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The magazine’s Ethicist columnist on judging people who use prescription drugs to lose weight.
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By Kwame Anthony Appiah
Recently, two of my good friends (neither of whom is obese) have joined the masses taking semaglutide for weight loss. Because the three of us live in different parts of the country, our friendship is maintained by annual visits and frequent texts. Lately in our text thread, all they can do is rave about how these drugs have been “life-changing” in helping them drop the stubborn 20 pounds they’ve been wanting to lose since hitting their 40s. I’m conflicted about the safety and popularity of these drugs for weight loss, and so I’ve remained silent whenever this topic comes up. Our annual trip is coming up, and I fear I’ll be forced to offer my opinion about their weight loss, especially since the trip involves time at the pool. Should I compliment them to keep the peace? Or is there a tactful way to make my differing opinion about these drugs known? — Name Withheld
From the Ethicist:
It’s not the job of friends to play doctor. People who have been prescribed semaglutide will have received medical advice about possible side effects. More than a few will have experienced them. You imply there’s a moral problem about taking the drug, but you don’t say what it is.
Maybe your concern is that your friends have been prescribed a semaglutide medication for an “off label” use, one that hasn’t been authorized by the F.D.A. But physicians use off-label therapies all the time (including for serious conditions like macular degeneration, with backing from E.U. and U.K. authorities). You’d want to be specific about why this off-label use is objectionable.
Or maybe you’re worried that they’ve been using a drug that has been in short supply, posing difficulties for those with diabetes who need it. That was a real issue — though, as manufacturing has ramped up, a temporary one. You might still feel they had been selfish to make even a minuscule contribution to that shortage. (There are millions of semaglutide prescriptions in the United States alone.) If so, you might invite a broader discussion with your friends about the problems to which your own various habits of consumption are making similar contributions. Not knowing what your specific concerns are, I can’t tell you how to broach them. But if what’s really bothering you is the thought that your friends are taking the easy way out, well, I doubt that’s a cogent position. In any case, the evidence is clear: Moralizing weight issues doesn’t help solve them.
A Bonus Question
I’m 82, and my mother died when I was 8. I always thought she was buried in our family plot near the city where we lived at the time, but when I became interested in genealogy, I discovered her grave was actually in another state. Curious about the choice, I wrote to that cemetery’s office last year and asked if nearby gravestones bore any of my mother’s family names. They told me they would answer my question after I paid for the upkeep on my mother’s grave, which had been accruing for over a century. They enclosed a bill.
I’ve been a widow for almost 20 years, and my husband spent his final years in a nursing home, which drained our savings. It would be a serious hardship for me to pay this bill. But we’re talking about my mother’s grave — universally regarded as almost sacred. I loved my mother dearly, and part of me feels as if I’m abandoning her if I don’t pay up. But I don’t believe we stay in our graves, and another part of me thinks she would understand. I keep wondering where I stand, morally. The cemetery, meanwhile, has sent me another bill, this one larger than the last. — Name Withheld
From the Ethicist:
I see why you’re drawn to do something. My sisters and I were horrified when our parents’ joint burial plot in Ghana was set upon by grave robbers, and, at some expense, we put it back in order. However secular-minded you and I may be, the burial grounds of our parents feel somehow special. Still, you don’t owe this cemetery anything: It wasn’t you who decided where your mother would be buried. You shouldn’t be on the hook for money a cemetery chose to spend on the grave’s maintenance. Your mother died long ago, when things were different, but nowadays there’s an arrangement called an “endowment care,” in which people can set up a special trust fund that secures a grave’s future maintenance. Most cemeteries are also required to put some of their revenue into a “perpetual care fund.”
What do you owe your mother? Probably the love and gratitude you already feel. You aren’t letting her down by not paying this bill. In fact, you might be letting her down if you did: If your mother was anything like mine, she would have been horrified by the thought of your impoverishing yourself in your 80s for this reason.
Readers Respond
The previous column’s question was from a reader who, concerned about a friend’s obesity, wondered whether she should intervene. Regarding her friend, she wrote: “Food is her drug. It is clear she lives for it as an addict would. She steadfastly refuses to talk to me or her family about it. … What, if anything, can I do to help her?”
In his response, the Ethicist noted: “Unlike her primary-care provider, you have no special knowledge of complex conditions. (One such complexity: the vicious cycle that can arise between depression and obesity.) You may not be the right person to make a difference here. She has explicitly asked you not to raise the issue with her. As someone who cares about her, you obviously have reason to want her to get healthier. But you can’t insist on it. If the time comes when she cracks the door open to a conversation about her health, there’s plenty of good advice out there (including from the federal site Health.gov) about how to get into it — keeping your focus on her well-being, not her eating habits; avoiding fault finding, judgment and shame; talking with her, not at her.” (Reread the full question and answer here.)
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I can imagine everyone in this person’s life, with the best of intentions, is telling her that she should change. A more compassionate approach could be to offer loving presence; invite her to share what she is experiencing and feeling in her life, without judgment masked as instruction. In that safe space of acceptance, she may find an inner motivation for real change. — Matt
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One of my dearest friends has been quite overweight all her life. It is not for lack of knowledge, motivation, or effort. I know it is a hardship for her. I intentionally do not bring it up. As in any deep friendship, we need to know that we love each other, regardless of our physiques. — Linda
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The Ethicist missed an important part of the situation — whatever life pain or challenge is driving the friend to self medicate with food in the first place. The letter writer can be a good friend by offering curiosity and support about these different areas of her life, all without needing to mention the friend’s eating habits or body. — Amy
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Your friend has made it very clear that she doesn’t want you to talk to her about this. It’s not as though you’re telling her something she doesn’t already know. Instead all you are doing is creating an environment of distrust between you. You may not think you are being judgmental, but I would find it surprising that your friend does not feel judgment coming from you. Respect her wishes. — Elayne
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As someone who participates in a 12-step recovery program, I know the pain of watching loved ones struggle with addiction and difficult life choices. But I now also know the freedom of accepting my powerlessness in trying to change others and their choices. Your friend has shown you her boundaries. Now it’s time for you to take care of yourself and manage your own feelings around her choices. In finding ways to meet her where she’s at, you might actually be able to enjoy your friendship with her again. — Luca
Kwame Anthony Appiah is The New York Times Magazine’s Ethicist columnist and teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to ethicist@nytimes.com.
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FAQs
Is it safe to take Ozempic if you are not diabetic? ›
Ozempic is a type 2 diabetes medication which is prescribed to manage blood glucose levels. It is not a medication for people who do not have diabetes or are at risk of type 2 diabetes.
How long can you stay on Ozempic for weight loss? ›How Long Can You Stay on Ozempic (semaglutide)? A person can stay on Ozempic® so long as they are tolerating the medication and it is deemed appropriate by their treating provider. There is no specific time frame when someone should stop taking Ozempic as it is a medication that is intended for chronic (long-term) use.
How much weight can you lose on Ozempic in a month? ›So, on average, with the recommended starting Ozempic dose of 0.25 mg, a 500 to 1000 calorie reduced diet, and exercise 3 times a week, you can expect to lose 3-5 pounds in the first month of treatment, which works out to about 3% of body weight for most overweight or obese individuals.
What happens when you stop taking Ozempic for weight loss? ›If you stop taking Ozempic, the weight you lost will likely return, fast. People who ceased use of semaglutide gained back, on average, a full two-thirds of the weight they had lost on the drug within one year, according to an August 2022 study, the Wall Street Journal reports.
Can people without diabetes take Ozempic for weight loss? ›Ozempic is not FDA-approved for weight loss. Another brand, Wegovy, also semaglutide, is. Experts share that people who are not diabetic or obese should not use Wegovy or Ozempic for any reason, including to lose small amounts of weight.
Is it safe for anyone to take Ozempic? ›Ozempic is only intended and approved for people with type 2 diabetes. You should not take it solely for weight loss. Doing so may prevent patients who require the medication for blood sugar management from getting it. Interrupting their treatment with Ozempic creates serious health risks.
Do you gain weight back after stopping Ozempic? ›The anti-diabetic medication “Ozempic” (semaglutide) made by Danish pharmaceutical company Novo Nordisk. Patients taking blockbuster obesity drugs Ozempic or Wegovy will pack the pounds back on after they stop taking the medications.
Can you keep weight off after stopping Ozempic? ›Teresa Shepherd said she lost 90 pounds while taking an off-brand version of the drug Ozempic for around eight months. Shepherd, who lives in Florida, told "Good Morning America" she has been able to maintain her weight loss two months after stopping the medication.
What foods should be avoided in Ozempic diet? ›It is recommended that you take Ozempic before meals, rather than after, to minimise any potential side effects from eating high-fat or high-sugar foods. Foods high in fat or sugar include candy, ice cream, doughnuts, processed meats, french fries, fried chicken, any other fried foods, crisps and other fatty snacks.
Can you lose belly fat on Ozempic? ›Yes, Ozempic can be used to reduce belly fat. Studies have shown an average weight loss of 7.5% and a reduction in waist circumference by 5.09 cm.
How do I maximize my weight loss on Ozempic? ›
How can I maximise my body weight loss on Ozempic? You can assist Ozempic by lowering your overall calorie intake, moving your body where possible and limiting your alcohol consumption.
What does Ozempic do to your face? ›“Ozempic face” is a term for common side effects of the type 2 diabetes medication semaglutide (Ozempic). It can cause sagging and aging of facial skin. A doctor may recommend lifestyle modifications or facial fillers to treat these effects.
What is the biggest side effect of Ozempic? ›The most common side effects with Ozempic include stomach problems like nausea, vomiting, diarrhea, stomach pain and constipation.
Is Ozempic weight loss permanent? ›The viral diabetic drug and its active ingredient, semaglutide, have recently soared in popularity over their weight loss properties. That said, dietitians warn the drug's effects are far from permanent.
Can you quit Ozempic cold turkey? ›For most people, stopping Ozempic cold turkey is not recommended. When to stop Ozempic is an individual decision you should come to with the help of your healthcare provider. If your health provider agrees it's time to stop taking Ozempic, they will provide you with instructions for tapering off your dose.
What is the downside of Ozempic? ›Common Side Effects of Ozempic
“The most common side effects are gastrointestinal in nature: nausea, vomiting, diarrhea and constipation.” While the majority of people who take Ozempic will most likely experience these symptoms at some point during their treatment, they should subside over time, continues Dr. McGowan.
Celebrities who have used buzzy weight loss drug Ozempic — and who's denied it. Jimmy Kimmel joking about A-listers on Ozempic at the 2023 Oscars showed the drug is now mainstream. Celebrities such as Elon Musk have said they have taken weight loss drugs. Others, such as Khloe Kardashian, have denied it.
Why is Ozempic not covered by insurance? ›Did You Receive an Ozempic Health Insurance Denial? Perhaps We Can Help. Although Ozempic was FDA-approved in 2017 to treat adults with type 2 diabetes, some physicians prescribe it to obese or overweight individuals for weight loss. But health insurance companies often deny Ozempic, in part because it is expensive.
Do you stay on Ozempic for life? ›“There's a warning here: You take this drug and you lose a lot of weight. But you need to stay on it for the rest of your life. Are you willing to do that? And if you get off of it, the chances are really good you're going to go right back to where you were,” Heymsfield told Verywell.
Why do I feel so hungry on Ozempic? ›Ozempic contains semaglutide, which mimics a hormone called glucagon-like peptide-1; when people take the drug, higher levels of that hormone flood the receptors in our brain that regulate our eating behaviors, Dr. Hwang said, changing how our neurons transmit signals to the rest of our body.
Does Ozempic cause hair loss? ›
Hair loss was not reported as a side effect in clinical trials of Ozempic for type 2 diabetes. In a clinical trial of tirzepatide for weight loss in obesity, 5.7% of patients taking the highest dose (a 15-milligram once-weekly injection) reported hair loss compared to 1% of those who got a placebo.
Can I eat eggs while on Ozempic? ›For those on the drug, Rubin recommends increasing your intake of lean protein such as chicken, turkey, fish, eggs, beans, soy and low-fat dairy.
Can you drink coffee on Ozempic? ›The general guidance is that it's best to limit consumption to no more than one cup of coffee per day when taking Ozempic®—but listen to your body and, most importantly, stay hydrated.
Can you eat pizza on Ozempic? ›Foods that are high in fat
Plus, since Ozempic slows how quickly the stomach empties, these foods have even more time to hang around and upset the gut. Examples of these foods include: Fried foods: like french fries or fried chicken. Greasy foods: like pizza, cheeseburgers, and donuts.
Rapid weight loss from taking GLP-1 medications like Ozempic and Wegovy can cause a decrease in muscle mass, lessen bone density, and lower your resting metabolic rate, leading to sarcopenia. Sarcopenia is the gradual loss of muscle mass, strength, and function and is typically associated with aging.
How long does it take to lose 25 pounds on semaglutide? ›Try Semaglutide Injections for Weight Loss!
Most people expect to see results within 12 weeks of starting treatment. That said, semaglutide should always be taken along with regular exercise and healthy eating habits for optimal results.
With Calibrate, members can expect to start seeing results after a couple of weeks of tapering up on the medication. You'll likely notice some changes in appetite and reductions in food cravings within the first week.
What is the best day to take Ozempic for weight loss? ›What is the best time to take Ozempic®? Administer Ozempic® once weekly on the same day each week, at any time of the day, with or without meals.
Can you lose weight on .25 Ozempic? ›Ozempic isn't technically a weight loss medication. But it's considered safe and effective for Type 2 diabetes, and you may lose weight as a side effect of treatment. If you're prescribed Ozempic and you don't have diabetes, this is considered off-label use.
Can Ozempic cause rapid weight loss? ›The prescription drug Ozempic helps people with diabetes control their blood sugar. But its wild popularity is due to a side effect: rapid weight loss.
Does Ozempic leave saggy skin? ›
3 But the often quick weight loss people see on these drugs can lead to the unwanted issue of sagging skin—commonly known as “Ozempic face” or “Ozempic butt.” Age in particular is a big risk factor for loss of skin elasticity.
How do you prevent saggy skin with Ozempic? ›“If a person stops taking the medication and is able to maintain their weight, eventually the skin should retract some,” says Kadaj. When the skin retracts, the face will still look slimmer than it did before Ozempic, but there will be less sagging skin over time. As a result, the face will look less hallowed.
What are the emotional side effects of Ozempic? ›In rare cases, the use of Ozempic may cause anxiety and mood swings, irritability, shakiness, and confusion. However, when you take other medications along with Ozempic, it may escalate anxiety or mood change. Hence, discuss these potential issues with your physician beforehand to avoid any side effects.
What organ does Ozempic affect? ›Drugs such as Ozempic have caused new or worsening kidney disease, including kidney failure, in some people. If you become dehydrated from other side effects of Ozempic, such as vomiting or diarrhea, this could also cause kidney problems. Your doctor may monitor your kidney health closely during your Ozempic treatment.
How long does fatigue last with Ozempic? ›It may last for a few weeks while your body gets used to the medication and while your dose is increasing. Fatigue may be caused by other factors, however, so how long it lasts can vary. Lower your sleep debt and get in sync with your circadian rhythm to boost your energy levels.
Can Ozempic cause extreme fatigue? ›Yes, Ozempic® can make you tired. Why the medication has this effect in some people is not fully understood. It could be because Ozempic decreases appetite which leads a person to eat less and therefore get less energy from food.
Can I skip a day of Ozempic? ›If you miss a dose of Ozempic®, use it as soon as possible within 5 days after your missed dose. If you miss a dose for more than 5 days, skip the missed dose and go back to your regular dosing schedule. If you miss a dose of Wegovy™, and the next scheduled dose is more than 2 days away, use it as soon as possible.
What happens when you go off of Ozempic? ›The feelings of suppressed appetite will start to go away, and people will start to feel hungry much like they did before starting Ozempic, doctors explain. If you've lost a lot of weight quickly, you may feel even hungrier than before.
Do the side effects of Ozempic ever go away? ›Most people who develop side effects from taking Ozempic have only mild, short-term symptoms. Side effects of Ozempic should go away on their own after a few days or weeks. In rare cases, Ozempic can cause some side effects that may not go away. But these can be managed.
What are the dangers of taking Ozempic? ›- inflammation of your pancreas (pancreatitis). ...
- changes in vision. ...
- low blood sugar (hypoglycemia). ...
- kidney problems (kidney failure). ...
- serious allergic reactions.
- gallbladder problems.
Can I get Ozempic for weight loss? ›
Ozempic is sometimes prescribed off-label for weight loss but is mostly used to treat people with diabetes, she says. Health insurance companies can have other guidelines for covering Ozempic and Wegovy. Speak with your doctor and health insurance provider to see if you qualify for these drugs.
Can Ozempic cause low blood sugar in non diabetics? ›Ozempic is known to cause nausea, vomiting and low blood sugar when taken without advice from a doctor, and those taking the drug without a prescription should speak to their doctors before doing so. Additionally, diet and exercise must be taken into consideration when using Ozempic as part of any weight loss plan.
What happens if you eat sugar while taking Ozempic? ›High fat foods or sugary foods
Ozempic can cause nausea and vomiting if taken after eating foods high in fat or sugar. It is recommended that you take Ozempic before meals, rather than after, to minimise any potential side effects from eating high-fat or high-sugar foods.
“Overall, Ozempic is a very safe medication,” explains Dr. McGowan. “The most common side effects are gastrointestinal in nature: nausea, vomiting, diarrhea and constipation.”
Can I stop taking Ozempic cold turkey? ›For most people, stopping Ozempic cold turkey is not recommended. When to stop Ozempic is an individual decision you should come to with the help of your healthcare provider. If your health provider agrees it's time to stop taking Ozempic, they will provide you with instructions for tapering off your dose.
Can Ozempic damage kidneys? ›There is a potential risk of kidney injury associated with both Wegovy and Ozempic use since semaglutide is cleared out of your blood through the kidneys.
Why do I feel so sick on Ozempic? ›Nausea and Vomiting
The reason behind these unpleasant symptoms is that Ozempic slows down the movement of food through your stomach and intestines. This can occur particularly during the first few weeks of starting the medication as your body adjusts to the medication.