is doing—more harm than good. For example, many of my patients need lunch—not Ozempic—to experience satiety. Some need a good therapist—not Ozempic—to work on body acceptance. Others need more time in their day—not Ozempic—in order to cook healthy meals to control their diabetes. Some need anti-anxiety medication—not Ozempic—to get out of their own way.

Ozempic can have unpleasant and potentially dangerous side effects. It carries serious risk for people who struggle with restrictive eating disorders, pancreatitis, colitis, and myriad other gastrointestinal, metabolic and social-emotional problems. Ozempic already has done great harm on a societal level. Tragically for people who need and appropriately use this drug, Ozempic has generated moral outrage. It has been scorned by the fitness industry and by leaders within the Health At Every Size movement. It has been gate-kept by both our health care system and the insurance industrial complex. It has birthed a new generation of questionable drug compounders and profiteering prescribers. It has widened inequities between people who can afford Ozempic and those who cannot. It has been wildly and inappropriately misused by people who conflate thinness with health.

But for those who understand Ozempic’s mechanism and limitations, whose health goals extend beyond achieving a number on a scale, who are fortunate to have trusted guides to monitor their physical and emotional health, and whose health problems stem from the combination of unfortunate medical facts, some less-than-ideal habits, and a sizable serving of shame, Ozempic can be a wonderful tool.

What happens when people stop taking Ozempic?

I get this question a lot. First, not everyone should stop taking Ozempic. Chronic health conditions such as diabetes are managed longitudinally, with medications adjusted as needed. Second, other than a serious adverse event due to the drug, there is no medical reason that a patient would have to “just stop” taking Ozempic. Doctors can adjust the dosing, timing, and frequency of Ozempic just as we do with other medications. Lastly, the psychological impact of Ozempic—specifically, improved insight and self-awareness—isn’t something that disappears after the drug is gone.

Agency plus faith in what’s possible are two crucial ingredients for health.

Therein lies the power of Ozempic.

What’s next?

What’s even more fascinating—and, to me, lies at the intersection of spirituality, consciousness, and medicine—is considering the multiple uses of Ozempic for people with problems like addiction or other compulsive behavioral health problems.

Of course Ozmepic is only one tool in the toolbox. However, if you’re human, you know first-hand that stopping an unhealthy habit is easy to talk about and more difficult to execute on. To the extent Ozempic’s effect on the brain is that of reducing the shame and limiting the self-sabotage that accompanies our most un-proud behaviors—and to the extent Ozempic helps create space between thoughts, feelings, and behaviors—it is poised to begin helping more and more people who struggle with issues such as alcohol overuse and nicotine addiction.

I’ll be long gone before our healthcare system prioritizes mental health, before diet culture is dead, and before Ozempic is appropriately delivered to people who need it most. In the meantime, I will keep writing about the intersection of risk and reward, mental and physical health, medicine and magic. Because none exists without the other. 🧚‍♂️