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Unknown Speaker: With my Ozempic Tri-Zone, I lowered my A1C--

David Remnick: At the Oscars recently, Jimmy Kimmel had a line about a drug that seems to be coming up a lot these days.

Jimmy Kimmel: You look great. Everybody looks so great. When I look around this room, I can't help but wonder, "Is Ozempic right for me?"

David Remnick: To listen to some people talk about Ozempic you'd think we're walking into a sci-fi future of universally trimmed bodies all achieved without sweat or tears. If you turn your brain back on, you'll think it's probably a lot more complicated than that. Staff writer Jia Tolentino has been reporting on the use and misuse of Ozempic and what it says about our relationships to our bodies today. Jia, let's start with the drug itself. Let's start with Ozempic. What is it supposed to be used for and what is it actually being used for?

Jia Tolentino: Ozempic is part of this relatively new class of drugs called GLP-1 agonists. They have existed in some form since 2005, so they're not totally new but they're fairly new. Ozempic was first approved in 2017 as a treatment for type 2 diabetes. It's a substance called semaglutide. The same substance was approved as a treatment for obesity under the name Wegovy in 2021.

David Remnick: How does it help you lose weight because that's what we're hearing about? We're hearing about Ozempic as a weight loss drug now.

Jia Tolentino: These drugs, these GLP-1 agonists, the reason that they help people lose weight is because they replicate a hormone that our body produces naturally called glucagon-like peptide-1, and this hormone, to oversimplify it just a little bit, what it does, our body produces it after we eat. It lowers our blood sugar, it balances our blood sugar, lowers it, and it also produces the feeling of satiation.

David Remnick: It makes you feel full.

Jia Tolentino: It makes you feel full, which is one of the reasons people, quite simply, they can't eat as much. One doctor that I spoke to compared it to a turkey dinner in a pen.

[laughter]

David Remnick: How come I never heard of it a year ago, and now I hear of little else?

Jia Tolentino: One of the things that has made the Ozempic conversation a little bit confusing and misdirected is that the most prominent users of it are celebrities who don't ostensibly need it. We all heard about it probably for the first time through reports of celebrities that had suddenly lost like 40 pounds and were posting bikini pics but saying that it was just because they worked out a lot. It became this big thing in the popular consciousness because of how skinny all these celebrities were suddenly getting and how people were talking about there was this miraculous hormone shot that you could get and suddenly you would be skinny. Which I think is a pretty significant representation of what, A, what the drug actually entails, and certainly, as you were noting, what it's actually meant for.

David Remnick: Ozempic is not something you can take as a pill, it's an injection?

Jia Tolentino: No. Despite all those jokes of everyone's doing Ozempic in the bathroom at the Oscars, there is a version of a type of drug like this that can be taken via pill but most of them, it's a weekly injection, and crucially, these are drugs that were designed and intended for lifetime use. Obesity and type 2 diabetes, they're considered chronic conditions. They were designed for effectively weekly injections for the rest of your life to control your weight or your blood sugar. I think that signifies they're not meant for casual use. They're not meant to go on it and go off of it. They're meant for people who are experiencing weight or blood sugar-related health issues significant enough.

David Remnick: If you're 10 or 15 pounds overweight and you want to get down to what you think is your ideal weight, however wise or misbegotten that might be, if you think Ozempic is going to do the trick, how would you counsel them after the reporting you've done?

Jia Tolentino: A lot of friends have asked me in reporting this piece-- because the thing is also it's quite easy to get this drug.

David Remnick: Consider me one of your friends on this. [laughs]

Jia Tolentino: Yes. I've noticed from your text messages, you seem to be quite interested.

David Remnick: Exactly, because I'm sick of the gym and I want to eat a bagel once in a while.

Jia Tolentino: Exactly. Also the thing about this, you might not be able to eat a bagel. There are wild side effects that you get from messing with your most fundamental metabolic processes. People vomit and get diarrhea so bad it sends them to the ER. It's not--

David Remnick: From Ozempic, you can get that?

Jia Tolentino: Yes, because, basically, you know how after bariatric surgery you hear people really can't eat the same way that they used to. They'll get quite sick if they eat any more than a really small amount. The same is true for Ozempic and very specifically if you eat anything fatty or highly caloric, you will get physically ill. It's not the kind of thing where you get a shot and you eat as much as you want forever. You'll actually get quite sick if you do that.

What I would tell my friends is, A, there is no large-scale safety data. These drugs have not been tested in large numbers in people who do not have obesity or type 2 diabetes. Another maybe more pragmatic thing is that clinical trials show as these drugs were intended for lifetime use, once you stop using them, the weight does come back on. You're supposed to get blood work every three months to make sure that your kidneys and pancreas and gallbladder haven't failed you and you have to get them removed. It's not like something that came up so often, people would be like, "Should I take it? Is it good or bad?"

David Remnick: Exactly.

Jia Tolentino: It was like it's like any technology, it's very complicated. For some people, this drug might save their lives, and for others, it just does not make sense to me to use in any casual way.

David Remnick: Jia, you write a lot about the Kardashians in your piece. How did they get to be part of this story?

Jia Tolentino: I think it is an undeniable fact of our contemporary reality that the Kardashians have been-- I think I use this phrasing in the piece. They're like the weather veins of how the winds of the beauty standard are blowing. I think that, one, that they are rumored to have been early adopters, certainly has not been confirmed, but they were some of the earliest celebrities to just prominently-- they had been famous for a certain kind of body that had become the social media beauty standard. They had been known for a look that was significantly curvier, and they just started shrinking at some point in the last two years. A lot of other celebrities have also shrunk. This is when the drug started to seep into the popular consciousness and people were like, "What is going on?"

David Remnick: Isn't that crazily unhealthy in all manner of speaking, whether medically or psychologically? It just sounds very dangerous.

Jia Tolentino: One of the things that initially piqued my interest in this phenomenon of this drug being misused as a vanity tool was that I was a preteen adolescent in the era of Lindsay Lohan and Paris Hilton and Nicole Richie when everyone was looking very, very skinny. It had wild psychological effects on girls my age. It was normal to do extremely disordered things to your body because you wanted to be skinny.

Unknown Female: You look really skinny, I have to tell you. You look really skinny.

Unknown Female: Of all the skinny minis in Hollywood, Nicole Richie could be the most shockingly thin of them all.

Unknown Male: Much of that attention is thanks to her new slimed down look. Lindsay says that's just her unless it isn't.

Unknown Male: You look good to me.

Lindsay Lohan: Thank you.

Unknown Male: You have trimmed down. Is that just because you want to get in shape?

Lindsay Lohan: I'm growing up. I'm learning about eating healthier and working out and just taking care of myself.

Unknown Female: When we look at you we don't see a model. As much as I hate and preach about models not having to be stick skinny, we have to face it that we are in the fashion industry. If you don't fit the clothes, you don't work.

Jia Tolentino: In the last couple of decades it had seemed that the dialogue had developed past that. That there was lots of talk about fat acceptance and body diversity and health at every size and stuff like that. That the single-minded desire to be thin as the only aspirational vision of what a female body could be, that that was just deeply, deeply unhealthy as you said physically, psychologically, and every way, and now it's back. It's back and a lot of the language around it still revolves around wellness. These factors are very confusing right now. That was part of why I wanted to write about this.

David Remnick: Jia, with all these people snapping up this drug supposedly to drop a few pounds, how is that affecting the people who need it for chronic disease?

Jia Tolentino: One thing about these drugs is that they are still really expensive and out of pocket, they can cost upwards of a $1,000 a month. You can get them from compounding pharmacies for cheaper. That's a bit of a complicated issue. You're not getting the exact same thing that comes in the Ozempic pen or the Wegovy pen. Anyway, to get these drugs covered by insurance is a bit of a hurdle. Insurance companies don't like to cover it because it's, again, expensive.

There are stories all over the internet, people would just-- their insurance plan would just suddenly stop covering it. I think that's part of what has made the focus so intense on the celebrity usage of it or the ostensible celebrity usage of it that it can be instantly available to someone that has a $1,000 to pay out of pocket every month just because they want to look skinnier in photos.

David Remnick: You did an experiment where you tried to get Ozempic from two different compounding pharmacies, as you mentioned. How difficult was it to get them?

Jia Tolentino: It was terribly easy to get. I wasn't getting name-brand Ozempic. I was getting semaglutide, which is the ingredient in Ozempic, and it was compounded slightly different. I did want to see how easy it was to get because a lot of the people who will be taking this drug for vanity purposes will go the route of getting it as cheaply and under the table as possible. I wanted to see how easy that actually was. I made an account on this telehealth website, put in my real height, and then a weight that gave me a BMI of 30, which is the clinical cutoff for what's considered obese.

Within 60 minutes, I got a DM full of emoji back from a nurse practitioner that she was dying to give me semaglutide and could give it to me at a great price. I had assumed that I might have a Zoom call or I might have to provide some documentation that that was actually my height and weight. No such thing. I placed the order for this pharmacy in Florida. I got this box. This cardboard box two days later full of syringes. I can literally show it to you right now. It's on my desk. It was alarming how easy it was to get.

Then I figured I would say okay, I was like, "Let me see if I can get it without lying about my weight." I tried another clinic with an office in New York and I entered my real weight and I'm not overweight at all. I'm pretty small, and I just said, "I had a baby in 2020 and I want to lose 15 pounds." They were like, "Amazing. We can get you enrolled right away."

[laughter]

Jia Tolentino: I was like, "Damn." I was like, "Okay, do I have to go see the doctor? Do I need to do blood work?" Because essentially I should be doing all these things. There are plenty of places that are prescribing responsibly to the people that meet the criteria, but it was shockingly easy to get as someone who doesn't.

David Remnick: Let's forget for a second about people who want to lose 10 pounds or something like that. On the much more serious side, we have changed how we think about or talk about fatness, and rightly so. At the same time, there's a very high rate of obesity, as you mentioned, which for a lot of people is not healthy. What is the sane medically sound way to think about weight loss for people who really do need to lose weight?

Jia Tolentino: I think that's something that seems clearly important is that weight is not used as a one-to-one signal of whether you're healthy or not. There have been plenty of studies that show that people of a "normal weight" a significant amount of them will be metabolically unhealthy. A pretty significant portion of people who are technically overweight or obese will be perfectly metabolically healthy too. There are other criteria like level of fitness and what you eat that are actually much better predictors of whether you're healthy at whatever weight you are.

I think one of the important things is to separate being overweight and being automatically unhealthy, which is still something that many doctors believe despite plenty of research that shows otherwise. I think that when you are asking what is the sane way to think about these drugs within the extremely complicated landscape of body politics, the first thing I would say is what we hopefully won't see is that the advent of these drugs that can make people lose weight very drastically and rather quickly, I hope it doesn't close down the discourse about all of that. About health being possible at every size, all of that stuff.

David Remnick: Absolutely.

Jia Tolentino: Then also I hope that it opens up for people who are actually dealing with serious weight-related health problems. I also hope that there is not a stigma against them using these drugs. There's a certain amount of stigma that's they're taking a "shortcut". I think that that framing is based in the idea of thinness is something you're-- a moral state you're supposed to struggle for. Like a protestant work ethic idea that thinness is the state of salvation that you're supposed to crawl on your hands and knees towards. For plenty of thin people, they're just thin and life just works that way. There's no reason why people should not use this tool if they have a medical reason to, and they think it's a good idea.

David Remnick: What I glean from your piece is that the doctors and medical professionals that you talk to think that the ideal direction here is that it will still be used for the people who need it, but this business of it as a fad is highly dangerous, seems to be still growing, and they hope that it'll burn itself out at some point.

Jia Tolentino: I think people are hoping that the vanity use case burns itself out. I don't think that it will. I don't personally think that it will, and that is really worrying to me. I do think that as time goes on, I am hopeful that more and more people will understand it's not a casual thing to mess with your metabolism. It's not a casual thing to change how your pancreas secretes hormones that tell your brain how full you are and how much sugar is-- it's not like an easy miracle. It's not casual. It's pretty serious. It's significant, significant technology.

David Remnick: Jia Tolentino, thank you very much.

Jia Tolentino: Thank you.

David Remnick: You can find Jia Tolentino's reporting on Ozempic at newyorker.com. Now, I hope this is obvious, but we are not saying you should lie about your medical information. If you're thinking about getting semaglutide in any form, you should talk to a doctor, a real doctor.

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