I’ve covered Ozempic and similar drugs since 2022.
In the past two years, Ozempic has become a synonym for weight loss. When celebrities slimmed down, tabloids wondered whether they were taking the drug. Activists argued that the drug entrenched old norms about body image — people still seemed to want to be thin. Ozempic was weight loss; weight loss was Ozempic. It’s like Kleenex or Scotch tape: totemic.
Technically, while Ozempic is a diabetes drug, people can, and do, take it to drop weight.
But the drug — and others in its class, such as Wegovy, Mounjaro and Zepbound — is about much more. Scientists believe the drugs are about to revolutionize several fields of medicine, such as cardiology and endocrinology. Researchers are also running dozens of trials to see whether they might help with Alzheimer’s, liver disease, polycystic ovary syndrome and even skin conditions. If these trials prove successful, the drugs may extend many lives by years, save billions in medical costs and divide public health into before-and-after epochs. A researcher studying these drugs told me he felt like the scientist who first discovered antibiotics.
Those are some sky-high hopes, and not all will be come true. But we’ve already seen a real-world impact. In March, the Food and Drug Administration said that doctors could use Wegovy to reduce the risk of heart problems. Last month, a trial showed that the compound in Ozempic reduced the risk of complications from chronic kidney disease. And last week, two trials found that tirzepatide, the substance in Mounjaro and Zepbound, could improve symptoms of sleep apnea.
The idea that a single drug that could target so many kinds of disease might sound too good to be true. These drugs, called GLP-1s (glucagon-like peptide 1 receptor agonists), mystify even the scientists who study them. When I asked researchers how it was possible that Ozempic might help with cognitive issues and nonalcoholic fatty liver disease and opioid addiction, they gave the same answer: We don’t know!
But we have early clues about where these drugs might take us — and what that means for medicine. In today’s newsletter, I’ll explain.
Fighting inflammation
Some researchers think Ozempic and drugs like it may have something of a medical superpower: lowering inflammation in the body.
Inflammation is a key part of the body’s defense system. When we sense a threat, such as one posed by a pathogen, our cells work to help us fight off the intruder. But chronic inflammation contributes to heart disease, lung disease, diabetes and a host of other major illnesses. If new obesity drugs really do reduce inflammation, that could explain their effect across such a wide spectrum of diseases.
Still, there are already limits. Not everyone responds to GLP-1s. Even those who slim down inevitably hit a floor, typically after losing about 15 percent of their body weight. And the drugs come with side effects (nausea, vomiting, diarrhea and constipation) and rare but serious risks: People can develop gallstones and an inflamed pancreas; they can eat so little they become malnourished; and, more commonly, they can lose muscle mass.
Limiting urges
We know that these medications target the areas of the brain that regulate appetite. But there are questions around what else the drugs do to the mind. I’ve interviewed dozens of people taking these medications who say they’ve lost all interest in alcohol.
Could these drugs curb other compulsive behavior, too, the way they silence “food noise”? Studies in rats suggest that GLP-1s reduce cravings for cocaine. Scientists are examining whether these medications might even be able to alleviate gambling addictions and smoking.
The great experiment
Ozempic and drugs like it are considered “forever drugs” — that is, people are supposed to stay on them for the rest of their lives. They’re like statins or blood pressure medications. When you stop taking them, they stop working.
But this class of drugs has existed for less than 20 years. Ozempic itself has been on the market for only six. We don’t know what happens after lifelong use of these drugs. Researchers point to past examples of drugs we once thought were miraculous, chiefly fen-phen. It, too, was astonishingly effective for weight loss. Then doctors learned that it damaged the heart and stopped prescribing it.
It will take years, more diverse trials and much more data to determine the potential of these drugs. We are years away from solid evidence underpinning their use to treat Alzheimer’s disease, for instance. There’s a chance they won’t do what scientists hope.
Researchers sometimes tell me that we’re living through the great Ozempic experiment.
Hundreds of thousands of people across the globe are taking GLP-1s. The number will rise as they’re approved for other uses. It may be years or generations before we know their hidden limitations — or their full powers.
For more
-
We know where the new weight-loss drugs come from — but not why they work.
-
These medicines are incredibly expensive. One state stopped covering some of them this year.
THE LATEST NEWS
Russia Shootings
Metropolitan Diary: Cashing in the tattoo fund.
Lives Lived: Silvano Marchetto’s Greenwich Village trattoria, Da Silvano, became a star-studded canteen and a Page Six fixture over four decades. He died at 77.
SPORTS
W.N.B.A.: Angel Reese recorded her eighth straight double-double in the Chicago Sky’s big win over Caitlin Clark and the Indiana Fever.
Soccer: The U.S. men’s team defeated Bolivia, 2-0, in its first game of this year’s Copa América. The captain, Christian Pulisic, scored one goal and assisted on the other.
N.H.L.: The Oilers and Panthers play tonight in Game 7 of the Stanley Cup Final.
ARTS AND IDEAS
How high are your socks? It’s an intergenerational debate. Fashion-minded Gen Z-ers have declared a preference for crew socks, which generally rise midway up the shin, and thumbed their noses at the low-rise socks that were staples of the Millennial wardrobe. “I think part of growing up is people trying to separate themselves from what came before them,” said Night Noroña, 18, who recently threw away all of his socks that hit below the ankle.
