November 28, 2023

Under a rehearsal piano in a studio on the MGM lot in Hollywood in 1952, Debbie Reynolds crumbled. She was in the middle of preparing for Singing in the Rain, which would be her first leading role for the studio, alongside Gene Kelly, and the first time she’d have to dance, really. She was 19 years old, had three teachers, and was spinning around eight hours a day. It hurt everywhere, she wrote in her autobiography 60 years later, “most of all my brain and my feet.” She lay there, under that piano, until Fred Astaire materialized to coax her back up. She wasn’t going to die, he told her. If you’re not sweating, you’re not doing it right. So she shot “Good Morning” from eight in the morning till eleven o’clock that night. When it was over, she collapsed. For days, she didn’t get out of bed at her doctor’s behest. The studio had its own MD, who wanted to administer what they called a “vitamin shot”—amphetamines. Possibly, the same ones, Reynolds wrote, that “ruined Judy Garland.”

Since its inception, Hollywood has been the land where unrealistic beauty standards collide with financial pressure that hinges on its stars keeping thin, energetic, and always ready to make more hits. And there’s always been a quick fix or two. Since Reynolds’s era, the nature of the fixes have evolved from “vitamin shots” and “pep pills” to phen-fen to Adderall to clenbuterol—a medication used to treat breathing problems in horses. That’s to say nothing of the extra-medicinal aesthetic boosts by way of CoolSculpting, injectables, and Brazilian butt lifts, which suck pockets of fat from one part of a body and insert them into another, in order to create a generation of Instagram-age Jessica Rabbits.

It should have been no mystery, then, that when the people of Hollywood started dropping dozens of pounds in a matter of weeks, it wasn’t that everyone had suddenly started practicing moderation and logging 10,000 steps. It seemed like overnight everyone knew someone who was injecting semaglutide, whose brand name is Ozempic. The insulin regulator, developed by the Danish pharmaceutical giant Novo Nordisk in 2012, won FDA approval to treat type 2 diabetes five years later. It works by stimulating insulin release, which helps lower blood sugar levels and slow down food leaving the stomach, in turn making Ozempic users feel satiated for longer periods of time. When doctors noticed that patients using Ozempic were losing weight as a side effect of the drug, Novo Nordisk saw opportunity, conducting clinical trials on obese and overweight individuals to find that its drug did, in fact, lead to weight loss of about 15 percent of body mass in a few weeks or months. Soon the manufacturer started marketing a higher-dose semaglutide, called Wegovy, to treat obesity. Injections, which, mostly, people give themselves once per week, usually take six to eight weeks to cause significant weight loss.

“Ozempic is a real lifeline for people, and for those who need it, what it’s teaching people to do is exactly what we should be doing: eating often and eating smaller amounts of food in order to balance your blood sugars, because the longer we can have balanced blood sugars, the longer our lives will be, and the more balanced our blood sugar, the less diseases we will have in life,” said Kim Shapira, a registered dietitian and celebrity nutrition therapist who’s been in practice in Los Angeles for 25 years and sees 50 private clients each week. “The average American gained 29 pounds in COVID, and so losing that weight will decrease your risk of high cholesterol, cardiovascular disease, having a stroke, diabetes, high blood pressure, and high triglycerides. And it’s taking away emotional eating, because they’re now physically in tune with what their body can and cannot eat.” The problem, she said, is not Ozempic. It’s people looking for a quick fix, or people who don’t really need the drug, or the absence of other professional help to address the roots of their issues.

Which, anecdotally in Hollywood anyway, seems to be the people who are seeking out Ozempic. When a preposterously famous star very publicly shed a great deal of weight in a short window of time, people wanted what she was having. The onscreen talent dropping weight led to off-screen producers and bosses and friends trying it too. Then came the socialite brides prepping for their nuptials, new moms eager to lose baby weight, Brentwood ladies whispering at school drop, full-bellied businessmen who’d ditched their Pelotons, and the various Instagram famous discussing it on their way to work out at Dogpound. Some people who are concerned enough about vaccine safety to delay their children’s immunization schedules but who have made peace with Botox have also found comfort with Ozempic. As one observer explained to me, finding out that all of these people weren’t just magically losing significant amounts of weight was sort of like when Dorothy’s world all of a sudden goes Technicolor. Some claim there is a off-label tell—a gaunt face, the if-you-know-you-know signature. “Once you know it exists, you start to see Ozempic everywhere.”

Those whose eyes are open to it are getting the drug through a crosstab of specialists—high-profile endocrinologists, ob-gyns, cardiologists—some of whom people say are looser with their justifications for prescribing it. The real proliferation has happened through telemedicine. Several people I spoke with told me that they’ve heard of people lying about their weight on video chats with doctors in order to get the prescription (the party line is that your body mass index has to indicate that you are obese). The drug’s side effects, which mainly occur as someone starts Ozempic, make it easier to lose weight initially. “I haven’t seen anybody not experience nausea, which can be very upsetting and crippling for like two or three days,” Shapira told me, adding that most of her clients have had to take the anti-nausea pill Zofran to counteract it. Along with the nausea further suppressing their appetite, the Ozempic takers I spoke to have told me that it’s given them headaches, making alcohol less pleasurable. And because blood sugar levels change, some are so bone-crushingly tired that they aren’t going out to dinner as often.

With qualifying insurance, people can pay as little as $25. But some in Hollywood are paying out of pocket, up to $1,500 per month. The demand has overwhelmed pharmacies and made it difficult for people who actually need Ozempic to get their prescription on time. This fall, the Therapeutic Goods Administration in Australia issued a statement asserting that there is a shortage of semaglutide injections “due to an unexpected increase in consumer demand…[which is] significantly affecting people using Ozempic for its approved use for type 2 diabetes.” The TGA expects the shortage to continue for months and urged prescribers to consider alternatives. It’s extended in Los Angeles, where pharmacists are urging people who have a prescription to refill it as early as possible to avoid a potential shortage when they need the medication.

There has been no long-term study of the drug for people without blood sugar diseases taking the medication. And less of a guide for those tired of feeling tired or nauseous or injecting themselves or paying thousands of dollars a year to poke themselves with a drug people don’t know much about other than it seems to work. Because the drug is relatively new, it is unclear what the long-term effects could be, particularly if someone is not diabetic. How long can someone using it off-label stay on it? As Bravo’s Andy Cohen tweeted earlier this fall, “Everyone is suddenly showing up 25 pounds lighter. What happens when they stop taking#Ozempic ????”

Shapira said that those who haven’t been working with a registered dietitian or made real lifestyle changes alongside taking the injections are likely to gain back the weight that they lost. Which would be a throwback, in a sense. “We saw with phen-fen and any of the other weight loss drugs that people didn’t learn anything and that they didn’t change any of their habits.” She added: “I’m worried about the long-term effects of people who only look at things short term.” 


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