The Downsides of Ozempic are Real
Risk, reward, and rolling the dice 🎲
ICYMI 👉
I love a debate.
In the spirit of civil discourse, today I will dissect some reactions to my most-popular-to-date piece last week: Ozempic is a Sophisticated Mind-Body Drug.
While I enjoy getting positive feedback on something I write, I’m also here for the questions and criticisms. They sharpen my thinking, challenge my biases, and help me dig deeper into what I don’t know.
Let’s dive into the top three reader concerns re: Ozempic.
MUSCLE LOSS DUE TO OZEMPIC
Muscle loss (or “sarcopenia”) due to Ozempic is a real and potentially serious consequence of the drug. Here is a reader question about it:
I have written extensively about the importance of dietary protein, strength/weight bearing exercise, and skeletal health in general. Why? Because maintaining muscle mass and tone is critical for our skeletal health. We need adequate muscle tissue in order to move, exercise, balance, prevent falls, and limit injuries.
Ozempic is designed to help people lose excess adipose (fat) tissue in order to improve metabolic health. Loss of muscle is an unintended consequence and potential risk of Ozempic and its GLP1 cousins. It can also happen to anyone who loses weight, intentionally or as a result of medical illness.
Importantly, losing muscle is not inevitable. Muscle mass can and should be maintained by consuming lean dietary protein and engaging in strength/muscle-building activities. This is important for everyone, and especially for anyone engaging in purposeful weight loss for their metabolic health.
In short, not all weight loss is healthy. Healthy weight loss, however, is weight loss that is a net benefit (i.e., total benefits outweigh total harms) to one’s whole health.
OZEMPIC AS A PROXY FOR LAZINESS
Below you will find the kind of messaging that demonstrates the profound ease with which people judge and police other people’s bodies in this country. This is an age-old social phenomenon, one that drives a lot of individual fear and self-loathing around body image, and one that only perpetuates hyperbolic messaging and moral outrage about weight loss.
It’s as if weight loss achieved through diet and exercise is deemed virtuous, whereas weight loss achieved with appropriate medical support—and for appropriate medical reasons—is labeled cheating. I fully understand the argument against quick fixery and the profit-driven gizmo-ification of health in this country. I recognize that the medical profession is often complicit in peddling pharmaceutics that don’t always serve the patient’s best interests. However, my argument for considering Ozempic was never about replacing healthy eating and exercise with a drug.
To me, what’s most fascinating about the notion of Ozempic as an “easy way out” is that when taken to its logical conclusion, these folks seem to argue that weight loss achieved through suffering—e.g., through expensive and often punishing hacks or by puritanical restriction and restraint—is morally superior compared to weight loss that involves less pain and suffering.
Conflating weight with morality, body size with worthiness, and suffering with virtue is not only nonsensical; it speaks to widespread misinformation about health that only fuels the wellness and weight loss industries. It perpetuates diet culture and body shame.
The upshot: Beware of a messenger with a (known or subconscious) agenda!
OZEMPIC AS CHEMICAL CASTRATION OF THE MIND
And then there are those who make an excellent point—but only after they are willing to ditch the attitude ✌️
This is the argument against Ozempic that I find most interesting and compelling. Many holistic health and wellness practitioners have argued that leveraging Ozempic’s effect on the Dopamine receptor to help people experience a sense of satiety, agency, and control over their relationship with food—thereby employing Ozempic as a tool to create space between thoughts, feelings and behaviors around food—is akin to playing God or tinkering with Mother Nature.
I agree that altering brain chemistry can be dangerous, even a slippery slope. But what is “health” if not to employ medical evidence, self-awareness, and trusted guides—with humility and self-awareness of what we don’t know? What is “wellness” if not to integrate body, mind, and spirit? What is “longevity” if not to live better, and not just longer? What is “awareness” if not the process of integrating our unconscious and conscious minds?
The obvious flaw with the argument that Ozempic’s effect on the brain inevitably does more harm than good is that health, by definition, includes behavioral health. Behavioral health is rooted in conscious thought, self-awareness, and the unconscious mind. That’s the brain at work!
To me, the argument not to offer patients the option of modern pharmacology for the benefit of behavioral health is to deny people the opportunity to improve their whole health. It is the same argument I’ve heard over and over again about the “unnatural” (ergo harmful) effects of antidepressants. Sure, someone might inappropriately take an SSRI like Prozac instead of “doing the work” of quitting alcohol or leaving a toxic relationship. And sure, it’s easier for physicians to prescribe Prozac than to suss out a root cause of someone’s mood disorder and to formulate a nuanced plan around it. However, when prescribed appropriately, Prozac is highly effective at helping depressed patients find the emotional “reserves” they need to move forward with things like therapy, AA or other behavioral changes.
The same thing is true with Ozempic. As I wrote last week, 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.
However, 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 beginning to unlock 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.
Is obtaining informed consent (that is, explaining to patients the risks and rationale for recommending a mood-altering medication) a moral imperative? Absolutely. Is prescribing Ozempic or Prozac a form of “chemical castration”? I think not.
And consider this: we are chemically altering our brains every day with alcohol, caffeine, sugar, nicotine, and even shopping and social media algorithms, all of which provide Dopamine surges that ease suffering and pain—and all of which alter behavior in important, and sometimes harmful, ways.
Brains and bodies are intrinsically connected. To intervene in the process of self-awareness and health promotion is to measure risk and reward, to educate and support, and to remain humble about what we do not know.
Civil discourse is a team sport. This is what I’m here for. So tell me what you think. I’m all ears!
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Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
One of the most articulate and reasonable pieces I have read. Weight bias and stigma are so widespread and persistent despite us knowing their harm. I’m so glad you are taking on this topic directly. We can, in fact, find a middle ground between body acceptance and weight health. Thanks for helping spread the word!
Thank you for taking the time to write this article, and the last one, regarding Ozempic. I am on my 6th week of using it for weight loss, and appreciate your viewpoints. I’ve used food to numb my emotions since childhood. While I was never overweight until the past few years, I’ve always known that I have an unhealthy relationship with food. I got really scared when I gained 15 pounds this past winter. Breast cancer and the fallout emotionally from my newly mutilated body put me over the edge as the scale read OBESE. It’s interesting to be able to observe my thoughts and emotions as I’m on this drug. Sometimes it feels like I have an itch that I can’t scratch when I want to turn to food for comfort while simultaneously being unable to overeat. It gives me space to ask myself what I’m feeling, pay attention, and practice better coping skills. It’s been a real journey for me as I am doing my damndest to learn portion control, eat more protein, and exercise faithfully. And be kind to myself.