Ozempic. Wegovy. Mounjaro. They’re all over the headlines, at least in my health-and-wellness-heavy algorithm. Semaglutide agonist drugs have taken the world by storm as the miracle of the weight loss world, touted to possibly be the cure to the world’s obesity crisis!
As a chronically and clinically obese 44 year old woman with a current BMI of 34, these magic pills (or injections, whatever!) certainly are tempting. I have been on a weight loss journey for over 3 decades and at the time of writing and have 63 pounds to lose in order to break into the “normal” category. That’s almost 28% of my current body weight.
I’m still not planning to do it, at least not yet. I support any and all who weigh the pros and cons for themselves and find more in the pro column. At this time, the juice is simply not worth the squeeze for me, and I’ll tell you why:
Lean Loss = Fat Loss?
Studies show there is a greater proportion of lean mass loss than fat loss as compared to other weight loss approaches. In typical weight loss interventions, there is always some percentage of lean mass loss along with fat loss. Generally, the accepted ratio of fat loss to lean loss is about 2:1. According to Dr. Peter Attia, the ratio with semaglutide is 1:1, and the studies I looked at seem to show 1.6:1.
As a woman in perimenopause, when sarcopenia or deterioration of lean body mass tends to progressively increase, this is SCARY to me. I monitor my body composition with pretty regular DEXA scans, and my most recent ones are already showing slight decreases in bone density & lean muscle mass despite the fact that I have not toned down my resistance training or physical exercises that are known to be osteogenic, or bone building.
Some of this may be already be on its way to being remedied now that I have started using bioidentical progesterone cream, and progesterone supplementation/HRT has been proven to fight sarcopenia – but WHY would I take a drug that would enhance sarcopenia instead? I’m hoping I have another 66 years left on this earth at a minimum, and I’m going to need every ounce of healthy muscle & bone mass I can maintain to make it a fun ride!
Threats to Income & Quality of Life
The common side effects don’t currently fit in with my livelihood. I am a chef. My focus is on special diets and nutritional healing, so what I make for my clients and eat myself is generally 95% whole food ingredients, anti-inflammatory, nutrient-dense – and I am really happy with it! I love cooking, eating, and delivering deliciousness to every dish I make – which requires a fair amount of tasting.
You know what kills the joy of tasting? Nausea.
You know what interferes with preparing a dish in an efficient manner? Diarrhea and/or vomiting. You can’t make sure something doesn’t burn on a stovetop if you have to continuously run to the bathroom.
You know what else would detract from the attention to my job? Stomach pain, not only because pain in itself is distracting, but also because I go into an anxiety spiral when I’m in pain, freaking out that I’m dying. (It’s the product of having had a triage RN for a mother & having higher anxiety levels than ever before thanks to newfound hormonal fluctuations.)
Nausea, diarrhea, vomiting, and stomach pain are listed as the most common side effects ON THE OZEMPIC WEBSITE & DRUG INSERT. No thanks! These are common to all of the semaglutide drugs.
Cost Benefit Analysis
Speaking of my livelihood, to continue the beneficial effects, it is currently understood that you have to stay on the medication indefinitely and it’s EXPENSIVE. While my BMI might qualify me for a prescription, I have ZERO comorbidities, so insurance likely would not cover semaglutide. And $1200 a month out of pocket, if it’s even available, doesn’t make sense to me. There are too many other things outside of my already substantial life expenses that I would rather spend my money on, like activities with friends, travel, self-care, cultural experiences, and crazy stuff like saving for retirement.
We need to ask ourselves – is this weight we’re carrying REALLY detrimentally affecting our quality of life? For me, the answer is no. It’s not inhibiting my ability to move, my metabolic/cardiac/lipid numbers are on point, my mental/emotional health is strong, and my fitness level measurements are ever improving. While I would like to subjectively “feel better” and more confident wearing a bikini, that’s a mindset issue, not an actual physical problem.
There Are No Guarantees It Will Actually Work
Another factor that has me personally saying no to semaglutide is that I have watched it NOT work for some of my clients. If you do a Google search about semaglutide NOT working, you will find plenty of other people talking about it online. Now, there is a possibility that the people for whom it is not working aren’t “doing the work”, but semaglutide is hailed as something that’s supposed to make it EASIER to do the work! At this time, risking this NOT working would be a bigger blow to my joie de vivre than continuing along as steady as I am.
No Long Term Studies
Finally, there really are no long term studies on these drugs. For a pharmaceutical that as previously mentioned would only be about vanity and not actual health increases for me, that matters.
These are not the first “miracle weight-loss drugs” to come on the market.
All the way back in 1934, DNP was introduced as a rapid-fat-loss drug and openly prescribed until 1938, when due to the sheer number of deaths, it was banned. While it did successfully “burn fat”, the corresponding increase in body temperature caused severe rashes, blindness, and organs being “cooked” within the human body.
In the 1940’s, amphetamines as weight loss aids started their bumpy ride in the pharmaceutical market – with virtually every new iteration getting banned after a relatively short period of time. Phentermine is the last man standing – with very long lists of both precautions, unpleasant side effects, and strict consumption guidelines indicating that use WILL result in physiological dependence.
The 1960’s ushered in the advent of the HCG diet, a 500-calorie-per-day diet plus weekly shots of pregnancy hormone. There are actually STILL people who do this – even though there are comprehensive studies that prove: it’s not the shots – it’s the extremely low-calorie diet that result in the weight loss, so much lean body mass is lost that it has detrimental effects on the heart muscle, and it lowers resting metabolic rate (how many calories your body burns at rest) possibly irreparably. The peers I know who have tried it have *all* regretted it. Not a single friend who has tried HCG has recommended it.
1999 brought orlistat, aka Xenical and Alli – that comes with a “you might poop your pants” warning among others.
2000 welcomed Belviq – which after 8 years was pulled from the market due to higher incidences of cancer associated with the drug.
Now, semaglutide came on the market for diabetics in 2017, which does give it a bit of a longer lifespan for studies – but they’ve thus far only been on diabetic patients. A year after withdrawal, the vast majority gained back over 2/3 of the body weight they had lost – and remember, they are likely still on diabetic medications. There are no long term non-diabetic weight loss studies.
It makes more sense to me at this time to sit back, wait a few years, and watch what happens to the brave souls who have offered themselves up as tribute while I continue plugging away at my goals with less expensive, less invasive, more fun methods.
Making the choice about whether or not semaglutide and/or tirzepatide is right for you is a personal choice and I am absolutely not bashing anyone who has chosen this path. I just know it’s not right for me right now, though I do reserve the right to change my mind in the future.