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Ozempic, the trade name for the medication semaglutide, wasn’t designed to be a diet drug. It was initially a treatment to help Type 2 diabetics manage their blood sugar levels.
But its side effect of weight loss has led to a massive surge in popularity, with the Therapeutic Goods Administration (TGA) describing a worldwide shortage last November.
Ozempic works by mimicking the GLP-1 hormone that is released in response to eating, and can reduce appetite and signal a sense of fullness.
It’s one of a plethora of drugs that, from the early 20th century to today, has been touted as a revolution in weight loss.
But often they’ve put consumers’ health at serious risk.
‘Our bodies are not trends’
New York Magazine journalist Matthew Schneier has written about the rise of Ozempic in the United States.
“This is really the first major weight loss drug in the age of social media,” he tells ABC RN’s Rear Vision.
In 2022 billionaire Elon Musk went online to credit his weight-loss to Ozempic, the Australia-registered version of which is subsidised on the Pharmaceutical Benefits Scheme.
Indeed, studies show semaglutide helps 66 to 84 per cent of people who use the drug to lose weight, making it more effective than other drugs on the market.
But, once the injectable drug is stopped, patients notice a gradual regain of up to two-thirds of the weight they lost.
So, semaglutide works only while taking it.
Mr Schneier thinks the drug’s popularity suggests that the body positivity movement is not as strong as we might like to believe.
“People want to be inclusive and supportive of all body types but they don’t necessarily want that body type for themselves,” he says.
But body positivity advocate Jameela Jamil points to the power of external influences, like social media, where she says there’s been a “normalising” of Ozempic as a weight-loss drug.
“We tried this in the 90s and millions of people developed eating disorders,” she said last year.
“We’re not doing this again. We’re not going back. Our bodies are not trends.”
Meat packers pivot to diet drugs
Before it was capitalised upon by Western fashion trends, weight — specifically obesity — was recognised as a public health issue, beginning earlier than you might think.
Historian Nicolas Rasmussen says being overweight was noted as a factor predicting reduced longevity before 1900.
“The major [insurance] companies began pooling data when analysis of large data volumes became feasible … [and] all found very clearly that being overweight shortened life span,” says the author of Fat in the Fifties: America’s First Obesity Crisis.
The search was on for treatments.
Endocrinology, a new field of medicine looking at problems caused by hormones, emerged in the early 1900s and began focusing on drug treatments for weight loss.
The idea was that being overweight could be connected to a gland problem or sluggish metabolism.
One of the earliest drug treatments for weight loss was thyroid hormones, and soon thyroid powders and animal gland extracts became popular.
It was an open opportunity for a new industry ready to pounce.
Ordinarily, animal glands from abattoirs would be ground up and used in low-grade applications like fertiliser.
But if used to make a drug, animal glands were worth a lot more.
Laura Dawes, a historian of modern medicine at Australian National University, has written about the history of these drugs in the book, Childhood Obesity in America: Biography of an Epidemic.
Dr Dawes says meat packing companies began setting up subsidiaries “which were essentially drug companies”.
But using gland extracts from animals came with a range of potential side-effects, like heart palpitations, increased blood pressure and anxiety.
Consequently, thyroid hormone was removed from non-prescription use in 1938, but it remained as a prescription slimming therapy for adults for much longer.
The rise of rainbow pills
By the 1950s, the weight loss industry had expanded to include special weight loss clinics, which became widespread in the United States.
These clinics were known for offering so-called “rainbow pills” primarily to women.
“[These were] brightly coloured pills that would typically contain thyroid [hormone] and amphetamines and then other drugs to counteract their unpleasant and dangerous side effects,” Professor Rasmussen says.
For example, barbiturates were prescribed to counter the jumpiness and insomnia that people on amphetamines would typically experience.
The drug digitalis was thought to help correct the heart irregularity that thyroid hormone can produce.
But by the 1960s, these weight-loss clinics and rainbow pills were coming under closer scrutiny.
Professor Rasmussen says there had been some high-profile deaths of young, slim women who were prescribed these pills and later died.
In 1968, Life Magazine reporter Susanna McBee decided to go undercover to learn more about the industry. She later wrote about her damning experience.
Ms McBee was a slender woman who, over six weeks, visited 10 weight loss doctors, expecting them to “bounce her out” of their clinics.
She was wrong.
“Although three of them said I had no weight problem and another even congratulated me for catching the problem … before it developed, they all, every last one of them, gave me diet pills,” she wrote in her exposé.
Professor Rasmussen says Ms McBee found the unscrupulous industry was “drugging women to take advantage of their body insecurities”.
Her investigation had an impact. The same year it was published, the US Food and Drug Administration (FDA) began removing rainbow pills from the market.
A deadly quick fix
The search for a miracle diet drug took another tragic turn in the 1990s with the arrival of the infamous weight loss treatment Fen-Phen.
It was a combination of two readily available diet drugs: fenfluramine and phentermine.
Michael Cowley, professor of medicine at Monash University, says Fen-Phen was an example of off-label prescribing.
“The label refers to what the company and regulators have agreed the drug is for. But a doctor has the right to prescribe whatever they like for the benefit of their patient.
“This combination of drugs showed dramatic weight loss results in a small sample but [this] was never evaluated in a clinical study,” Professor Cowley says.
Then, in 1997, two separate studies appeared in the New England Journal of Medicine linking Fen-Phen to several serious and potentially deadly side effects.
“It caused damage to the heart, which could cause pulmonary hypertension, which is catastrophic in some patients,” Professor Cowley says.
“It took many years for the cases to become evident and it destroyed lives.”
In Australia fenfluramine and phentermine are approved drugs, however they were never widely prescribed in combination.
The need for evidence and careful thinking
Ozempic is among the latest in a new class of medications, with new and more potent drugs in development.
It’s too early to know the precise likelihood of risks, but questions surrounding semaglutide have been raised, including around the risk of pancreatitis, and thyroid and pancreatic cancers.
Vivienne Lewis, a clinical psychologist and assistant professor at the University of Canberra, says while weight loss drugs can be useful in some circumstances, there is a combination of factors to consider when it comes to weight loss — including psychological ones.
“If you don’t address those [psychological factors] and you just give the person drugs for weight loss, then as soon as they go off those drugs the weight just comes back,” she says.
“So really, the first line of call has to be, okay, what’s behind this person’s obesity? Is it their metabolism, is a medical issue, is it a psychological issue? … Or do they have some sort of eating disorder?”
“And if you don’t actually address those issues, you don’t solve the problem.”
Dr Lewis says the first port of call in seeking help for weight management is a GP, who can refer on to a clinical psychologist or other specialist.
“The first line of call should not be to give someone medication,” she says.
Dr Lewis believes there are drugs that can be effective in treating weight loss.
“[But] not addressing the root cause of why someone is putting something in their mouth” means weight loss “is not necessarily going to be sustainable and it’s not necessarily going to solve the problem”, she says.
“It’s when a person is really well educated and understands the pros and cons of the medication, and also the psychological reasons why they eat — I think when someone follows both of those, then they can achieve longstanding success.”
Please note the information in this article is general. Before making health decisions, consult a medical practitioner for individualised advice.
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