[MUSIC - Luscious Jackson: Citysong]

Alison: This is All Of It. I'm Alison Stewart, live from the WNYC Studios in SoHo. Thank you so much for sharing part of your day with us. If you tuned it to the Emmys on Monday night, you may have seen actor, Christina Applegate, at the microphone who surprised the audience when she walked out to present an award. The crowd stood and applauded her because Applegate announced in 2021 that she had been diagnosed with multiple sclerosis and has since been out of the spotlight. Due to her illness, the actor gained some weight from medications. She said this on stage.

[applause]

Christina Applegate: Thank you so much. Oh my God. You're totally shaming me with disability by standing up. It's fine.

[laughter]

Christina Applegate: Body not by Ozempic. Okay, let's go.

Alison: You heard Christina Applegate saying their body not by Ozempic, referring to her own. It was a knowing joke to make in front of a spelt crowd. It's been reported that the drug can help shed weight, and it's quite common now, among showbiz folks. Many of you probably already know that Ozempic is a drug that was originally approved to treat diabetes. You probably have seen one of the TV commercials.

Speaker 3: Oh.

Speaker 4: Oh.

Speaker 5: Oh.

Speaker 6: Ozempic.

Speaker 7: People with type 2 diabetes are excited about the potential of once weekly Ozempic.

Alison: It's just one brand name for a semaglutide, which has been approved for use by the FDA for these reasons. I'm reading this from the FDA's website. "Ozempic injection is approved to lower blood sugar levels in adults with type 2 diabetes in addition to diet and exercise. Ozempic is also approved to reduce the risk of heart attack, stroke, or death in adults with type 2 diabetes and known heart disease. Wegovy injection is approved to help adults and children age 12 years and older with obesity and some adults with excess weight overweight, who also have weight-related medical problems to lose weight and keep it off in addition to diet and exercise."

But there are many darker underlying realities of the proliferation of the FDA approved drug, the high price, who and who doesn't have access to it, and the consequences for our culture and how we feel and think about weight. With me now to talk about this and take some calls is Constance Grady. She's a senior correspondent on the culture team for Vox. She wrote a piece called The Year of Ozempic Bodies and Barbie Botox. Constance, welcome back.

Constance: Thanks so much for having me.

Alison: Listeners, we want to hear from you. This is a judgment-free zone, by the way. What have your reactions been to the rise of Ozempic? Are you yourself on Ozempic for either diabetes or for weight loss? How have you found the experience? Give us a call, 212-433-WNYC, 212-433-9692. You can call in and join us on air, or you can text to us at that number as well. You can reach out on social media, @AllOfItWNYC. If you're on Ozempic, what was the process for getting a prescription? Or maybe you're on a similar weight loss drug, what made you want to use one?

212-433-9692, 212-433-WNYC. Or maybe you're someone who considered Ozempic and decided against it. We'd like to hear from you as well. As I said, judgment-free zone for this conversation. 212-433-9692, 212-433-WNYC. Let's talk about how Ozempic ended up in conversations everywhere in late 2023 and early 2024. What is going on in our culture right now that's led to so much discourse around weight loss and Ozempic specifically?

Constance: It's very interesting. Ozempic is first approved by the FDA to treat diabetes in 2017. While it's making its way into the marketplace that researchers start noticing that, "Hey, wow, people who are taking this drug also seem to be losing a lot of weight." Then we slowly see it making its way into a Hollywood on this off-label usage that you can get a prescription for Ozempic that isn't on the label, you have to pay out of pocket. It's a lot of money, but you can take semaglutide specifically to lose weight.

You start seeing that reported out in variety in the fall of 2022, that Ozempic has become the new "It" drug in Hollywood, and that a lot of actors are quietly taking it to shrink down a little bit. Then in April of 2023, there's a big piece reporting on this for New York Magazine that blows the whole thing wide open, and that's the threshold, the tipping point when, all of a sudden, Ozempic becomes a thing that people are talking about all over the place and not just in Hollywood.

Alison: As you were writing your piece, what was something that surprised you as you started thinking about your piece and started thinking about the piece you wanted to put together about Ozempic?

Constance: One thing that surprised me was seeing what happened with plus-size models. I didn't expect it to be this quantifiable, but one of the things I wanted to look at with this story is how we're coming out of this moment of pop culture, body positivity when a lot of brands are building a message around this idea that we used to be bad and we used to make our money from teaching you to hate yourself, but now, we're better and we love all bodies. You see things like Victoria's Secret rebranding in 2022.

They had that big ad campaign where they got rid of the angels and were like, "Oh, we hear you. We're better now. We're letting you define what sexy is." One of the ways that this plays out is you start seeing more plus-sized models on runway shows at Fashion Week. This reaches its peak in 2020 when 5% of the models who walked on the runways were plus-sized. In 2023, as we're entering into the Ozempic era, Vogue business reports that just 0.6% of the models who walk the runways are plus-sized, and only 3.8% are mid-sized. That means 95% of the models on runways right now are sizes zero to four.

Alison: Wow. Oh, that's in just that three-year span.

Constance: Yes, the backlash was that fast.

Alison: Let's take a call. Barbara is calling in from Brooklyn to share her experience. Barbara, thank you so much for calling in.

Barbara: Okay.

Alison: You're on the air.

Barbara: I live in Brooklyn. Maybe four months ago, my primary care doctor recommended Ozempic for weight loss. He didn't say anything else. For about two months, I was good. The last six weeks, I have been deathly and I don't want to understate, that deathly ill. Not being able to eat, going through extreme nausea. If I put anything in my mouth, including water, I threw up. I am weak. I can eat a portion that's about the size of a quarter now, and I can have that in four days without throwing up.

My doctor thinks that I've turned the corner, but I'm just so weak and so dragged out from this whole process. I'm going to go to my better way of losing weight, which is smart eating.

Alison: Barbara, please, please, please take care of yourself. Thank you for calling in and being so candid and honest with your story. Let's talk to Tom from Garden City. Hi, Tom. Thank you so much for calling in.

Tom: Hi, Alison. You're welcome. I was listening to the previous call. A similar situation, really bad side effects. I stopped taking Ozempic after three or four months, although I had lost 30 pounds and I have kept it off, but my issue was, it didn't make me want to stop eating. Although it slowed the movement of food through my system, I was still shoveling it in. I have to take some responsibility for those GI side effects that I had. It's not for everyone and I don't think that people hear about the side effects. Everybody's very high on the results, but it's not for everyone.

Alison: May I ask, and feel free to tell me no, I'm not comfortable saying this, what led you to want to take Ozempic in the first place?

Tom: I'm pre-diabetic. I've had consistently high sugar taking other-- metformin is the other standard medication, which really wasn't having an impact and so the doctor said, "Well, here you have another high blood sugar reading, let's try a drug. Here's a drug you can try," and it was Ozempic. I have to say, I really didn't notice a change in my blood sugar readings during that period either. Maybe stayed the same or dropped slightly, but that was the reason for it.

It was a nice side effect, positive side effect that I lost 20, 30 pounds, which is welcome and I have kept it off, but I think for me, it's a psychological issue of my eating. It's not something that's physical, so I need something different, some other drug.

Alison: Tom, thank you so much for being candid call in. Please take care of yourself and your health. We are talking about the rise in Ozempic. Constance Grady is my guest. She's a senior correspondent for the culture team at Vox and has written about Ozempic. Realistically, Constance, how much weight will people lose on Ozempic?

Constance: This is something that varies quite a bit as it does with all of these weight loss drugs. Everyone's body is different. About 70% of people do lose a pretty significant amount of weight up to 30, 40 pounds. Some people don't lose any weight at all. There are people who the drug doesn't really work for. The way that Ozempic works is by mimicking the hormones in our bodies that tell us when we're no longer hungry. It disrupts our hunger signals. We tend to feel fuller.

People will generally end up eating less than they would've otherwise they digest more slowly and their blood sugar ideally stays pretty low. This doesn't work for everyone. One thing to keep in mind is that as with a lot of weight loss remedies, Ozempic is not statistically speaking very good at helping you keep weight off if you go off it. People tend to find that once they go off of Ozempic, they do gain the weight back.

Alison: We are discussing Ozempic. This is a judgment-free conversation. We'd like to know what has been your reactions to the rise with Ozempic for weight loss. Are you an Ozempic user, whether that be for weight loss or for diabetes? How have you found the experience? Please give us a call, 212-433-WNYC, 212-433-9692. You can join us on air or you can text us at that number, 212-433-9692, 212-433-WNYC. Or maybe you're someone who has decided against taking Ozempic. We would like to hear your reasons as well.

Again, this is a judgment-free zone. 212-433-9692, 212-433-WNYC. I'd like to read this text to you, Constance. It says, "I'm a diabetic who was prescribed to Trulicity, hope I'm saying that right, which has been great for keeping my HGA1c levels at an exigent level. The problem is that there has been almost insurmountable difficulties obtaining the medicine when it's time for a refill because those who weigh a hundred pounds would prefer to weigh 90 pounds, are creating nearly deadly scarcities. My last refill was available 140 miles from here in Brooklyn."

This brings up a really important part of this story, access to the drug. What has the rise in popularity in Ozempic done to access? We've got one story here anecdotally, and in terms of cost, how does economic standing factor into this?

Constance: Yes, that's a really good question. Because Ozempic is a relatively new drug, and it has very recently become extremely popular for this off-label use, it is currently in limited availability. That was the case throughout most of 2023, and it's still the case, at least for the end of January. It's what the manufacturers are saying. We start seeing reports that people with diabetes are having delays accessing their drugs starting in January of 2023. By around October of last year, Ozempic starts to be really hard to find in a lot of different pharmacies.

As a result, we hear people who are either rationing their doses or cutting down on what they take or potentially even switching to different drugs that may be less effective for them. There's also counterfeits semaglutide that's entering the market which, at this point, we don't really have the information to say if that's in any way dangerous. At this point, the adverse reactions that have been reported from the counterfeits semaglutide are pretty similar to the adverse reactions that we know about with the name-brand stuff. Nausea, vomiting, general digestive distress is known to be a side effect for Ozempic.

Because this is such a powerful and such a new drug, there are a lot of unknowns in this situation. It's just another thing that people who do need this medication and are potentially desperate for it end up having to navigate.

Alison: We'll continue our conversation about Ozempic with some of your calls. We've got a couple of medical professionals on the line, some folks who've decided against taking Ozempic. We'll hear from them and more from our guest, Constance Grady, after a quick break. This is All Of It.

[MUSIC - Luscious Jackson: Citysong]

Alison: You are listening to All Of It on WNYC. I'm Alison Stewart. The subject we're discussing is the rise of Ozempic. My guest is Constance Grady, senior correspondent on the culture team for Vox. She has written about it. You're our guests as well. This is a judgment-free zone. We're having these conversations with each other to learn and to learn about each other. Let's take a few calls, Dr. R calling in from Wayne, New Jersey. Hello, doctor.

Dr. R: Hey, thank you so much for having me on the line.

Alison: Happy to have you.

Dr. R: I just want to give a couple of comments on Ozempic. First, I think for the right person, it's really been an amazing drug for those people who've really struggled for a long time with weight loss and diabetes. It's really been a breakthrough, of course. There's going to be a lot of patients who are going to have side effects to it, but I think in general, it's really been a a game changer, which is great. I just wanted to comment on the surgical side of things.

I'm an ophthalmologist here in northern New Jersey and something that I think a lot of people may not know is that Ozempic has really been having an effect on our operating room schedules. I have had a ton of cancellations because of patients that are on Ozempic and actually just recently, anesthesiologists have come out with new recommendations in regards to Ozempic that not only have to do with general anesthesia cases, but even local cases like mine.

For my cases, it's in and out the same-day ambulatory surgery centers. Even for my cases, the rule now is that any patient has to be off of Ozempic for at least one week. The reason for this is because it obviously leads to delayed gastric emptying because that's how the drug works. You can eat something 3, 4, 5 days ago and theoretically, it could still be sitting in the gut and there's a risk of aspiration. It's gotten to a point where I think a lot of anesthesiologists have seen some cases of aspiration and they're taking a very conservative approach in regards to it now.

I just wanted to give people a heads-up. Anyone who is thinking of having a surgical case, just to keep these things in mind that it's very important to tell your doctors if you're on it, and if you are, they will likely want to plan ahead in regards to you being off of it, even for the simplest cases like short cataract cases that may be 9 or 10 minutes, or even any other surgical cases that even involve local anesthesia.

Alison: Doctor, thank you so much for calling in. Really, really appreciate the call. Let's talk to Renee from Kew Gardens. Hi, Renee.

Renee: Hello. Hi, Alison. Great to hear you on the radio always.

Alison: Thank you.

Renee: I called in because I decided against taking Ozempic and I'll tell you why. About a decade ago, I was in the final human trials for liraglutide, which was the precursor to semaglutide, was one of the best obesity researchers in the country, Dr. Louis Aronne. Now, it was the same pen delivery system as the current Ozempic and Wegovy and all of that. You had to take it every day. That wasn't my issue. As Ozempic exploded, I thought about the fact that I don't have diabetes, I'm a curvy girl now.

Don't get me wrong, I'm a good 14, 16 on my best flush day, but I decided that I did not want to get on a drug for the rest of my life. It was as simple as that for me. Now, I can tell you I did not have the side effects that people are having with semaglutide and the GLP-1s with liraglutide, but I did rebound. I lost about 25 pounds and I did rebound, not the full 25 pounds, but I did not have the nausea, the discomfort, the diarrhea, the illness that goes with it.

I have a family history of diabetes, but while I'm not pre-diabetic now, I was unwilling and not just because of the cost, not because I likely wouldn't get it prescribed by my doctor. My lady doctor knows that I'm healthy. She has all my health records. I couldn't commit to being on a drug for the rest of my life.

Alison: Renee, I'm going to dive in there. Thank you so much for sharing your story and let's talk take one more call before we go back to Constance. David calling in for Manhattan. Hi, David.

David: Hi Alison. Long-time listener. First-time caller.

Alison: Thank you for calling.

David: Nice to hear you. I am the person who has type 2 diabetes and gave up on Ozempic, actually a very similar drug, same drug class, Mounjaro, which is another very popular drug for weight loss. I was simply basically unable to get what I needed. I needed 15 grams, and I was getting no more than 7.5. I was running all over the place, getting samples from my doctor, and then I thought to myself, "You know what? I don't want to be on this drug for the rest of my life anyway." I did take myself off. I gained 10 pounds, I lost six of that fat. It's a bit of a struggle.

My A1C has not been fantastic, but I don't want to be on this drug the rest of my life and will just one last thing say that I am Medicare Part D for the first time in my life. I retired from the New York City Department of Education two months ago. That drug would cost me about $275 out of pocket every month. That is a negative.

Alison: David, thank you for calling in. Got a text. "I started Ozempic on February 1st last year. Lost 20 pounds. I no longer think about food all day. I get hungry in time for meals, and I watch my portions. I'm so grateful that I have taken this 'off the table' and I no longer have to worry about my weight." Someone else texted in, "People don't realize that these drugs don't magically make the weight melt off. It takes discipline and effort, but before the drugs, the effort was in vain. On the drugs, the effort pays off. After six months, my level of hunger was no longer as low but I think it works as a tool in order to diet."

Then this text which gets me to you, Constance, and some of your reporting. "Could you please explain the Oprah Weightwatchers angle? Thank you." That's from Graham in Inwood. We've gotten to the part of the conversation where certain famous celebrities who have suddenly lost a lot of weight at first were saying they changed their diet. Then over time, became more comfortable saying, "You know what? Yes, I'm taking one of these drugs."

First of all, what do you count for not being forthcoming initially, and two, your take on the Oprah WeightWatchers, now that WeightWatchers--? I passed a sign last night about WeightWatchers advertising that they are getting in the Ozempic business the semaglutide business?

Constance: This is such a weird stuff. It's horrifying, but also so fun to dive into. I think that a lot of people are hesitant to admit that they are on semaglutide for weight loss. Not really because of the drug shortage or because it's making it difficult for people with diabetes to get these drugs, but because the way we talk about weight, it's so moralized. We tend to talk about there being a right way to lose weight and that right way being eating specific ways, working out, and disciplining the bodies through punishing yourself a little bit.

It's a little bit medieval in what way. You're chastising your body to get it into this most virtuous possible shape. I think that people tend to think of semaglutide and other weight loss drugs like that as cheating the easy way out. I think for a lot of celebrities, especially who are early adopters, it would be a little shameful to say that they had chosen to go onto Ozempic and then gradually as the drug became more widely known, they started to feel more and more okay about admitting to using it.

As for WeightWatchers, I think this is a really interesting turn from WeightWatchers who just a few years ago was rebranding itself as WW and talking about how it's not about helping you lose weight anymore. It's about helping you be well, so as the WeightWatchers as new. Now, all of the companies that were positioning themselves as wellness companies as a euphemism for losing weight are shutting that euphemism and being like, "No, actually, we are weight loss companies after all, and now we are going to try to help you get this allegedly miracle cure weight loss drug."

It's as though Ozempic has given people permission in a way to stop pretending that they care about being healthy and allow them to focus more on the aesthetic possibilities of getting thinner and smaller.

Alison: Your last answer is going to dovetail very nicely into our next segment, Constance Grady. Thank you so much for sharing your reporting and thanks to everyone who called in and texted and shared your thoughts and experiences.

Constance: Thank you.

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