With new-generation drugs now approved in New Zealand for weight loss, debate still rages on whether they are the best way to tackle obesity.
Three years ago, Evelyn Ebrey wrote an article for the website Fashion NZ headlined “Representation Matters: Why Plus-Size Models are Not a Trend”. She looked at how perceptions of beauty were starting to shift and fashion brands were responding by making clothes in larger sizes. Back then, the body positivity movement was in full swing and seemed to be creating lasting change.
Next, Ebrey teamed up with producer/director Julia Parnell to develop a documentary series that would cover those same themes. That series, Cutting the Curve, launches on RNZ Video on August 25. But the story they have told is not the one they expected to tell.
Since they started making their documentary, the landscape has changed. Plus-size models are working less than before. The most recent Vogue Business size inclusivity report found that at the Autumn/Winter 2025 shows, there was a drop in the number of curvy models on the catwalk. Only 0.3% were plus-sized (NZ size 18+), down from 0.8% last season. And only 2% were mid-size (NZ size 10-16), down from 4.3% last season.
Berlin-based fashion label Namilia even sent a model down the runway wearing a tank top emblazoned with the phrase “I Heart Ozempic”. Meanwhile, Cutting the Curve follows Samoan Kiwi Isabella Moore, a successful plus-size model in London, as she wonders whether she needs to take a weight-loss medication for the sake of her career.
Ebrey identifies the 2022 Met Gala as the moment things started going backwards. “Kim Kardashian lost a whole bunch of weight in three weeks to squeeze into Marilyn Monroe’s dress and that felt like a cultural shift,” she says. “We were talking about skinny again. That was when Ozempic was starting to take off in America and it’s kind of snowballed since then.”
The arrival of GLP-1 agonist drugs, which have revolutionised obesity treatment, has undoubtedly contributed to the move towards thin being back in.
“They are absolutely at the heart of it,” says Parnell. “It’s not that the body positivity movement is over, but when something like Ozempic makes it so easy to lose weight, people are reverting to what has always been a societal standard. As is said in the documentary, skinny always seems to win.”
Between 8 and 10% of Americans are taking GLP-1 drugs, according to PwC, which reports that in 2023, semaglutide became the best-selling drug in the US. Among the well-known people who have publicly acknowledged using GLP-1s are Oprah Winfrey, Elon Musk, Rosie O’Donnell and Sharon Osbourne (who lost too much weight and has stopped taking Ozempic). Many other famous figures have been quietly shrinking.
Although these medications have been slower to land in New Zealand, an older drug, Saxenda (liraglutide), which is delivered daily via an injection with a pre-filled pen, is under assessment by Pharmac to be funded for weight loss. And in March, Medsafe approved the newer treatments Ozempic for diabetes and Wegovy for weight loss. Both medicines are injected weekly and contain the same active ingredient, semaglutide.
Hawke’s Bay communications specialist Sarah Thornton had spent years trying to lose weight, but nothing worked long term. When her doctor prescribed Saxenda, she started on a low dose and wasn’t sure it was working. “It took a good six to eight weeks before I noticed a thing,” says the 61-year-old. “I was ready to give up, and then I put on a pair of jeans and thought, ‘Oh, hang on.’” Thornton, who doesn’t have a set of scales at home, has now lost 16kg, according to her GP’s scales, and her health has benefited. Her blood pressure is down, her resting heart rate has improved, there is less load on her joints and she has more energy to exercise.
“It’s unbelievable,” she says. “It’s done something that I’ve spent years and years trying to achieve with Jenny Craig, Weightwatchers, low carb, high protein, you name it.”
Thornton refers to injecting herself with the medication as “being on the pen” and says apart from the cost, she can’t see any downside. Side effects of GLP-1s can include fatigue, nausea and vomiting, but only on a couple of occasions has she felt physically ill and that was when she had eaten too much.
“By too much I mean two pieces of toast for breakfast rather than one,” she says. “Your food intake is cut in half. You can still enjoy good food, just not as much of it. These days, I get full from eating a salad.”
Reducing the noise
Like many other users of this class of drug, Thornton reports a quietening of the “food noise” in her head when she is taking Saxenda. “I’m a biscuits and cake person usually and a massive baker, but I lost any need or desire for those things,” she says. “It’s improved my relationship with food.”
Thornton has noticed that when she stops taking the drug, the food noise returns after a while and she starts craving lollies again, so now has a maintenance dose with a couple of jabs every few weeks.
All of these medications work by mimicking the action of the neuropeptide GLP-1, which is released after we eat and signals to the brain that we are full. Normally, this is a fairly short-term effect, but in the 1990s, scientists discovered that the venom of the gila monster lizard contained a longer lasting version of the peptide – they called it exendin-4. That paved the way for the development of the drugs we have today.
Robyn Brown, an associate professor at the University of Melbourne’s department of biochemistry and pharmacology, says GLP-1 agonists appear to have multiple actions in the brain. “They commandeer the signals to the hypothalamus, which controls appetite. But we also have GLP-1 receptors in areas of the brain associated with reward and they seem to be acting on those, dampening down the rewarding effects of food,” she says.
“For some people, this is transformative. They feel liberated because they’re not thinking about food all the time and may actually have to remind themselves to eat. For others, it’s too much and they feel nauseous – I liken it to the way you feel after eating too much Christmas dinner, except they are like that all the time.”
Studies show impressive results for those who can tolerate these drugs. A US trial of Wegovy reported that participants lost 14.9% of their bodyweight in 68 weeks. And research with tirzepatide (sold as Mounjaro and Zepbound) showed even greater benefits. Tirzepatide is a dual agonist, so it targets not only the GLP-1 receptors but also GIP, which influences insulin secretion and, potentially, appetite. So far, tirzepatide has not been approved by Medsafe, but it is already available in Australia.
More options, more uses
There are more options on the way. Drug company Eli Lilly has been trialling a GLP-1 drug in tablet form for Type 2 diabetes. Called orforglipron, it is thought it might also be helpful as a maintenance dose for people who have achieved weight loss using injectables. Novo Nordisk is working on a drug, amycretin, that targets both GLP-1 and amylin receptors to help control blood sugar and appetite. This has been reported to reduce body weight by up to 24.3% when injected over 36 weeks, and 13.1% when taken orally over 12 weeks. And researchers have developed a slow-release hydrogel for semaglutide that would mean it would need to be taken only once a month rather than weekly.
It appears weight-loss drugs are useful for other health problems and numerous trials are under way. GLP-1 agonists have been linked to a reduced risk of Alzheimer’s and dementia. Australian researchers found they significantly reduced kidney deterioration and failure in people with and without diabetes. There is evidence they reduce heart attack and stroke, lower the risk of several cancers and reduce inflammation. Tirzepatide may also have benefits for bone health.
The way they seem to dial down the reward parts of the brain means they also hold promise as a treatment for drug and alcohol addiction as well as smoking cessation. And Robyn Brown is interested in how the GLP-1 drugs might be useful for people with binge-eating disorders. “In my lab, we’re very focused on the types of eating that occur when you’re not hungry. So, stress eating or eating because you’re compulsive about food.”
With other researchers, she is planning a trial that will look at how effective these drugs are for binge-eating. “We talk about high-fat, high-sugar, ultra-processed foods as having an addictive nature, so these drugs are potentially going to help with that. But if you’re eating as a coping mechanism for stress or emotional trauma, I don’t see how that will unwire, although I’m fascinated to find out.”
The GLP-1 drugs aren’t effective for every-one. Some 10-15% of people who take them don’t lose significant amounts of weight, and there is emerging evidence that anyone who has been extremely obese for a long time may be less responsive to the drugs and require a higher dose.
Some people feel liberated because they’re not thinking about food all the time.
Some deaths have been associated with them. In the UK, the Medicines and Healthcare Products Regulatory Agency has received reports of 82 deaths among people taking the drugs. Acute pancreatitis is one of the more potentially serious side effects and there are investigations under way to see if some people have genes that put them at higher risk.
There are also downsides associated with rapid weight-loss. So-called “Ozempic face” refers to the sagging skin, wrinkles and sunken look caused by a reduction in facial fat. Some people have “Ozempic hair” – loss of hair linked to nutritional deficiencies. And even “Ozempic teeth” with inflamed gums, dental decay and bad breath caused by dry mouth, dehydration and vomiting.
Since the drugs delay gastric emptying, they can make things tricky for anaesthetists during surgery by increasing the risk of a person’s stomach contents being regurgitated and aspirated into the lungs.
And as with any strict calorie-controlled diet, another concern is that 20 -30% of lean body mass is lost along with the fat. We lose muscle anyway as we get older, which leads to frailty. Potentially widespread use of the GLP-1 drugs will exacerbate this, exposing higher numbers of people to a greater risk of falls and fractures as they age.
“We need to make sure that we’re prescribing these drugs only when they’re needed and that we’re avoiding misuse,” says Brown, who has heard stories about women getting their husbands to go to the doctor claiming they want to shed belly fat and then using the prescription themselves.
“There’s no argument that if you’re suffering from health complications associated with your obesity, you need help,” she says. “But when there are people who just want to lose a few kilos or look good for the Oscars … the minute you get something that’s going to work, there is a risk of misuse.”
Regular resistance training, such as with weights, is recommended to minimise muscle loss and frailty for those taking these drugs.
Real-world prescribing
Auckland GP Chaey Leem, who specialises in obesity medicine, has been working with GLP-1 drugs for more than four years – first, Saxenda and now Wegovy – and says he is probably one of the top prescribers in the country. He works at North Shore Hospital and in private healthcare clinics alongside bariatric surgeons.
“Private weight-loss patients tend to be well off,” he says. “There’s a higher proportion of women and they mostly range from age 30-60, although we do have older and younger patients.”
Leem believes there’s still a place for bariatric surgery because it is more cost-effective in the longer term and generally results in greater weight loss. Still, most of his patients have been tolerating the GLP-1 drugs well enough.
“Side effects almost always go away after a period of time. The real-world data is better than the trials, because in the real world, we can start people on a very low dose and increase it very slowly.”
When prescribing these drugs, he considers far more than BMI (body mass index), screening patients for obesity-related conditions such as sleep apnoea, polycystic ovary disease and metabolic conditions to ensure treatment is appropriate and they will benefit.
“Diagnosing obesity is harder than you might think and you can’t judge people from the outside. A person may seem to be a normal weight, but have excess fat in their central area and so have high cholesterol or type 2 diabetes and that might justify them having treatment.”
However, taking these drugs purely to look skinnier or fit into smaller-sized jeans, may be counterproductive, he cautions. “Those people who are doing it for aesthetics usually don’t get the drugs from the right sources and don’t take them for very long. They may risk muscle loss and then, when they stop the drug and gain the weight back again, they’ll gain adipose tissue [body fat] and not the muscle they’ve lost. So, their body composition actually gets worse.”
For those who are suffering the negative health effects of obesity, Leem sees these drugs as gamechangers and he is advocating for increased funding. “We’re funding all kinds of expensive things already, but it seems like obesity doesn’t really deserve its own space and funding, and we’re working to change that so more people will be able to access treatment. We want to take this to the next election and force the government to do something, because having obesity is not a choice.”
There has long been stigma around obesity, but now science has established that genetic factors play a bigger part than willpower, and that losing weight and keeping it off is a challenge because the body’s mechanisms work to get it back to a set point by increasing hunger signals and slowing metabolism.
Combined with the increasingly obesogenic environment most of us live in, with fast food outlets and ultra-processed food almost impossible to avoid, it is hardly surprising that worldwide adult obesity has more than doubled since 1990, according to the World Health Organisation.
“These drugs help you make better choices,” says Leem. “You can still enjoy food. Actually, you can enjoy it more because you’re in much better control and you don’t have to worry about counting calories or feeling guilty.”
It seems like this is only the start of the weight-loss revolution. Scientists are racing to develop similar drugs that work via multiple pathways and are even more powerful.
“It’s getting really exciting,” says Leem. “Rather than having muscle loss with the GLP-1s, there will be medications that promote muscle gain while you’re on them. Or drugs for weight loss that target different organs, so the liver or the heart. There may even be obesity vaccines that you take once a year. This is going to be a new area in medicine.”
A band-aid only
Former boxer David Letele is dedicated to battling the disease of obesity. He has set up free gyms and food schemes in some of the country’s poorest areas. Through his social enterprise BBM Motivation, he provides free boot camps and health programmes to help New Zealanders get fit and healthy. Although Letele sees the GLP-1 drugs as a useful tool to suppress appetite, he doesn’t believe they are the whole solution.
“Even if they were to be funded, it would need to be done in conjunction with a programme like ours, a lifestyle programme,” he says. “These drugs don’t take you out of the environment you’re living in – in our areas, they’re fast-food swamps and health-food deserts. It doesn’t change anything for your family, because a lot of these issues are generational.
“We work with people who have locked themselves away and haven’t left the house unless it’s in an ambulance. There are serious issues going on and [the drugs] don’t deal with any of that. If we’re going to break cycles, we need to use them in conjunction with programmes where we educate.”
Previous medications that were developed to treat obesity haven’t been very effective, hence the excitement about the GLP-1 drugs. For some people, they can be transformative, but Robyn Brown agrees we need to do much more.
“We haven’t actually cured obesity,” she points out. “People have to take these medications for the rest of their life because the minute the stimulus is taken away, they feel hungry again. To my mind, they’re a Band-Aid – a necessary one, because we do have the problem – but it would be great to see governments addressing our obesogenic environment and regulating ultra-processed foods like they do drugs of addiction. We don’t want the whole population to be on medication, we want to prevent the problem.”
The use of GLP-1 drugs is already having a wider impact. Food manufacturers are having to adapt as large numbers of people lose the craving for sugary, high-fat treats and start turning towards healthier protein-rich snacks and meals. In the US in May, diet company Weightwatchers filed for bankruptcy, citing the rapidly changing weight-management landscape. That followed another well-known diet business, Jenny Craig, shutting its doors a couple of years earlier (and since revived online).
Meanwhile, the weight-loss medication market has seen exponential growth. Morgan Stanley estimates it could reach US$150 billion (NZ$253b) globally by 2035, and also predicts restaurants, beverage and grocery companies could see a negative effect, whereas apparel may benefit.
Which brings us back to the fashion industry. Some clothing brands are already scaling back their larger size ranges in anticipation of their customers getting smaller. Plus-size influencers are losing weight as plus-size models lose work.
How all of this will affect societal attitudes in the longer term remains to be seen, but for the moment it seems as though body positivity may be the loser.
“There is a huge amount of psychosocial pressure, particularly for women, around how we look,” says Brown. “It’s really interesting seeing how much attention these drugs are getting, and that’s because as a society, we are still so obsessed about how we look. It would be very sad if we went back to the 1990s heroin chic vibe.”
Know your drugs
■ Ozempic (semaglutide) is Medsafe-approved for diabetes and Wegovy (semaglutide) is approved for weight loss in adults with a BMI of 30 or more, or a BMI of 27 with at least one weight-related comorbidity, and for adolescents if their BMI indicates they are obese and they weigh more than 60kg. Neither is funded. Wegovy costs $460-$500 for four weeks of medication. There is no stock of the Ozempic brand in New Zealand currently.
■ Saxenda (liraglutide) is Medsafe approved for weight loss, but not funded. An application has been received and Pharmac has it under assessment. Currently it costs $480-$550 a month.
■ Jardiance (empagliflozin) is funded for type 2 diabetes with cardiorenal complications and separately for heart failure with reduced ejection fraction (a reduction in the amount of blood the heart pumps).
■ Trulicity (dulaglutide) and Victoza (liraglutide) are funded for type 2 diabetes with cardiorenal complications.
■ Mounjaro and Zepbound (tirzepatide) are not yet approved by Medsafe.