Why the Ozempic Conversation Has Become Unavoidable: Breaking Down the Controversy

Oh, ho, ho, no, it's not magic—you really are hearing about Ozempic a lot these days.

And if you're guessing the reason for all the chatter is that people started making TikToks about it...

Well, you are a winner at the game of Guess Where the Latest Trend Originated. In fact, TikToks tagged #Ozempic have been viewed hundreds of millions of times over the past year.

But what starts on social media rarely stays there, and it spread like wildfire that Ozempic—the trade name of an injectable medication called semaglutide that was FDA-approved in 2017 to treat Type 2 diabetes—was helping people lose weight. By last August, the FDA logged a reported shortage of the drug due to an increase in demand. 

"We're getting asked about it over and over again," Dr. Taz Bhatia, a board-certified integrative medicine physician and wellness expert, told E! News in an interview. "There are people having dramatic results—initially—and I think that motivates everybody, from 'I need 5 pounds off' to 'I need a hundred pounds off,' to start running to it as the answer and cure-all for everything. And we've had to navigate that in practice to help educate, from when is it an appropriate use to when is it not."

Meanwhile, the Internet has had plenty of opinions about taking Ozempic and whether it's OK or not. 

"Everyone is suddenly showing up 25 pounds lighter. What happens when they stop taking #Ozempic ?????" Andy Cohen tweeted last September, a day after Variety published a story declaring the substance "Hollywood's secret new weight loss drug."

The Watch What Happens Live host may have intended for that to be a humorous—and perhaps rhetorical—drop in the bucket, but the replies ranged from sober descriptions of what Ozempic is to jabs at Hollywood celebs for doing anything to stay thin to serious concerns about the drug's availability for diabetics who use it to manage their condition. (There was at least one plain "lmao.")

How does Ozempic work?

Semaglutide is in a class of drugs called GLP-1 receptor agonists, which stabilize blood sugar levels by mimicking a hormone in the body that regulates insulin levels.

"Blocking the ups and downs of blood sugar, that's indirectly how you manage appetite," Bhatia explained. "We get hungry when our blood sugar gets low. When we eat, our blood sugar goes up. We're technically supposed to feel satisfied, but for some people that natural rhythm is not there for different reasons, so that's what ends up being a problem."

(Meanwhile, not everyone on semaglutide is on Ozempic, a liquid that comes in a pre-filled pen that users self-administer once a week: Rybelsus is a version of the drug you can take orally, and in 2021 the FDA approved a higher-dose injection called Wegovy for chronic weight management in adults with at least one weight-related condition, such as high blood pressure or Type 2 diabetes. On Oct. 1, Elon Musk answered a fan's tweeted question about how he looked so fit with, "Fasting," followed by, "And Wegovy.")

Used as intended, Ozempic and its sister medications can bring diabetes markers down for people, Bhatia said, "as long as they can tolerate the medication." (See: the list of potential side effects that accompanies every pharmaceutical ad, on TV or in print.) 

And for some patients, a drug like Ozempic can be "a game-changer," she noted. "But it doesn't stay a game-changer unless they're able to manage the rest of their health."

The drug trial snapshot on the FDA's website states that Ozempic is most effective as a treatment for Type 2 diabetes when used in addition to diet and exercise.

How did Ozempic go viral?

Ozempic's biggest viral moment of 2022 came when a TikToker theorized last fall that Kim Kardashian used the drug to shed 16 pounds ahead of the 2022 Met Gala, in order to fit into the Jean Louis dress that Marilyn Monroe wore like a second skin to sing "Happy Birthday" to President Kennedy in 1962.

Kim never directly addressed the unfounded rumor, having told Vogue last May that she reached her goal size by wearing a sauna suit, running daily, eating "the cleanest veggies and protein," and excising sugar and carbs from her diet.

"I didn't starve myself," she said, "but I was so strict." (Her explanation proved controversial anyway, and when asked about her critics she told the New York Times that she "didn't do anything unhealthy...I wasn't saying, 'Hey everyone, why don't you go lose weight in a short period of time?'")

Khloe Kardashian, however, clapped back in January at a commenter who speculated, "The fact that she uses dibetic [sic] medicine to get this skinny is disturbing." The Good American co-founder replied, "Let's not discredit my years of working out. I get up 5 days a week at 6am to train. Please stop with your assumptions. I guess new year still means mean people."

So while there's been a reported increase in off-label prescriptions—i.e. taking a drug for reasons other than its FDA-approved purpose—among the celebrity set, Hollywood nutritionist Matt Mahowald told NBC News in October that, from what he's witnessed, the clamor for Ozempic for weight loss purposes knows no professional or geographical bounds. (Though it might know some financial ones, a one-pen package holding four doses—roughly a month's supply—costing upward of $900 without insurance.)

"People are always looking for the magic pill," he said. "They'd rather just take a pill and not worry about what they're eating."

Bhatia has observed the same trend in health care.

"Who doesn't want the easy way out?" she told E! "Who wants to talk about hormone health and inflammation, when our medical system and our culture is designed to say, 'What is the one thing I can do?'"

But while we may be in the midst of peak-Ozempic, the pendulum is starting to swing the other way.

"I think we're going to see a turn," Bhatia predicted. "Initially it was, 'Oh my gosh, I want this, I want this, I want this,' and that's led to a shortage. And now you're seeing a little bit of a backlash [from patients]: Oh my gosh, this made me miserable,' 'I have Ozempic face,' or 'The weight came back right after I came off of it.'"

New York dermatologist Dr. Paul Jarrod Frank, who says he coined the term "Ozempic face," explained to The New York Times in January, "A 50-year-old patient will come in, and suddenly, she's super-skinny and needs filler, which she never needed before. I look at her and say, 'How long have you been on Ozempic?' And I'm right 100 percent of the time. It's the drug of choice these days for the 1 percent."

Which celebrities have spoken up about Ozempic?

But though Hollywood has caught its share of the blame for popularizing the drug, there aren't all that many celebrities volunteering as tribute.

Though Tim McGraw and Faith Hill's 26-year-old daughter Gracie McGraw opened up about previously using Ozempic to treat her polycystic ovary syndrome and Shahs of Sunset alum Golnesa "GG" Gharachedaghi recently said she didn't "see a reason to hide" her Ozempic use, Khloe isn't alone when it comes to bold-faced names wanting to be clear that they haven't touched the stuff.

Kyle Richards also denied taking Ozempic several times in response to multiple comments left on her Instagram fitness pics, while Meghan McCain recently wrote a Daily Mail essay describing how shocked she was by how many people, "from casual friends to industry acquaintances," brought up Ozempic as an option to drop baby weight after she gave birth to her second child.

For the record, put Meghan down as a hard no.

"It's hard to take a drug because swimsuit season is around the corner, while others need it to stay alive," she wrote. "And how can this be healthy? A pill or a shot can't solve every problem in life, yet too often that's what Americans reach for. And Ozempic plays into that perfectly."

Ozempic maker Novo Nordisk previously told E! News that the drug is not FDA-approved for chronic weight management, nor is it marketed as a weight loss aid.

"While we recognize that some healthcare providers may be prescribing Ozempic for patients whose goal is to lose weight, Novo Nordisk does not promote, suggest, or encourage off-label use of our medicines and is committed to fully complying with all applicable U.S. laws and regulations in the promotion of our products," the Danish pharmaceutical company said in a statement. "We trust that healthcare providers are evaluating a patient's individual needs and determining which medicine is right for that particular patient."

The FDA's latest update from May on the Ozempic supply still has the lower-dose pens categorized under "currently in shortage" due to demand increase. (Novo told NBC News in October that "incredible demand, coupled with overall global supply constraints" was impacting various doses, "leading to intermittent disruption of patient supply.")

So, it's not inconceivable that the fascination surrounding who's taking Ozempic to lose weight or not is making it seem as if its use is more prevalent than it is. Even though the impression for some is that everyone is taking it, or is at least Ozempic-curious.

"My anti-aging doctor just hands it out to anybody," Chelsea Handler said on the Jan. 25 episode of Call Your Daddy. "Obviously now I can't say her name, but I didn't even know I was on it. She said, 'If you ever want to drop five pounds, this is good.'"

The comedian explained that she did know she had injected herself with medication, she just knew it as semaglutide and didn't realize that's what Ozempic is. Handler said that, aside from suspecting it made her nauseous, "it was silly" for her to take it and she passed her supply along to friends.

Handler added that taking a drug meant to treat something else was too irresponsible, even for her. "I'm an irresponsible drug user," she quipped, "but I'm not gonna take a diabetic drug. I tried it, and I'm not gonna do that. That's not for me. That's not right for me."

TikTok style maven Remi Bader said on Amanda Hirsch's Not Skinny but Not Fat podcast in January that she was prescribed Ozempic in 2020 after being diagnosed as pre-diabetic. While it curbed her appetite and led to weight loss, she said, once she went off it, she gained twice as much back.

"It was making me think I wasn't hungry for so long," Bader said. "I lost some weight. I didn't want to be obsessed with being on it long term. I was like, 'I bet the second I got off I'm going to get starving again.' I did, and my binging got so much worse. So then I kind of blamed Ozempic."

Hirsch declared the drug to be "everywhere," adding, "It does upset me if literally the whole world is taking shots that have negative side effects that could potentially harm your health."

Is Ozempic an effective weight loss treatment?

"This is one of those medicines where it was initially studied for Type 2 diabetes, and when they did the studies they found, 'Wow, look at this, it also results in weight loss," NBC News medical contributor Dr. Natalie Azar said on TODAY in January. But, she continued, "When you stop it, so far the studies suggest, yeah, the weight's gonna come back on. The medicine really only sticks around, the benefit, for about three to four weeks."

And when it comes to using drugs like Ozempic for reasons other than their stated purpose, Azar noted, "whenever you're using something off-label, you have to be cautious."

There would have been "slower awareness" around Ozempic if it wasn't for social media," Bhatia told E!. "But social media plays into a lot around this topic—how we feel about our bodies, how we're comparing ourselves to everyone."

And, she acknowledged, it has become "really tricky" to talk about weight in a public forum.

"We all come in different sizes and shapes," the Super Woman Rx author said. "That's a different conversation from weight that is triggering inflammation, that is causing joint pain, messing with hormones, driving cholesterol up, increasing heart disease and stroke risk, and putting you on 10 different medications—those are two very different conversations."

Losing weight without drug intervention is "such an individual conversation for everybody," Bhatia said, but she points to tried-and-true methods: "moving throughout the day, drinking plenty of water, focusing on sleep, increasing muscle mass, and then really observing a healthy, non-inflammatory diet. Those are certain fundamentals and it really does help a person get the weight off."

In the meantime, she has seen weight loss and wellness trends come and go, and Ozempic-mania too shall pass.

"I think that's true of every trend," she noted. "It doesn't work for everybody, it's not all it's cracked up to be, and then it loses steam."

(Originally published March 1, 2023 1:00 p.m. PT)