S03E36 IN THE FUTURE ONLY POOR PEOPLE WILL BE FAT

The new drug, Ozempic (semaglutide) and its related medications Wegovy and Mounjaro are ushering in a new era of seemingly safe appetite reduction and weight loss with no need for willpower and mental effort.

As more patients who are being prescribed these expensive medications off label and speculation grows for every Hollywood star (or even acquaintance) who suddenly appears thinner, what does the future hold for our society in regards to what is the new normal for skinny?

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S03E36 IN THE FUTURE ONLY POOR PEOPLE WILL BE FAT

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Sam Rhee: The skinny revolution may have finally arrived, and it may be due to a new class of drugs. The one you probably have heard of is Ozempic or semaglutide. The other brand name for semaglutide is Wegovy, and the other related drug is tirzepatide, brand name Mounjaro.

 These drugs are going to revolutionize what it means to be skinny in our society. So what are these drugs? These drugs are GLP-1 receptor agonists, meaning that they mimic the action of human glucagon-like peptide GLP-1, which increases insulin secretion and improves blood sugar control.

This makes them great treatments for diabetic patients. GLP is actually a hormone which is released when you eat food. GLP signals your brain that you are full and reduces your appetite. So the physiologic mechanism that makes us feel really full, like we want to throw up after we stuff ourselves at Thanksgiving [00:01:00] dinner, that's GLP.

So, not surprisingly, some of the side effects of these drugs include nausea, diarrhea, vomiting, constipation, abdominal pain, and reflux disease.

 While these drugs have been primarily approved for diabetic treatment, with over 70% of America now overweight or clinically obese, these drugs are flying off the pharmacist's shelves.

A lot of patients are now using these medications who don't have diabetes, and it's working. These drugs make people feel full, so they eat less food and they lose weight, and that weight loss is significant. Studies have shown patients on semiglutide or Ozempic can lose up to 12% of their body weight after seven months, and Mounjaro users lost even more, over 20% of their body weight.

This sounds great. Why shouldn't everyone take these drugs and lose weight? Well certainly for patients who are clinically obese who have a BMI greater than 30; an example would be someone who's five foot five inches tall and weighs over 180 pounds. This would be a very [00:02:00] useful drug for patients who have real medical problems.

However it appears, the greatest increase in the use of these drugs is in people who are not overweight, but they're simply looking to become skinnier without a lot of willpower or effort. Just like Viagra was initially indicated for patients who had real erectile dysfunction, then became the recreational drug of choice for those crazy weekend Las Vegas vacations. 

These drugs are now being used by patients in ways not initially expected. A recent article in thecut.com called Life After Food written by Matthew Schneier, states that these drugs are changing the definition of being thin and what it takes to get there.

Many Hollywood tabloids speculate which celebrities are or aren't on Ozempic. The article says the drug's breakout moment was discussion whether Kim Kardashian used it to fit into Marilyn Monroe's dress for the 2022 Met Gala which she denied.

A few celebrities have admitted to using it openly, including Elon Musk [00:03:00] about using Wagovy.

A quote from a former fashion editor from the article says, quote, everyone in LA is skinny now. When asked, wasn't everyone already skinny in LA? The reply was, well, the last few people left in LA now are.

And it appears that the drug is popular everywhere amongst anyone who would like to be a little skinnier, whether they need it or not.

And for these pharmaceutical companies, the money is rolling in. 1.2 million prescriptions for Ozempic were filled nationwide in December of 2022, a 64% increase from last December, and Ozempic retails for about $900 a month. If your insurance doesn't cover it.

 There was a fourfold increase in prescriptions in California alone for patients who did not have diabetes. Of all of these non-diabetic patients who have been prescribed these medications, almost 40% of them are between 25 and 44 years of age. 81% of these prescriptions are written for women.[00:04:00] 

So are these drugs risky? So far other than the side effects mentioned before, the main FDA warning alerts users to the development of thyroid cancer in rodents, and it can be dangerous for those who have a history of pancreatitis or a certain type of thyroid cancer. \

Right now for non-diabetic patients, maybe there are issues, maybe there are not issues. We really don't know at this point. We don't have enough evidence because this drug hasn't been studied in those types of people, so we're going to have to wait.

Right now for patients, their biggest worry is just finding the drug.

Since Ozempic, Wegovy and Maunjaro took off, the pharmacies have struggled to keep these medications on hand, and there seems to be a production shortage as these pharmaceutical companies are trying to churn out as much of this medication as possible.

What happens if you stop taking these drugs? Well, studies have shown the appetite returns and the weight gain comes back. So obviously patients who are on this drug are struggling to stay on the [00:05:00] drug.

These new classes of drugs will redefine what it means to be skinny. They will also raise new discussions about body dysmorphia, and they will also fuel more debate about appetite and willpower. We're already starting to see some alarming conflicts about the haves and the have nots, judgments and pre-assumptions regarding who is taking these drugs, and whether being even thinner will be the new normal.

The one thing that is sure is that these pharmaceutical companies will be making more money than ever, and we will see way more O, O, O Ozempic commercials in the future.