Weight loss injections have taken over the internet. But what does this mean for people IRL?

Good side effects, bad side effects

At first, the weight loss was just a side effect. GLP-1 ARs were first developed to treat type 2 diabetes; their hormonal mimetic action causes the production of insulin. In 2005, the United States Food and Drug Administration approved the first drug of its kind, exenatide, for people with diabetes. During the 2000s, more and more AR GLP-1s came to market. Immediately, patients noticed that these drugs not only treated their diabetes, they also helped them lose weight.

Ozempic and Wegovy, the brand names of a GLP-1 AR known as semaglutide, are both manufactured by Novo Nordisk, a Danish pharmaceutical company. Although they both contain the same active ingredient, the drugs have different indications, dosages, prescribing information, titration schedules and delivery devices. In 2017, Ozempic was first approved as a treatment for diabetes, and doctors quickly began prescribing it off-label to overweight patients. Subsequently, Novo Nordisk developed Wegovy specifically for weight loss. In June 2021, it became the first new treatment for chronic obesity approved by the FDA since 2014.

Then, in May 2022, the FDA approved Mounjaro as a treatment for diabetes; now the agency is officially “accelerating” the investigation of its active ingredient, tirzepatide, for obesity. A spokesperson for the drug’s maker, Eli Lilly, said it is currently only approved for blood sugar control in adults with type 2 diabetes and that the company “does not promote or encourage the use of Mounjaro outside of its FDA-approved indication”. However, ever since the drug hit the market, doctors have been prescribing it off-label for weight loss – there are nearly 100,000 members in a Facebook group called “Mounjaro Weight Loss Success”.

Clinical trials have shown that tirzepatide patients lose at least 20% of their weight in 72 weeks, while overweight adults on Wegovy lose an average of 15% of their body weight in 68 weeks.

Edenfield is one such success story. Unable to work at the height of the pandemic, he had stayed home “eating a lot and eating very unhealthily”. He compares his diet to that of a teenager: the regular consumption of fast food sandwiches, cheesesteaks and hamburgers was accompanied by a “crippling addiction” to Coca-Cola. When his weight soared to 357 pounds (he is 6ft 3in), he requested gastric sleeve surgery because his employer would cover the cost. Yet the doctor he met suggested Ozempic instead. He lost 15 pounds in his first month on the drug and switched to Wegovy in February 2022. He now weighs 228.

“It changed every aspect of my life,” Edenfield says. He no longer feels “held hostage” by hunger and does not run out of breath on the way to work. “I feel like I’m in my twenties again,” he says.

The results may be enviable, but the day-to-day reality of weight loss injections isn’t always pleasant. The most common side effects are gastrointestinal, including nausea, diarrhea, and constipation. Edenfield took to Reddit for advice on ‘brutal’ nausea relief. A number of semaglutide-dedicated subreddits have sprung up or gained popularity over the past year – the one Edenfield posted on was created in 2021 and now boasts nearly 22,000 members. Meanwhile, countless Facebook groups were also created during the weight loss injection boom. People here report vomiting, headaches, fatigue, ‘sulphur burps’ and hair loss, although the vast majority seem to think it’s a small price to pay for weight loss.

During the 68-week Wegovy trial, 4.5% of participants discontinued treatment due to gastrointestinal events. Peter Kurtzhals, Novo Nordisk’s chief scientific adviser, says these side effects normally diminish gradually as patients develop a tolerance to the drug. A company spokesperson adds that patients experiencing nausea on Wegovy “should contact their healthcare provider, who can offer advice on how to manage it.”