Who Deserves the New ‘Miracle’ Weight-Loss Drugs?

Kaitlyn Wade (30) has struggled with her weight all her life. She’s been trying every diet fad since she was 19 years of age. All of them had temporary, but not lasting effects.

She says, “I have realized that it’s a lot more about the science and biology of your body.” It’s both mental and physical. This is not a quick fix.

Wade was concerned about her weight while she was preparing to give birth to her son in 2021. But after the baby arrived, her postpartum depression led her to eat more and an increase in blood sugar levels. She was officially pre-diabetic. She weighed in at 403 pounds by September. She says, “It almost feels like death.”

Wade found a group of creators scrolling through TikTok. They were testing a new drug called Tirzepatide. It was sold under the name Mounjaro. Mounjaro, an injectable drug that was originally developed for type 2 diabetes treatment, is similar to the popular semaglutide drugs (known under the brand names Ozempic or Wegovy). These drugs can improve blood sugar control by increasing insulin secretion in the pancreas. They also delay food from your stomach, which reduces patient’s appetite. Both Ozempic as Mounjaro’s websites clearly state that they can help weight loss but are not intended for this purpose. Wegovy does, however, promote itself as a weight-loss medication for people with a BMI greater than 27.

Wade, a swimming teacher, began documenting her journey via TikTok as @mermaidkait1. Her 63,000 followers now follow her and have seen her weigh-ins and tips.

The drugs have been increasingly popular among non-diabetic people to lose weight over the past year. Varietyrecently stated that semaglutides are Hollywood’s secret weapon for weight loss. Elon Musk tweeted Wegovy about it in October. While completely unfounded, speculations that Kim Kardashian used a Semaglutide to fit into the Marilyn Monroe gown at the Met Gala added an extra boost to the drug’s popularity. The hashtag for Ozempic on TikTok has almost 300 million views while the one for Mounjaro is 200 million. Both videos are extremely positive, with creators and obesity experts giving advice and rave reviews to thousands or hundreds of thousands.

There are many drawbacks to the intense interest in this quick-fix for weight loss. Not only can there be nausea and vomiting but also the drug’s popularity has led to a shortage of Ozempic among type-2 diabetics who require it to live.

A new discourse emerged online. The backlash against the positive videos that populate the hashtags has been minor but enough to make some content creators uncomfortable. Some commenters have criticized non-diabetic users of creating shortages, while others have complained at the high price and list of possible symptoms. Some of those looking for a ” miracle” weight loss solution and some of the “experts” who encourage them to use these injections have responded by rebranding the procedure into self-care and wellness. They argue that chronic obesity should not be treated as seriously as diabetes.

The rise in prescriptions is not just the result of the creators. The marketing campaign for injections as well as the weight-loss-specific telehealth platforms has been extensive. They offer faster access to prescriptions. (The rise in popularity of numerous telehealth platforms have become increasingly popular in the Covid era, and they were most has been linked to the shortage of generic Adderall in the U.S. Advertisements are flooding the Instagram and Facebook algorithms, while being heavily rolled out on TV.

The real issues that obese patients face in medicine are what the online discussion misses. Although extreme weight loss has been celebrated for many years, obese people often have difficulty getting proper medical attention from providers that can’t see beyond their weight. Obesity can increase the risk of developing chronic diseases such as heart disease and diabetes. However, there are many other factors that can impact patients, regardless of their weight. Obese patients are often told to lose weight in order for them to receive essential care.

April, a registered nursing nurse, is known on TikTok as @thatnurseapril. She has struggled with her weight for over a decade but never lost more than 14 pounds. April was frustrated with her weight, which made it difficult for her to perform simple tasks like vacuuming. April wanted to lower her risk of developing type 2 diabetes, as well as the diagnosis of her sister and mom. She first heard about Mounjaro when she was in her 20s. Instead, her doctor encouraged her to stick with the traditional diet and exercise route. She was frustrated and joined a Telehealth program to be able get a prescription. Since then, she has lost 62 pounds.

April, like Wade, has documented her TikTok journey from the beginning. She now has over 60,000 followers, who have seen her success story. She met with her primary physician in November for the first time since being told not to take these injections. Her PCP was supportive.

Wade and April both reported minor side effects from Mounjaro. However, this is not true for all patients. Sometimes, nausea, vomiting, or diarrhea can become a daily burden. This is often caused by an increase in dosage, or fatty foods that linger in the stomach due to delayed gastric emptying. Patients with a history of disordered eating can find it triggering.

“You need to be cautious with people who have a history eating disorders or people that are too low in blood sugar,” Laura Cipullo, a certified dietitian, certified diabetes educator, and certified eating disorder specialist, says. She has not worked with Wade and April. Is this causing malnutrition in someone who isn’t well-nourished? This is something that must be closely monitored.”

Cipullo has noticed an increase in Ozempic requests to her practice. She worries that not enough patients have been prepared for the psychological and physical changes that can occur with these drugs. Regular visits with a doctor, dietitian and therapist are highly recommended for monitoring a person’s mental and physical well-being.

“If someone is saying, “Listen, this what happens when you take it, and then I need support,” and it’s only support, that’s great. The problem is that the average Instagram user who is trying to find support from a layperson is not necessarily getting the right information,” Cipullo says.

TikTok and Facebook have established grassroots support groups. Many videos are available under the Ozempic and Mounjaro tags. They offer advice on a range of over-the counter medications that can be used to treat heartburn, constipation and migraines. Commenters praise their favorite creators and complain that the drug is not working as fast for them. There are not as many videos that show what happens after you stop taking the drug. It is not as common to see videos that show what happens when a patient stops taking the drug, despite its popularity among non-diabetic people. These patients will likely need to continue taking these drugs for their entire lives, just like diabetics. Otherwise they are at high risk of losing most of the weight that they have lost.

Dr. Azza Halim is an anesthesiologist, physician, with expertise in aesthetic medicine and anti-aging. She also does not work with Wade and April. Patients at her practice have been prescribed semaglutides to aid weight loss. “I tell my patients that there is no magic bullet. It takes effort. Studies have shown that people can regain as much as two-thirds of what they lost if they stop using the semaglutide. You will not lose any weight if you don’t do behavior modification.

Many videos provide practical advice about the use of these injections. They also offer tips on how to get a prescription and not have to pay full price. The average Ozempic cost for those without insurance is $2,500 per year. Eli Lilly, a pharmaceutical company, offered a coupon for Mounjaro which reduced its cost to $25 per month for 12 months. However, there were growing concerns among patients who couldn’t afford the usual price.

Cipullo warns, “If there is a higher demand it will make it that much less expensive for those who really require it.”

Nurse April is both a Mounjaro patient and a nurse, so she has been fighting comments like Cipullo’s.

She admits that she can get heated, but she doesn’t respond to all of them. She says, “It’s often people who are diabetic and are having prescribing problems, which we have seen with Ozempic.”

Her defense is similar to many others: “The [commenters] will say, “Well, this medication is diabetic, and I can’t get it, because you’re taking it to lose weight, or to drop a few inches. It’s just aesthetic for you. So I try to educate them by saying that obesity, like other chronic diseases such as diabetes and chronic illnesses, is a chronic condition and should be treated the same way.

There are many people who use Mounjaro and Ozempic to help with obesity-related risk warnings and risks like Wade and April. However, there is a danger that these drugs could be re-shaped to suit those who just want to lose a little weight. Fad diets have become cultural norms over the past several decades. They are promoted with flippant ease on talk shows and in lifestyle magazines. TikTok and social media have raised alarming concerns about rising body and facial dysmorphia among younger generations.

TikTok is increasingly popular among Gen Z users. The app’s opaque personalized algorithm has been criticized for pushing dangerous diets, weight loss products, and “thinspo,” videos. It wouldn’t surprise if the algorithm had suggested all of these to users who just wanted to learn more about the injections.

Elizabeth Altukara is the director of education at the National Eating Disorder Association. She says that body dissatisfaction is caused by the pressures of diet culture, and society’s expectations of how one should look. “It is time to stop body shame and embrace body acceptance, both for mental and physical health.”

The body positivity movement has made significant progress in fat liberation and representation to counter the negative effects of diet culture in the past decade. Many are now able to see that health does not depend on how large or small they are. These figures are still targets of virulent hatred online, as though their existence is a problem and not an offense.

Wade and April both wondered at times what it would feel like to let go their desire to lose weight and embrace their bodies regardless of how they fluctuate in weight. Their personal decisions to seek Mounjaro were not made for aesthetic reasons, but to avoid real health risks that they had faced in recent years. Both were tired of hoping for better.

Wade says, “I want to accept my body and know I’m beautiful no matter what size it is.”

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