Losing lots of weight was something I had only ever daydreamed about. I’d been an overweight child and clinically obese most of my adult life, but I just learned I’d lost 64 pounds. Despite this, no real emotions washed over me as I stepped off the scale.
It wasn’t my first weigh-in by any means, just one of many after unexpectedly being diagnosed with type 2 diabetes, largely prompted by a debilitating COVID-19 infection earlier that year. Since then, I’d changed almost everything about my lifestyle, overhauling my diet and dragging myself into a fitness routine while also starting a slew of new medications. As I watched four or five pounds drop off weekly, I fantasized about what I’d feel if and when I reached that 50-pound benchmark.
But when it finally happened five months in, I found that I didn’t care much about the weight loss — I didn’t feel as glorious or triumphant as I’d long imagined. Instead, I was more worried about the results of the HbA1C test (a blood test to measure your average blood glucose levels over the last 3 months) that were going to be in soon. I was going to find out if my body was producing insulin as it should, or if I would need regular, painful insulin injections, joining the more than 8 million Americans who rely on these shots to survive.
That was the reason I started on Ozempic: If I got my A1C down, I wouldn’t have to take insulin. My doctor explained to me that the medication would help my body overcome widespread diabetic damage. It was August 2022, exactly when this drug was starting its social-media-fueled ascent as the latest “weight loss miracle,” one that so many people don’t truly need, yet are dying to get their hands on. These days, however, discussion of this kind of medication has become so far-flung when it comes to weight management that even WeightWatchers plans to get in on the action. But my diagnosis of a chronic disease at only 27 made me realize that becoming slimmer wasn’t the point; I was fighting to prevent diabetes from seizing control of my own body.
This terrifying story began on a sweaty July morning, when I woke myself up to go to the bathroom. I had just finished a round of Paxlovid a few days earlier, and was working to recover from my first COVID infection. I live in a cramped Manhattan studio, so the bathroom is just eight feet from my bed — yet I didn’t make it, and urine pooled on the floor. That’s when I knew something was really wrong. At the doctor’s office later that afternoon, I was told I was diabetic without any indication of when I crossed that threshold, and that I had a raging kidney infection. I’d need a new specialized primary care doctor immediately, to get my disease under control and help me avoid ending up in the emergency room.
Diabetes runs deep in my family, and since I have spent almost seven years covering nearly every medical condition under the sun as a journalist, I knew what I was in for when the doctor confirmed my diagnosis eight days later. Before COVID, I wasn’t even prediabetic, the phase in which doctors grow concerned and during which lifestyle changes can often prevent the disease itself. But it turns out, as recent research has confirmed, that COVID-19 may also increase the risk of type 2 diabetes.
Suddenly, I was forced to think about how diabetes can shave years off life expectancy, and I braced myself to hear about the multitudes of drugs I’d need to keep myself as healthy as I could be — and the exorbitant costs of having to use these medications every day.
Editor’s Note: Weight loss, health and body image are complex subjects — we invite you to gain a broader perspective by reading our exploration into the hazards of diet culture.
What is Ozempic?
People with type 2 diabetes need help regulating their blood sugar, because our bodies struggle to use or store glucose, which is the sugar we get from the digestion of food. Glucose is one of the most efficient sources of energy for our bodies. But we need insulin to help our bodies process glucose, and when it doesn’t respond well to insulin (or the pancreas doesn’t produce enough of it, which is more frequently seen in type 1 diabetes), our blood sugar levels spike. Left unchecked, high blood sugar can damage blood vessels, the nervous and immune systems, as well as impact multiple organs. That’s why people with diabetes often use insulin, to make up for what the pancreas can’t do on its own.
My primary goal when I started Ozempic was to lower my A1C. This is a tough business, as those with the disease will tell you. My A1C was 9.8% when I was first diagnosed in July. Ozempic is made with semaglutide, which mimics a gut hormone that prompts the pancreas to produce more insulin when blood sugar is high, and helps offset spikes that contribute to a high A1C.
At that time, evidence was starting to appear showing semaglutide’s promise for those who were clinically obese; products like Wegovy (the same medication as Ozempic but at a higher dosage) had already earned the Food and Drug Administration’s (FDA) formal approval in 2021. Hollywood’s elite had started to jump on the bandwagon, but all I knew was if this worked, I could avoid sticking myself every day and a very high pharmacy bill.
When I found the courage to scan my A1C test results in December, I almost didn’t believe it; I had dropped down to 5.4% in just five months. It was the first time I felt like cheering, shouting from the rooftops or jumping for joy in a really long time; I called my mom and, without shame or embarrassment, let out a few tears of relief.
My family and closest friends were thrilled, but I won’t lie: Most reacted to my tighter chin and jawline, a shrinking frame and how I was drowning in my clothes. It was a weird disconnect for me, because no one immediately grasped that my relief came from narrowly escaping a future where I was doomed to inject myself daily to survive. I felt like I finally had my health under control and wasn’t in crisis anymore, a sense of euphoria that I could hold on to some semblance of freedom that I never fully realized I had until it was almost taken away — I wasn’t going to be bound to insulin shots.
Ozempic is not a vanity drug.
As time went on and I lost more weight, because of how Ozempic has been covered in the press and on social media, this disconnect only widened. I didn’t feel as if I could share my victory with others — in fact, I had a hard time discussing my journey with anyone.
The media and most social media users discuss Ozempic exclusively in terms of weight loss, who should have access to drugs like this and if they are really necessary at all — according to most, everyone should be able to diet and exercise their way to slimness, something that is not feasible for many people. For someone who is intimately familiar with the shame of being overweight in a fatphobic society, I was startled to see yet another stigma rise up around those who have had to turn to Ozempic and other GLP-1 medications (a class of type 2 diabetes drugs that have the potential for weight loss) to improve their health.
Even friends who I consider to be well-informed and well-meaning didn’t get it. When I disclosed to my first friend that I was on Ozempic earlier on, they leaned in and excitedly whispered some questions, like I had won some perverse lottery. Just after Christmas, someone I hadn’t seen in months crudely quipped about my body, their eyes narrowing above a sly smirk when I shared more about my injections. They mentioned they’d been watching TikToks about Ozempic (there are more than 568 million views on tagged content alone) and referred to a few common inaccuracies I’ve since seen floating around — it was clear they thought I had somehow gamed the system and cheated my way to a slimmer waist. I felt like I was owning up to a dirty, shameful secret as they drew their own conclusions.
That’s why I’m speaking out now. There’s a slew of misconceptions about how this drug works, why people need it and what it really means to need it, as opposed to wanting it. For the most part, people assume semaglutide gets you instant results, a silver bullet that reverses diabetes or, more annoyingly, drops 15 pounds in just a few weeks’ time — and the reality is far different.
Ozempic’s real job is to reinvigorate the pancreas.
Semaglutide is an injectable medication, known to doctors as a GLP-1 receptor agonist. It mimics a gut hormone called incretin, prompting the pancreas to naturally produce more insulin when blood sugar levels are high, something that the pancreas usually does on its own. Long before it was regarded as a so-called “miracle” drug, Ozempic attracted the attention of obesity medicine specialists after extensive clinical trials in 2017 revealed weight loss was a significant side effect of the medication. Since over 80% of those with type 2 diabetes are clinically obese, doctors were interested in how the drug seemingly tackled two birds with one stone — and would later craft the same drug in different doses to treat obesity alone.
I was prescribed Ozempic to help stimulate my pancreas to release insulin after I eat and my blood sugar increases. Even if I hadn’t lost a pound, a significant A1C reduction would have been an indicator that semaglutide helped my pancreas rebound from being overloaded due to uncontrolled diabetes — and that would mean Ozempic was a successful treatment for me, full stop. The fact that I lost weight (much of which is due to better habits) is a bonus.
So why do people also lose weight on Ozempic? In a roundabout way, in working to keep blood sugar levels consistent, it suppresses appetite. The drug physically slows down your digestive tract and the food leaving your stomach, which stabilizes blood sugar levels, explains Lakshmi Priyanka Mahali, M.D., an endocrinologist at Yale New Haven Health’s Northeast Medical Group. But the weight loss Ozempic produces has largely overshadowed the drug’s primary purpose. In clinical trials, the drug was also shown to reduce cardiovascular risk for patients who also had heart health issues, she says.
In short, Ozempic is used to stabilize blood sugar first, and doctors consider any weight loss an added benefit, if it was necessary in the first place, as not all those with type 2 diabetes are considered overweight.
“When I start somebody on Ozempic or another form of semaglutide, what I’m really looking for is an improvement to their blood glucose control,” says Beatrice Hong, M.D., an endocrinologist and diabetes and metabolism specialist at Duke Health, “Within three to six months, I’m looking to see a decrease in their hemoglobin A1C and to see a more stable pattern of blood glucose overall,” she says. “Those are the major metrics I look for to determine a patient’s success.”
Ozempic isn’t magic — I changed my entire life to help the drug work.
Semaglutide won’t lead to lower blood sugar or weight loss from weekly injections alone. If I had continued to eat an unrestricted diet full of added sugars, unhealthy saturated fats and processed, refined carbohydrates, my A1C would have stayed elevated, even with Ozempic’s help. And I certainly wouldn’t have seen any weight loss. I immediately met with a registered dietitian for in-depth sessions helping me tailor my diet to manage my diabetes, and continue to do so currently.
“When you look at studies that were done for [semaglutide use] in both obesity and diabetes, they were all in conjunction with lifestyle changes,” says Ruchi Mathur, M.D., an endocrinologist specializing in thyroid disorders at Cedars-Sinai Medical Center in Los Angeles. “Those clinical studies were all done with a calorie deficit of at least 500 calories a day, along with an exercise goal of about 150 minutes a week, plus monthly healthcare check-ins to ensure lifestyle was being optimized… Benefits are always achieved in conjunction with lifestyle changes, it can never occur without them.”
Overnight, I made a choice to adopt a lazy keto-style diet to lower my blood sugar manually. I cut out things that I normally loved to eat — white breads, refined pastas and noodles, starchy potatoes, processed frozen and boxed meals, chocolates and candies, a myriad of sauces and condiments that sneakily contain sugar. I turned away from fried foods and took in lots of spinach, strawberries, avocado and tons of almonds. About three months in, I landed on a modified Mediterranean diet, incorporating a bit of beef and leaner cuts of pork; I have just a few cocktails each month and a rare piece of dark chocolate.
I also must wear a continuous glucose monitor to ensure anything I eat doesn’t impact my blood sugar control. My closest friends watched me obsess over multiple scans of my upper-arm monitor before and after meals, sometimes checking upwards of 30 times a day, during the first few months.
Ozempic doesn’t make eating this way any easier. As your body becomes accustomed to semaglutide, satiety gradually weakens, and I still fight things like cravings.
In short, if you want to lose weight with Ozempic, you have to do all the things people do without it. “Whether you’re thinking of medication or surgery as your avenue for [obesity] treatment, one pillar that contributes to success is diet… and that’s a loaded word,” says Todd Worley, M.D., FACS, an obesity medicine specialist and bariatric surgeon at Houston Methodist Hospital in Texas. Dr. Worley spends considerable time educating patients about common denominators in nutritional building blocks: Turning to leaner sources of protein, healthy fats, increasing consumption of fibrous vegetables and prioritizing complex carbohydrates.
“People just have this sort of false notion that [Wegovy] will be magical, or there’s some mystical aspect to it that just doing that one injection will help them lose weight,” he posits. “We have to think about weight loss with a more integrated approach; it is rarely just one thing or one tool that helps people be successful in managing obesity.”
If I don’t keep exercising, I’m in trouble — and Ozempic won’t save me.
For decades, doctors coached me on what seems a million different ways to become any semblance of active. Nothing stuck for me, and I never even came close to hitting well-established recs of 150 minutes per week. But when my doctor spoke to me about how movement would fortify my body’s efforts to lower drastically high blood sugar — something that all patients starting Ozempic are educated about — I found new motivation.
In order to get the most effective results, on Ozempic as well as Wegovy, becoming active is a must — and Dr. Worley works to ensure his patients embrace this as a new lifelong habit, even if semaglutide is eventually out of the picture. “It matters how active you are. And if that means, at first, you take more walking meetings or you start standing some, that’s a start,” he says. “[I consult patients on] how we can figure out to be more active in where they are at, to build a habit of starting small, just to start to build in that you make time in your life for activity.”
In my first four weeks of Ozempic treatment, I pushed myself to get up five days a week and walk just one mile, something I stopped doing during the pandemic. I rallied against chronic back pain, soreness, and terrible shin splints. But I noticed within a week that my blood sugar levels were staying steady and within range, even after meals, after a workout. And because I was scared that I would lose that edge if I let up at all, by week six, I had convinced myself to work out every single day of the week. By December, five months after starting Ozempic, I began jogging. Now I belong to a gym and weight train as well.
My doctor cautioned that I was in a marathon, not a sprint. Dr. Worley has the same conversations with his patients. “The thing to think about is how do we set a foundation so that we make these changes, a new lifestyle, better health and yes, weight loss, more durable?” he adds.
Despite what you’ve heard, Ozempic doesn’t guarantee weight loss.
GLP-1 agonist injections can use marketing language that zeroes in on weight loss; Ozempic specifically features consultation materials that suggest patients could lose “up to 14lbs” while taking the drug. Wegovy highlights upwards of 15% net weight loss. But what people fail to grasp is that diet and exercise contributed extensively to these figures.
“What they’re basing [weight loss figures] on are studies that were done over the last few years by the company that makes the drug,” Dr. Mathur at Cedars-Sinai explains, citing one in particular that was published in the New England Journal of Medicine in 2021 which included data from nearly 2,000 obese patients in clinical trials.
“In conjunction with exercise and dietary changes, which they refer to as lifestyle intervention, researchers noted an average weight loss between 13 and 15lbs, and that’s where these figures came from… But that’s in a study situation. That’s when you’ve got personnel that are calling these patients, encouraging them. That’s not real world [results]… Some people will lose very well on this drug and other people, not so much.”
Ozempic’s side effects are no joke.
Much of the hype around Ozempic last fall was quickly followed by accounts that highlighted the nature of 10+ potential side effects tied to semaglutide, some of which can be chronic and unyielding. Even those with diabetes, who found that Ozempic successfully tamed blood sugar levels, put up with nausea, vomiting and abdominal pain, and commonly, either diarrhea or a total blockage in firm constipation. Semaglutide may also lead to pancreatitis, some forms of kidney failure or thyroid tumors in some. Stories of people dealing with dire hospitalizations stemming from incessant vomiting or even heart failure became commonplace in most reports. Most patients experience the worst symptoms as dosages are initially ramped up, with your gastrointestinal tract beginning to slow down, Dr. Mahali explains.
The symptom that caused me the most pain was constipation. Within five days of my first dose, my digestive tract slowed to a crawl, and I simply couldn’t go. Almost four days went by before I woke up one morning with crippling pain in my lower gut – it took an hour on the toilet to relieve myself. I suffered a tear in my rectum that had me lying on my stomach for the next 18 hours, crying in pain.
For the first few weeks, I was so nauseous that I wouldn’t eat normally for up to 2 or 3 days afterward, skipping meals altogether. Even now, after being settled on a 1mg dose for over four months, I still feel sore after injections for at least 12 hours. My constipation eventually swung in the opposite direction and stayed there — I had severe diarrhea that lasted on and off for two weeks each time I changed my dose, per my doctor’s directions. Dr. Mathur says my experience is typical.
As bad as my GI distress often is, I chalk this all up as an inconvenience; the drug has helped stamp out high blood sugar and has helped me lose weight. It’s a price I’m willing to pay, especially knowing I will likely regain weight if I stop cold turkey.
I may be on Ozempic for life.
Patients can indeed get semaglutide prescribed off label, especially if they’re able to pay for it out of pocket. But rarely do people realize doctors keep those with diabetes or patients with obesity on the drug for many years to avoid rapid weight regain, among other reversals. There isn’t a short-term use for Ozempic or most semaglutide products on the market currently, and patients won’t be asked to stop using the medication unless the side effects are unbearable for them.
“[Semaglutide] is a long-term therapy, because you’re going to lose the benefits once you stop the medication,” explains Dr. Mahali. “That’s expected because we are not curing obesity or diabetes; we’re just treating it with this medication… Your body will go back to where it was [after you stop] because we didn’t cure anything, we just treated you.”
Meaning, if you get on Ozempic or even Wegovy for one reason or another, you should expect to stay on it in some fashion — or you’ll likely regain any weight you’ve lost. This is especially true for those who don’t adapt their lifestyle in any shape or form.
“There’ll be patients that need to continue [semaglutide injections] at the same dose indefinitely,” Houston Methodist’s Dr. Worley adds. “Will there be patients that need to continue at a lower dose, or switch to a different medication? Maybe.”
The weight loss hype is making it hard for those of us who really need Ozempic to get it.
Nothing (including side effects!) has disrupted my life more than the monthly hunt I go on for Ozempic. In August 2022, when I filled my prescription for the first time, my neighborhood CVS called to let me know they were out of stock. Not knowing just how expensive Ozempic was, I asked them to transfer my prescription to a different chain nearby. When I was presented with an initial $450 co-pay at the counter, I started to cry in earnest; no one had briefed me on the cost, and I soon learned I wasn’t getting the best price because this pharmacy wasn’t my preferred provider.
I spend three to four hours on the phone with several CVS pharmacists looking for a dose, because I can’t afford to go outside the CVS network. Most locations are perpetually out of Ozempic, which is something I don’t find out until I am due for my refill. That means I have to scramble, spending hours on public transport — twice to a Bronx pharmacy an hour away near Yankee Stadium, once to Roosevelt Island via a cable-car tram — to find what I need. I have pleaded with pharmacists in hysterics, 6 hours from missing a tightly scheduled dose. This is the reality for many others who are on Ozempic.
Why the shortage? There are several reasons. The medication’s manufacturer, Novo Nordisk, had previously indicated it was experiencing Wegovy supply issues in 2021. That prompted people to seek out Ozempic (a lower dose of the same drug), via off-label prescriptions. This led to a shortage in 2022. Most believe that the use of Ozempic off-label for its weight loss benefits alone is what is prompting more Americans to seek it out, leaving less availability for those with diabetes. But others say a persistent supply issue across the globe, partially prompted by the pandemic, was a key reason why a social-media-fueled fad exacerbated an already low supply.
In a statement to Good Housekeeping, Novo Nordisk said that supply levels for its 1mg and 2mg Ozempic pens have stabilized, aside from “supply disruptions” for the starter dose injections at .25mg and .50mg that are expected to resolve this month. Wegovy, meanwhile, has fully recovered from supply shortages, the company says. “Keeping supply stable is a priority; we will closely monitor prescribing trends and phase promotional efforts as we assess demand,” the company’s statement reads.
“While we recognize that some healthcare providers may be prescribing Ozempic for patients whose goal is to lose weight, Novo Nordisk does not promote, suggest, or encourage off-label use of our medicines and is fully committed to fully complying with all applicable U.S. laws and regulations in the promotions of our products. We trust that healthcare providers are evaluating a patient’s individual needs and determining which medicine is right for that particular patient.” — Novo Nordisk
In California, where experts say the semaglutide shortage is at its most rampant, Dr. Mathur says she’s worked with colleagues at Cedars-Sinai to create a protocol for patients who need the medication to continue to keep blood sugars stabilized. This includes strategies like sending patients to pharmacies in Canada: “Patients that have diabetes… they are the top priority to get the drug right now, and we’ve had to strategize a little bit.”
Social media hot takes and Ozempic tabloid coverage adds to fat shaming.
As fall turned into winter, tabloids went from glorifying celebrities’ hush-hush use of semaglutide to highlighting how social media users “accused” them of using some sort of undeserved shortcut. Public statements made by celebrities created even more stigma around Ozempic and weight loss medication in general. Meghan McCain wrote she was horrified when her doctor said “one injection, once a week, for a cool $1,000 a pop” could “just melt the pounds away,” a mischaracterization that captures the essence of what many think. I watched as Kyle Richards of Real Housewives fame painstakingly detailed her fitness routines and diet to illustrate that she wouldn’t dare use Ozempic in this way; that she would never “take the easy way out,” as she told People. Fellow Bravolebrity Jackie Goldscheider referred to the drug as an “eating disorder in a needle” and Khloé Kardashian claimed people were “mean” because they were discrediting “years of working out” when they accused her of using Ozempic.
The message? Ozempic is essentially “cheating” and if you can’t lose weight solely through lifestyle changes, you’re not trying hard enough — you deserve what you get.
This fuels the idea that anyone who uses Ozempic to get their health in check aren’t doing it the “right” way, reinforcing stereotypes that people who are obese don’t pay any attention to their diet or exercise; and more damagingly, that overweight individuals like me don’t have the discipline to change things on our own.
If there’s one thing that I hope my family, friends and peers take away from my diabetes journey so far, it’s this: I have never demonstrated this much restraint, patience and dedication toward my physical health. In fact, as of this writing, my A1C has remained steady at 5.5% and I’m down 64lbs in total. Patients who see success on Ozempic, or other options like Wegovy, have to adopt the same determination and work just as hard as anyone else must to actually get in shape.
In short: I worked my ass off to get here and I still have a long way to go.
I do it happily, though, because I have spent decades trying to get where I am now: In a healthier way of life. Like many who have turned to semaglutide, I feel lucky to have Ozempic — it seems like my last hope for real change. And if you truly value and cherish your friends and family who have struggled with their health and weight, you’ll realize just how much they’ve invested in themselves — and recognize it’s a lot deeper than before and after photos on Instagram.
Zee Krstic is a health editor for Good Housekeeping, where he covers health and nutrition news, decodes diet and fitness trends and reviews the best products in the wellness aisle. Prior to joining GH in 2019, Zee fostered a nutrition background as an editor at Cooking Light and is continually developing his grasp of holistic health through collaboration with leading academic experts and clinical care providers. He has written about food and dining for Time, among other publications.
Rekha Kumar, M.D. is recognized as an international leader in the field of obesity medicine. She is a practicing endocrinologist in New York City and served as the former medical director of the American Board of Obesity Medicine. Dr. Kumar has lectured internationally on the topic of the medical assessment and treatment of obesity. She has published several papers and textbook chapters in her field and serves as an associate editor of the journal Obesity. She is frequently quoted in the media on topics ranging from the diabetes epidemic in the United States to discussing fad diets, exercise trends, and the complications of Covid-19 in patients with obesity. Dr. Kumar’s areas of expertise include the clinical assessment of patients’ obesity and metabolic syndrome, the effect of obesity on reproductive health and fertility, as well as thyroid disease, and metabolic bone disease.
Dr. Joshua J. Joseph is an assistant professor of medicine at The Ohio State University Wexner Medical Center in the Division of the Endocrinology, Diabetes and Metabolism. Dr. Joseph is a 2023 Castle Connolly Top Doctor and is co-chair of The Ohio State University Wexner Medical Center Obesity and Nutrition Steering Committee. Dr. Joseph’s clinical focus is the prevention and treatment of obesity, type 2 diabetes and cardiovascular disease in people and populations made vulnerable due to the impacts of the social determinants of health. You can learn more about him and his latest research on his website.