Few drugs in recent years have shaken up medicine and society at large to the degree that semaglutide and its siblings have.
Semaglutide is the active ingredient in diabetes drug Ozempic and obesity medication Wegovy (since Wegovy was approved in 2021, Ozempic has become a common off-label treatment for obesity). It’s a synthetic version of the hormone GLP-1, which helps regulate our metabolism and hunger. Semaglutide and other newer GLP-1 medications have proven to be far more effective at treating obesity than diet and exercise, and their benefits seem to extend beyond just weight loss. Just this month, for instance, a study of VA data suggested that GLP-1 use is associated with a reduced risk of up to 42 different health conditions, including heart attacks, dementia, and substance use disorders.
As game-changing as these medications seem, many people—including those who might be eligible to take them—still don’t know much about them. Alexandra Sowa, an obesity medicine specialist and instructor at the NYU Grossman School of Medicine, has debuted a new book this month, titled The Ozempic Revolution, intended to change that. The book is billed as a “comprehensive user guide” for both prospective patients and people taking them right this moment. It not only includes advice on how to secure health coverage of the often-expensive medications, which can cost over $1,000 a month without insurance, but also offers tips on how to manage and avoid the gastrointestinal side effects common to taking them.
Gizmodo spoke to Sowa about her experiences in the obesity field, the misconceptions surrounding GLP-1 therapy, and what the future of obesity treatment might look like. This following conversation has been edited for clarity and grammar.
Ed Cara, Gizmodo: What has it been like for you, as a doctor specializing in obesity treatment, to see the rise of Ozempic and similar drugs over the past few years? And how much have things really changed since their arrival?
Alexandra Sowa: When I found the field of obesity medicine, there was no looking back for me. I wanted to be a doctor working in preventing disease, and this field allowed me to do it. But until very recently, people just couldn’t really comprehend what it is we were doing in our specialty clinics. So it’s been thrilling to see a widespread acceptance of the fact that obesity is a disease recently—that it’s not from a lack of well-power. And that it deserves thoughtful, caring, and comprehensive treatment.
I’m sure you know this, but GLP-1 medications for weight management have actually been out on the market for a long while, starting with Saxenda over 10 years ago. So we’ve had other tools—they just weren’t as effective. And so until we started to get these more effective injectables, we didn’t get people saying, ‘Oh, this really, really works.’ And that’s led, I think, to the meteoric rise in press coverage. And then social media has been part of this too, with people just sharing their stories. And that’s been really wonderful to see.
Gizmodo: What were some of the biggest myths or misconceptions about GLP-1 drugs that you wanted to dispel with your book?
Sowa: I think the biggest one is that people think of these drugs as just some sort of magic wand, an easy way out. And they’ll see it as that magic wand for themselves, or naysayers will say, ‘Well, this is the easy way out. You should just try harder.’ But these medications are not a magic wand. People still need comprehensive care in order to accomplish the goals they and doctors like us want: significant weight loss, improved health, disease prevention.
We still need to know how to eat, how to exercise, how to keep up our muscle mass, and how to think differently about our bodies and our journey. And that is really where I see the difference between people just getting a prescription for these drugs and people getting comprehensive care. So I have written this book to be a Bible for anyone thinking about going on these drugs, who are currently taking these drugs, or even contemplating quitting treatment because it’s not going as hoped.
I also think that there’s a big disconnect between people writing for the medications too. As an obesity medicine specialist, there are only thousands of us out of millions of doctors. Somewhere around 0.3% of doctors have obesity medicine training. And we know that a lot more people are prescribing these drugs now, which is great because we want to increase access and decrease barriers to getting the medication. But the problem I’m really seeing is that there’s often no time in healthcare systems or in these asynchronous platforms where people are getting comprehensive care.
Secondly, to that point, is that people are looking at this potentially as a short-term solution. But really, these medications are intended and approved for long-term, potentially forever, use. And so we shouldn’t be entering into taking these medications without at least having that very serious risk-benefit conversation with a doctor.
Gizmodo: Related to that, just how worried should people be about the overall safety of Ozempic and similar drugs? Are we likely to see really common serious health risks pop up down the road?
Sowa: That’s another very common misconception about these drugs: that they’re brand new, a fad, and they’re not safe. Well, we’ve had GLP-1 drugs around since the early 2000s. They have been studied extensively. They’ve been used exclusively for weight management for over 10 years. And really, they work and they’re very safe, with very, very, very few contraindications [i.e. reasons why a treatment should not be used]. They’re probably one of the easiest to prescribe medications in terms of thinking about, ‘What do I have to take into account here?’
What’s so unique about these drugs is that they’re not just for one indication. And what we’re seeing is a trickle down effect, right? It comes back to this concept of obesity care as preventive care, preventive medicine. You might not ever get to that place where you have a diagnosis of XYZ because you were on this medication. We have very large databases, with hundreds of thousands of people on these medications. And what we continue to see from this data is actually more improvement of disease states and prevention rather than new risks, which is wonderful to see.
That said, we really always have to treat this with respect. GLP-1 medications are a true modern medical miracle, and a revolution in how we can treat patients. But with that comes great need for respect of the process. And I’d say that even though we’re seeing that there is a benefit across the board, we still need to enter into that risk-benefit conversation with our patients.
Gizmodo: Where do you see the future of obesity treatment in general going?
Sowa: Obesity is complex and there are a lot of hormones at play and many, many genes. Other pathways that we had tried to treat in the past didn’t actually—in theory, they should have worked— but then they didn’t. So now that we’ve kind of cracked the surface of what is effective in obesity treatment, I think what we’ll see is more tailored-to-you therapy.
If you have X amount of weight to lose and have X comorbidity [pre-existing medical conditions], this will be the medication for you. Or genetically, if we know that potentially you are lacking in this gene, this is going to be the medication for you. Some of these newer iterations, the dual agonists, have such significant weight loss that not everybody needs those medications; we can actually start with some of the earlier iterations. So I think it will just become more targeted to what your specific needs are.
I also think, on a very, very important level, as we see more medications in the pipeline, that the cost comes down. The largest barrier to widespread use right now is cost. And I think we’ll start to see potentially easier modalities of taking the medications. Maybe it’s a once-a-month injection, maybe it’s pills or patches.
Gizmodo: What’s the biggest takeaway that you’d like to leave our readers with?
Sowa: I’ve written this book because I want people to feel really empowered. It shouldn’t just be as simple as getting a prescription walking out of the office and never thinking about it again. This is a whole sea-tide shift of how you’re going to live your life and how you’re going to approach food and exercise, and we should look at it as such. There should always be a conversation at the beginning about the long term risks, long term benefits and where do you fit into this. I don’t want to see this become a vanity drug where there really is no benefits for someone and just the risks. But if it’s used for the right indications, then generally, all the benefits far outweigh away any small minimal risk.
The other thing is I think there’s been a rise of influencers talking about these meds. And it’s wonderful that people can share their story. But expertise matters with these meds. And this is why I’ve written this book so that people can become their own experts. So that they don’t fall for the myths, the misconceptions or the fake news of it all—that they can be empowered to make really responsible and life changing decisions for themselves.
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