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Someone asked me a question this week that I get asked nearly every week lately:
What do you think of Ozempic?
The question was motivated, I believe, by the perception that many people are taking these drugs for cosmetic - not medical - reasons.
I told him, there are certain topics that I have an opinion about that I won't state in public because I'm guaranteed to offend someone. This is one such topic.
Perhaps I can safely say that I'm certainly happy that the "skinny shots" (or now, the "skinny pill") are possibly saving some people's lives.
Perhaps I can also safely say that I'm concerned about side-effects, including:
Nausea and Vomiting: The most frequent complaint.
Diarrhea or Constipation: Caused by the slowing of the digestive tract.
Stomach Pain and Bloating: Often described as a feeling of "extreme fullness."
Fatigue and Dizziness: Sometimes related to decreased caloric intake or dehydration.
Perhaps I can say that I'm concerned about rare but serious risks, including:
Gastroparesis (Stomach Paralysis): A condition where the stomach empties too slowly or stops moving food entirely. This can lead to severe, persistent vomiting and malnutrition.
Pancreatitis: Inflammation of the pancreas, which causes severe abdominal pain that often radiates to the back.
Gallbladder Problems: An increased risk of gallstones or cholecystitis (inflammation of the gallbladder).
Kidney Injury: Often a secondary result of severe dehydration from vomiting or diarrhea.
Vision Changes: Specifically, it may worsen diabetic retinopathy. Recent studies have also looked into a potential (though very rare) link to NAION, a condition that can cause sudden vision loss.
Perhaps I won't offend anyone to say that I'm also concerned about:
The "Ozempic Rebound" (Weight Regain).
Hormonal Snapback: When you stop the medication, the "food noise" and hunger return—often more intensely than before.
Statistical Regain: Clinical studies have shown that users who stop the medication tend to regain about two-thirds of the weight they lost within one year.
Psychological and Emotional Changes
Loss of "Food Joy": Many users report a "flatness" or "anhedonia" regarding food. While the goal is to stop overeating, some find that food no longer tastes good or that they lose the social pleasure of dining out, which can feel isolating.
Mood Fluctuations: There are ongoing investigations by the FDA and EMA into reports of increased anxiety, depression, or suicidal ideation. For some, the rapid shift in metabolic hormones can impact emotional regulation.
"Food Noise" Replacement: While the mental obsession with food often disappears, some users report a "transfer" of habits or a feeling of being mentally disconnected from their body's natural cues.
Financial Burden
Cost: Without insurance, these drugs can cost between $900 and $1,300 per month. Even with recent price drops in late 2025 for cash-pay patients (sometimes as low as $349), it remains a significant monthly bill.
Insurance Barriers: Most insurance companies cover these drugs for Type 2 Diabetes (Ozempic/Mounjaro) but frequently deny coverage for weight loss (Wegovy/Zepbound), leading to long "prior authorization" battles.
Muscle Loss (Sarcopenia): 20-25% of the weight lost can be lean muscle mass rather than fat. This can lead to physical weakness and a lower metabolic rate, making it even harder to stay thin if you ever stop the medication.
Now, for someone for whom a GLP-1 agonist is a life-saver, saving a life is the highest priority.
But for someone who wants to use it merely for cosmetic reasons ... ???
Question for your table: What do you think of Ozempic?
Shabbat Shalom
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