How Ozempic Warps Our Relationship With Food and Pleasure

Jess is using Ozempic: the “miracle drug” for diabetes that is rapidly gaining prominence as a weight-loss aid. For diabetics, it mimics a naturally-occurring hormone, lowering blood sugar levels. Now people who are not diabetic or even at risk are taking the weekly injection “off-label” for its effectiveness as an appetite suppressant.

In the UK, Wegovy – containing the same active ingredient as Ozempic, semaglutide – has recently been approved for use on the NHS as a limited treatment for obesity at a cost of £73 a month. Campaigners have hailed it as a “game-changer” for type 2 diabetics and people suffering from the health impacts of obesity.

But in the US, such drugs are already well established and widely prescribed “off-label” for weight loss, even for people who are not overweight – despite a monthly cost of around US $1,000 (£800) without insurance, and sometimes considerable side effects.

After seeing ads for weight-loss drugs online and discussing them with her doctor, Jess – who is speaking anonymously to protect her privacy – was prescribed Ozempic last November. “I was a little nervous at first,” she says. “You read about some scary side effects, like ‘I can’t stop vomiting’ or ‘I’m always on the toilet’... There are some horror stories where people have lost weight really quickly, and lost all their hair.”

But for Jess, the toll has been “pretty minimal”. More to the point, in her view: in six months, she has lost 35lbs. “I’m just not hungry all the time, while eating fewer calories – that’s the main big thing,” she says.

Jess has been overweight all her life; by (admittedly imperfect) BMI measures, she is considered to have obesity. She has had success losing weight in the past, through calorie restriction – but felt “starving, all the time,” she says. “Dieting becomes like an eating disorder because it’s all you think about: You get up, you track your calories and you try really hard, all day to just not eat more than what you’re supposed to.”

On Ozempic, Jess says, “I could just get up – and not eat”.

It has been so effective at suppressing her pleasure receptors, she believes, it has even made her less inclined to shop online. “There’s still enjoyment, but it’s not like this rush of good feeling,” she says. “It just feels like it’s curbing my desire… I don’t feel like food is a place for comfort as much anymore – it’s now just a thing that I need to do during the day to keep my body going.”

In this way, the so-called “skinny jab” is both just the latest in a centuries-long line of supposed silver-bullet solutions; and an exclusive, unsettling and uniquely modern means of transcending a world where our pleasures are anything but simple.

In the 21st century – suggests journalist and historian Louise Foxcroft, author of Calories and Corsets: A History of Dieting over 2000 years – dieting has become “a national neurosis”, with an obesity epidemic coexisting with pathological fear of fatness. Rather than navigate through this “cultural confusion born of conflicting opinions, moral panics, economics and environments”, some people would rather pay to opt out, Foxcroft says.

She compares Ozempic to the weight-loss pill Alli, still sold over the counter today, which was “huge news” in the 90s for its claim to stop fat absorption. “What happens is very frequent, very colourful diarrhoea, but of course they say: ‘You’ve lost weight’.” 

That is a common side effect of Ozempic, too – alongside nausea, vomiting, constipation and fatigue. Some people report becoming intolerant to most foods, and even water. “In short, it ruined my life,” a 26-year-old Londoner said recently of her five-month experience: she felt constant nausea and often vomited after waking. But, for some, even that is worth it. “I think a part of me felt like I deserved to feel awful as a punishment for my weight,” said the woman.

By such twisted logic, a weekly injection may have even more allure than a daily pill, seeming both less time-consuming and more cutting-edge. That’s the way the “wicked, humiliating” diet industry has always worked, says Foxcroft: by coming up with new and different solutions to sell. “There’s this huge hype, then of course it turns out that it doesn’t really do the job, and then the next thing comes along.”

Even the cost and difficulty of accessing Ozempic seems to bolster its legitimacy, making it more desirable as a status symbol. “It’s like having a £4,000 handbag: It says ‘I can afford this’,” says Foxcroft.

Certainly – after being rumoured to have helped Kim Kardashian into Marilyn Monroe’s dress – Ozempic was a palpable presence at this year’s Oscars, with stars such as Mindy Kaling and Real Housewives of Beverly Hills’ Kyle Richards seemingly smaller than they had ever been, and host Jimmy Kimmel even cracking a joke about it on stage. (For the record, Kaling has never spoken about going on the drug; Richards has flat-out denied it.) Saturday Night Live later satirised the night’s red-carpet coverage as “sponsored by Ozempic”. 

Thin might always have been “in” in Hollywood but, reports the Cut, “the last few people [in LA] who weren’t now are”.

But framing the rise of Ozempic – a pharmaceutical solution to the apparent issue of appetite – as a celebrity phenomenon is too narrow, omitting the mainstream and systemic problems with our modern approaches to eating.

“One thing I hear is how frightened people are of food,” says Janet Chrzan, a nutritional anthropologist at the University of Pennsylvania and co-author of Anxious Eaters: Why We Fall For Fad Diets. “They’re afraid of wanting it, they’re afraid of what it’s going to do to them physically, they’re afraid of what’s in it – or what they think is in it.”

Partly this is paralysis in the face of overwhelming choice. The average supermarket stocks between 25,000 and 50,000 food items. Advice on healthy eating, especially with a view to weight loss, can be over-complicated and contradictory.

Meanwhile, the stakes can seem high – even life or death, says Chrzan. “You’re going to be treated badly if you’re fat – I’m not saying that’s the way it is, but that’s how diet culture encourages people to think – so, all of a sudden, these choices become profoundly important.”

Against a backdrop of such anxiety, a relatively drastic intervention like Ozempic can register as proportionate. Chrzan likens it to the historic tradition of “heroic medicine”, which posits that the most serious conditions demand more radical treatments and led to dubious practices like bloodletting with leeches. “We think that the more profound, the worse the disease, the stronger the palliative action has to be,” says Chrzan.

She found the same flawed logic today when she interviewed people on restrictive diets. “They felt like they were doing the right thing simply because it is hard to do, rather than because it had a demonstrable outcome.”

This widespread adoption of Ozempic holds a mirror up to a world in which fat is both an intractable problem, and one that must be solved at any cost.

Chrzan notes its apparent similarities to Naltrexone – a drug commonly prescribed to treat alcohol and opioid addictions – in “taking away the pleasure that you get in satisfying that high”. 

“It sounds to me that what people are doing, culturally and psychologically,” she says, “is imagining [being overweight] as a chronic disease that then requires chronic treatment for the rest of their lives.”

Obesity is considered a disease by the Centers for Disease Control and Prevention in the US, partly to highlight what is considered a growing national crisis and its associated health impacts. It is likewise prevalent in the UK, affecting 26 percent of the English population, but calls for it to be officially reclassified as a disease have so far gone ignored.

Those against say that obesity is a condition that can be treated with diet and lifestyle changes – but there is mounting evidence to show that it’s not that straightforward. Likewise, weight alone is a woefully inadequate measure of health.

“There’s a tacit assumption that if you’re not slim, you’re not healthy,” says Chrazn. “We know that you can be slim and be very unhealthy – but we don’t recognise that quite so much.”

That so many people claim to feel out-of-control around food, and even addicted, is seen by some as an indictment of what we eat. “Highly processed foods are engineered to make us want them: They have the sugar, fats, salt,” says Chrzan. The optimal combination of these for maximum deliciousness is sought after by market researchers and flavour scientists as the so-called “bliss point”. 

On the other hand, Chrzan adds, “many psychologists argue that we have become habituated to the psychological soothing aspect of eating, and we train ourselves to have those pleasure responses – that we’re addicted to the physical action, rather than the components of the food”.

Some items, such as sugar and white flour, have been so vilified that the “nocebo” effect could be widely in play, she says – making it tricky to distinguish their intrinsic harm from their anticipated one. That is even without taking into account factors relevant to weight such as age, genetics, hormones, activity levels and socioeconomic status. Marketing adds another layer of obfuscation. 

All told, it amounts to what is known among dieters as “food noise”, encompassing messaging about what and how to eat as well as the siren song of the chocolate or crisps in the cupboard.

For Kelsey, 31 and based in the US, it was inescapable. She started taking the similar drug Mounjaro last September, to lose weight and manage her elevated risk of diabetes from insulin resistance and polycystic ovary syndrome.

She has since lost 56lbs: a result she has never seen after a lifetime of dieting. Her menstrual cycle has stabilised, and she has recommenced activities like running and dancing, which she used to love. “It has done nothing but improve my quality of life – it’s kind of a miracle,” she says.

But the most transformative effect, says Kelsey, has been in freeing up headspace that used to be devoted to food. “Some of those feelings are normal – but for someone like me, who has suffered from obesity for most of their life, it consumes you: ‘Maybe I should have a snack’, ‘What should I have for lunch?’, ‘What am I going to have for dinner?’”

On Mounjaro, “I wasn’t having those thoughts anymore”.

Kelsey – speaking anonymously to preserve her privacy – admits that she has been lucky to have had next to no side effects: only mild nausea when changing doses. But, she adds, compared to her past struggles with food, “I’ll take the nausea any day”.

In the past Kelsey has lost as much as 30lbs through calorie restriction then gained it back, several times over. It wasn’t sustainable, she says, and only turned up the volume on the food noise. “I couldn’t take that internal battle that would take place every time food was in front of me.”

Now Kelsey says she is able to resist treating herself when she’s stressed or upset, or finishing her plate though she’s feeling full. “It’s really empowering to be able to say, ‘You know what? I’m good’.” She still eats out at restaurants, but in smaller quantities and more straightforwardly for the social aspect.

There’s this one chicken sandwich that she used to crave, and eat at least once a week. “I would be so satisfied, it almost gave me a high,” Kelsey says. Now it doesn’t even occur to her to order it. That sense of satisfaction now comes from other sources – “from the fact that I can go for a run, or that I feel really good in my outfit”.

That is the possibility that Ozempic dangles, achieved through scientific innovation and unlocked with wealth: weight loss without sacrifice, or even much work. 

“The enemy changes – from sugar to fat, back to sugar to carbs – but the goal remains exorcising this dangerous pleasure from your life, but without feeling the deprivation of it. You can cut out sugar without losing sweetness; you can get rid of carbs but still somehow enjoy ‘low-carb bread’.”

It’s possible to see Ozempic as an extension of those unsatisfying trade-offs and diminishing returns, swapping treacherous food for no food at all, effortful hunger for effortless satiety. What’s more, relative to relying on willpower to consume fewer calories, it’s relatively foolproof.

But in another sense, Ozempic rejects that cycle entirely, says Berenstein. “For generations, we have participated in diet culture, substituting our desire for real chocolate cake with chocolate-flavoured yoghurt, and that did not work – now we just want to be freed from desire,” she says.

“It’s no longer about scanning the shelves for a suitably healthy replacement, a pleasure that doesn’t have the austerity of dieting – Ozempic is just a way of saying that we want out of this cycle of consumption, desire and decision making.”

The constant flip-flopping over the nutritional value (or otherwise) of dark chocolate, or red wine, or eggs, or caffeine alone is dizzying, and demoralising. In April, a misleading headline went viral, claiming that “half an egg a day is associated with premature death”. “Who wouldn’t want a break?” asks Berenstein. “Maybe it seems like a worthwhile sacrifice to give up that pleasure, in order to be freed from the constant obligation to make choices.”

But while Ozempic might seem like a means of sidestepping the exhausting, time-intensive undertaking of crash dieting, calorie counting, good-for-bad swaps and one simple tricks – the reprieve is temporary at best, and even illusory.

“Ozempians” still have to pay attention to their diet to ensure that they are receiving enough calories and nutrients, and exercise for the health benefits. “You haven’t opted out: You’ve opted into something else,” says Berenstein.

We just don’t know comprehensively, or with certainty, what that entails. While Ozempic is thought to be safe when administered under proper supervision, its long-term impact has not been extensively studied, and in people without diabetes, even less so. Chrzan suggests there could prove to be a lasting impact on our hormonal pathways, and other internal processes relevant to dietary intake.

Certainly, doctors have found that stopping Ozempic can cause blood sugar to surge and cravings to return, sometimes amplified. Regulatory approval also does not guarantee safe consumption. In 2020, the diet drug Belviq was withdrawn over a potential cancer risk that “outweighs the benefits”, a full eight years after it was approved by the US Food & Drug Administration.

Even setting aside the unknowns, there’s one fact about Ozempic that might appear to negate the entire endeavour: People often gain back any weight lost while on the drug as soon as they stop taking it – locking them into a costly, indefinite commitment to medication. 

In this regard, these “miracle cures” are no different to dieting, or any means of weight reduction other than sustainable lifestyle change. (Even gastric band surgery, a similarly drastic solution, has limited long-term success.) 

By artificially suppressing our internal measures of hunger and satiety, Ozempic could be warping our fraught relationship with food even further. Instead of learning how to eat and be active – how to nourish and accept the ever-changing body we’re in – we are effectively paying to make the problem go away.

“I think we’re going to look back on this and view it with the same concern and disdain that we now view the prescription of cigarettes and benzedrine for weight loss – we’re going to see how treacherous it really was,” says Christyna Johnson, a “non-diet” dietitian based in Texas.

Johnson’s approach emphasises intuitive eating, “health at any size” principles, and body-image acceptance: worthwhile but challenging work that is often slow-going, and easily overshadowed by celebrity solutions.

In a society that is sick “and getting sicker”, Ozempic “is a socially sanctioned way of coping”, Johnson says. “We know how much stigma, bias, harm and discrimination people in large bodies face – I’m not mad with people for making that choice, I understand it in the context. My gripe is with a culture that would make that a solution.”

Even doctors (in the UK as well as the US) receive nominal instruction in nutrition, and next to nothing in disordered eating – meaning they, too, can weight medicalised responses and cures over holistic ones, or prevention.

Fatphobia is also rife within the medical establishment, with people told to lose weight when seeking treatment for unrelated conditions, or dismissed out of hand. “When you are being told that your body size specifically is a medical condition, you’re going to do anything in your power not to have that condition,” says Johnson. 

It is evident in the vilification of hunger – especially in women. Johnson’s clients will often tell her of “attempting to earn” their next meal, holding off until they are light-headed to eat; or they will elevate disordered eating as enviable self-discipline. “We are so fixated on people not being hungry, not because they are well-fed, but because they are starving.”

In such a context, Johnson says, owning one’s appetites and learning to eat offers a path to liberation. She quotes Audre Lorde on self-care as “self-preservation, and… an act of political warfare”. 

“Choosing to take pleasure is the least I could do for myself in a system that’s hell-bent on making me a little worker bee – in a society that praises people for not being hungry,” Johnson says.

Ozempic, on the other hand, severs us from as base a sensation as hunger, distancing us from as essential a need – and as ready a pleasure – as food.

“I don’t think people anticipate that they’re going to be so repulsed by food as they embark on their Ozempic journey,” says Johnson. “You can’t wrap your head around it: ‘I’m putting something in my mouth that I know I enjoy, and I’m getting zero pleasure out of it… I’m just identifying: I’m eating scrambled eggs’.”

The implications for questions of free will and bodily autonomy are dismal. Even those for whom the drug has been personally revolutionary admit to ambivalence.

Kelsey is thoughtful and clear-eyed about her own preoccupation with her weight. “Growing up in the 90s and 2000s, seeing my mom do diets all the time, people saying ‘that’s unhealthy’ – I think decades of diet culture got to me,” she says.

She works hard to protect her children, aged six, three and one: They do not talk about weight, or “good” and “bad” foods. “I don’t want my kids to struggle with the same thing that I struggle with. When they go to the doctor and they have to be weighed, I cringe a little bit because of the memories that I have.”

But the path of self-acceptance that Kelsey is trying to carve for her children has proved unattainable for herself. “For ten years I really tried to embrace the body positivity movement and the body that I was in.” But it felt dishonest, and even damaging – “like when you’re in a relationship as a teenager and you’re trying to pretend it’s really good when it’s not,” Kelsey says.

“I feel very much like I’m part of that movement. It’s just, for me personally, I’m happier when I’m in a smaller body.”

Especially given her PCOS and risk of diabetes, Kelsey considers Mounjaro “life-saving medication” that she plans to take indefinitely – or for as long as she can. Mounjaro costs US $1,200 (£970) per month; Kelsey has only been able to afford it because of a promotional offer, which ends in June.

Her plan is to then switch to Ozempic, which has greater coverage under insurance, and hope she sees the same results. “If it came down to paying full price for a couple of months, I would do it,” Kelsey says. “I’d cringe every time, and it’s not something that I would be able to do forever – but I’d do it.”

Kate Moss’s quip that “nothing tastes as good as skinny feels” may have caused outrage, but it captured the deadpan nihilism of the 90s and heroin chic. Now slimming drugs are ushering in a return of that era’s extreme thinness – but it is telling that the slogan, updated for 2020s, lacks the same wry provocation: “nothing tastes as good”.

These days, Johnson suggests, “we are barrelling towards dystopian chic”. Indeed, one feature of a dystopia is the sense of no tomorrow: Ozempic promises thinness for today, as long as you can afford it.

In a world already marked by many of the defining characteristics of a dystopia – extreme inequality, dwindling nature, loss of faith in institutions, and pessimism about the future – an injection extending peace of mind and thin-privilege to an exclusive few is apt. After all, The Hunger Games franchise was so named for a reason – this modern “food environment” is hazardous and dehumanising for individuals to navigate, and next to impossible to resist entirely. At the very least, the demand for Ozempic reflects the desire for another way.

As much as food was a source of pleasure for Jess, it also caused her pain, anxiety, guilt, distress – Ozempic has removed it all, she says. “It really is just life-changing in that way,” she says, “because sometimes I wonder, about people who have more naturally thin bodies – is this how it feels?”

Jess is careful about how she speaks about her experience; she has experienced stigma over her weight, and supports people’s right to be happy and healthy no matter what their size. “I don’t want people to feel pressured to take this; I don’t want this to be like, ‘Well, you don’t have to be fat’,” she says.

But her mind keeps going back to her recent flight – her first since starting on Ozempic. “I’d been getting to a point, at the beginning of last year, where airplane seatbelts were small – and this time, it wasn’t a problem at all. I do think that that’s a problem with the airline, but also, like – it made my life better,” she says.

“It made my life easier at that time, in that moment going ‘OK, this is no longer an issue I have’. My brain keeps going back to that, thinking: ‘This is what I mean’ – we still have to live in this world.” For now, Jess says, “I’m glad that this treatment exists.”