Jeremy Clarkson and partner Lisa Hogan in June 2021. Clarkson is one of several celebrities who have spoken out in praise of Ozempic. Photo / Getty Images
Across the UK, diet clubs have been markedly emptier of late. Dwindling membership numbers aren’t the result of a new gym opening or food fad, but another must-have: Ozempic – the weight-loss drug that has sent the £60 billion (NZ$121b) diet industry into a tailspin.
The weekly jab, which was approved for NHS use in the UK last month (under the name Wegovy), has gone from diabetes treatment to the diet method du jour, transferring from the elite circles of Hollywood to Britain.
Found to lead to an average 15 per cent reduction in weight, users have been highly encouraged about the results, with 40,000 prescriptions being written for it each week by the end of last year.
Yet one group has been less enamoured: the diet industry. With billions in annual revenue at stake, the medication – now frequently followed by the words “game-changer” – is one that could kill off its business model for good. The threat doesn’t end there, either: there are currently at least 12 more medications being developed to mimic Ozempic’s results (or surpass them).
So transformative has its arrival been to the diet world that in March, WeightWatchers (now known as WW) partnered up with Sequence, a telemedicine company that prescribes Ozempic, in order to future-proof its customer base.
The drug’s apparent success has exposed the “scandal” of traditional diet methods, says Tim Spector, co-founder of genetic nutrition company ZOE and author of Food for Life: The New Science of Eating Well.
Comparing the jab to the likes of calorie-counting (“scientifically nonsense”), or costly weight-loss programmes “that do well for six months and then rebound horribly, wasting money”, will inevitably blow a hole in the sector.
“And part of me thinks, actually, it’s not a bad thing to shake up the industry.”
Ozempic and Wegovy’s active ingredient is semaglutide, a GLP-1 (glucagon-like peptide) receptor antagonist that works by slowing the movement of food from the stomach to the small intestine, leading to feelings of fullness more quickly, and for longer.
This curbing of appetite is not what its manufacturers, Novo Nordisk, originally made it for - it is a type 2 diabetes drug with the primary purpose of stimulating insulin levels in order to bring blood sugar down.
But this secondary benefit has become a goldmine for one of Denmark’s biggest companies, who cited a worldwide market growth of 50 per cent in 2022; a July report from Morgan Stanley predicted that US revenue alone from such drugs will jump four-hundredfold come the end of the decade, with obesity “set to become the next blockbuster pharma category”.
With thrilled users (including Jeremy Clarkson and Elon Musk) spreading the word and the heft of social media clout - the hashtag has been viewed on TikTok alone more than 600 million times. Ozempic is at the centre of an “exponential virtuous cycle”, the report concluded.
“Popular interest in obesity pharmacotherapy has rapidly intensified,” observes John Damianos, doctor at the Yale School of Medicine, who has found that “it is increasingly common for patients to inquire about these medications, even in those who do not have obesity”. (Among certain medical circles, it has become known as “the drug of choice for the one per cent”.)
In the latter half of 2020, Damianos wrote or renewed 130 GLP prescriptions; in 2021 that figure rose to 677. Last year, he signed 997.
While there is, for now, little doubt the drug works (albeit with potential side effects of nausea, diarrhoea and vomiting), the results among those who cease taking it has been less cause for celebration.
A paper published in Diabetes, Obesity and Metabolism last April found that people regained about two-thirds of the weight they had lost a year after stopping their 2.4mg dose of semaglutide, most pronounced among those who had seen the biggest reduction. (Another by-product reported among doctors is the rise of “Ozempic face”, used to denote people who suddenly appear gaunt from the neck up due to the speed of weight loss.)
There is also a less quantifiable issue at play: whether the medication actually fixes the root causes underlying why people overeat in the first place.
While semaglutide injections are recommended alongside healthy eating and regular exercise, simply zapping away hunger pangs makes it less necessary to bother with either.
Others fear that widespread availability may make it rife for abuse among those without the recommended BMI of 27 or over, who simply want to shed a few pounds on demand - an “injectable eating disorder” that could ultimately alter users’ metabolism for the worse.
Spector is more hopeful, believing that the apparent downsides are of less concern than the health consequences facing the 64 per cent of overweight and obese adults in Britain, whom the NHS spends £6m per year to treat (a figure predicted to reach over £9.7m annually by 2050).
It “could make us think more about our gut health, our immune system, and all of the other things that interact with our food, as we de-focus obsession with just weight alone”, he says.
And for the fad diet programmes - or “parasites” who are “misleading the public, never publishing the results or telling people that their chances of succeeding are small” - the death knell would be welcome. “I wouldn’t be sorry to see them all go.”
An entirely diet-industry-free future may be a way off, though. WW’s new partnership isn’t the first to pair a lifestyle programme with GLP-1 prescriptions: Noom Inc, an online weight-loss outfit that uses calorie counts to colour-code foods for users, launched a similar tie-up late last year. (Novo Holdings, which has the majority of shares in Novo Nordisk, is also a Noom investor).
“It’s hard to say for sure what diet businesses will do. However, if they are smart, they will embrace the future,” says Spencer Nadolsky, medical director of Sequence.
“If you look at the data, it is pretty clear that lifestyle alone will only help a minority of individuals with obesity resolve their obesity or obesity-related comorbidities [such as type 2 diabetes, heart disease and osteoarthritis] in the long run.”
Other diet-industry long-timers say they aren’t packing up just yet.
Carolyn Pallister, nutrition, research and health policy manager at Slimming World, says that semaglutide is only “a short-term intervention… our approach includes psychological and behaviour change support to help members change their mindset around their weight and their eating and activity levels, as well as powerfully motivating peer support from other slimmers. All of this is vital to sustaining any lifestyle changes in the long-term.”
The “essential role” Slimming World plays will remain, she adds - jab or otherwise.
Both Nadolsky and Spector, who speaks to me from Los Angeles, where he says adverts for Ozempic are “everywhere”, believe that this new era of weight-loss medication could alter the conversation around size for the better.
But while there was hope that it would lead to greater awareness that appetite, rather than just willpower, drives our size, the existence of get-slim-quick drugs may well reinforce thinness as the ideal state - and one that is now achievable without the hard graft of traditional methods.
That may be exacerbated as they become more effective, too: tirzepatide (marketed as Mounjaro) has in clinical trials been found to produce greater weight loss than Wegovy, according to its manufacturer, Eli Lilly – it is currently being fast-tracked for obesity treatment approval in the US. It has left doctors with a quandary on their hands.
“These medications [are] a tool,” says Damianos. “And like any tool, they can be abused.
“We walk a tightrope in medicine between the tensions of obesity and body dysmorphia. We want to identify and treat obesity to mitigate its complications, without fat-shaming or stigmatising. And at the same time we have an epidemic of body dysmorphia... Like with any other medication, we have to prescribe judiciously.”
GLP-1s are helpful, “but they are not the silver bullet”, Damianos adds. “Obesity will still be a problem… And we still need other lifestyle solutions to serve as the foundation of all weight management.” No matter how many Ozempic competitors flood the market.
A live cook-off featured ox heart, wapiti, wild boar and plenty of edible wildlife.