‘Ozempic helped me lose 40kg – and my social life?’
What if Ozempic didn’t just kill your appetite? What if it left you fundamentally changed, unable to experience desire in the same way again? At the weight-loss medication frontier, something weird is happening.
Les Bridges has always been a man of big appetites. Six coffees a day, dozens of cigarettes. Bacon and egg toasties for breakfast, burgers for lunch, four pints of Guinness after work, wine with dinner, “pissed as a parrot” at Friday afternoon poker games.
“I’ve been very good at excess,” the 57-year-old says.
“I like to let my hair down. But as I got older, my body started keeping score. I hit 122kg. My feet were killing me. I had high cholesterol. Last year my heart specialist asked me, ‘Would you be having more than seven standard drinks a week?’ I said, ‘Geez Doc, I’d spill more than that.’ He suggested I try Ozempic.”
On the day we meet, Les saunters through the door, tummy first, in a green shirt so loud it hurts my eyes. Standing six foot tall in his socks (“I’m 6’2 in sneakers”), he has dropped almost 20kg in six months and, like all the Ozempic users we spoke to for this feature, refers to his weight-loss experience in almost evangelical tones.
“I know I’m a work in progress, but I’m a featherweight compared to what I was,” he says. “All of a sudden, I’m getting eyes from the ladies. They’re saying, ‘Look at you, Les. Look how good you look’. I’m getting shitloads of attention and I’m loving it.”
Born in Germany and “dragged up” in Yorkshire, England, Les wagged school as a 13-year-old to sit in the library reading books on electronics. He became an appliance repairman, emigrated to Perth, grew a successful business, married for a third time.
His youngest daughter is now five. When we first speak, he’s barrelling down the Kwinana Freeway headed for home in Preston Beach, an hour and twenty minutes south of Perth.
“I’m the jolly fat guy,” he tells me with his phone on speaker, “the tubby guy playing cards, the lump at the lights eating in his van. But I didn’t wanna be the lump. I wanted my wife to be proud of me. I wanted to stay alive for my little girl.”
One milligram of Ozempic injected every Sunday has done more than obliterate Les’s appetite. It has smothered his lifelong cravings.
“It’s bizarre,” he says. “But on this drug, I’m completely turned off by junk food. You wouldn’t get me in a McDonald’s now. I couldn’t even set foot under the arches without feeling sick. I’m off bread. Coffee? Ugh. Bacon and egg toasties? Gross.”
It’s a familiar song sung by those who have lived with obesity; the sudden quiet after all that “food noise”.
Then Les adds: “Ozempic doesn’t just remove your appetite. Somehow it takes away desire. I’ve completely lost the desire for the bad foods I used to love.”
What we’re learning is, it’s not just food.
Losing weight has, until now, been a real accomplishment: the result of dedication and self-discipline. Injecting yourself thin, on the other hand, is a bit like finishing a marathon, only you did it in the car.
If willpower is not your superpower, and you’re one of the 13 million Australians considered overweight, perhaps you’re salivating at the prospect of trying this latest class of metabolic medicines.
Australia’s medicines regulator, the Therapeutic Goods Administration, insists there is still no medical antidote to obesity because these new injectables will not be effective for everyone.
Ozempic, it says, is only approved for diabetics, but admits: “We can’t force doctors to stop prescribing it for other reasons.”
And the TGA’s increasingly strident warnings to journalists writing about weight-loss drugs not to stray into promotion underscores the sobering truth that we still don’t know the precise mechanisms of how the drugs work.
Certainly, their often savage side effects have become a talking point: in January the British singer Robbie Williams became so malnourished on these drugs he was diagnosed with scurvy.
Jeremy Clarkson of Top Gear fame said he was projectile-vomiting several times a day. One GP tells me it’s common for patients to be afflicted by diarrhoea that “Jackson Pollock would’ve been proud to paint”, or to be “backed up to next Tuesday”.
There are reports of temporary blindness. And now, scientists are raising new and baffling questions about how obesity drugs could be altering the reward circuitry in the brain.
Les Bridges is almost giddy with hope that his lifelong obsession with food has been expunged.
“It’s human to want a magic bullet, because we all know the effort required to diet is exhausting and demoralising,” he says.
“I know there’ll be [fellow] non-diabetics who’ll only get grief from Ozempic. They’ll be sick as dogs. Me? I know it’s just a fluke I’ve had no nasty side effects. The injections don’t make me sick. My feet don’t hurt anymore. I’m not smoking, not drinking beer or wine.”
I raise an eyebrow, impressed.
“Though I have taken up vodka.” He snorts. I laugh. “But nothing has ever worked for me like this drug. Sure, I wee like Austin Powers and the number twos are like tennis balls – get comfortable with that idea. But I’m the best version of me now. It’s a wonderful place to be. Now I’ve got to work like buggery to stay here.”
So what must it be like to stop wanting? For some, the sudden absence of cravings feels like exquisite freedom. But for many, life on these shape-shifting medicines becomes emotionally dull and strangely empty.
As more and more people turn to new-generation diet drugs for warp-speed weight loss, there’s growing evidence that Ozempic and its bedfellows Mounjaro, Wegovy, Trulicity and Saxenda might be rewiring the pleasure pathways in users’ brains.
This latest class of weight-loss drugs are called GLP-1s because they mimic a natural hormone called “Glucagon-like peptide-1”, which prods the pancreas to release insulin to lower blood sugar after eating – a godsend for diabetics.
It also blunts the appetite by slowing the passage of food through the stomach, leading to feelings of fullness. And it produces all sorts of cascading effects because the human body has receptors for it not only in the gut, but in the liver and brain too.
Before prescribing GLP-1 drugs, doctors will advise patients of the uncomfortable side effects: diarrhoea, constipation, nausea, reflux, vomiting, headache. They’ll then map out the dosage schedule and the cost.
Diabetics get a three-week supply of PBS-funded Ozempic for $31.60; for weight loss, non-diabetics are slugged $250 to $380 per month, depending on how high a dose they need. For some, the cost is immaterial if these drugs tame the monster of food addiction. But those who can’t afford them accuse Big Pharma of discriminating against non-diabetics who need to treat their obesity.
Strange byplays are emerging in this field. The original science that underpinned Ozempic’s development has fallen apart. Researchers thought that GLP-1s worked primarily on the human gut, but then discovered their effect was broader on the human brain.
Now, they believe these drugs use the gut-brain axis to turn down the volume on all kinds of addictions, from alcohol to gambling to smoking and even nail-biting. Scientists are not yet certain if GLP-1s work directly on brain chemistry in these instances, or whether the ability to control overeating opens a door to other kinds of self-discipline.
But it begs the question, will injecting yourself with obesity drugs reduce all compulsions, or just the strongest ones?
In answer to our questions, the TGA states that it does not provide clinical advice, adding: “The use of medicines for an unapproved indication, for example Ozempic for weight loss, is known as ‘off-label’ prescribing, and is done at the discretion of the clinician with the informed consent of the patient.”
So, how far into the brain do these drugs go? Psychiatrist Dr Sally Kelderman says GLP-1s cross the blood-brain barrier, explaining: “We now think that GLP-1s are able to pull off a neat trick deep in the nucleus accumbens, the pleasure centre in the forebrain. We believe they act as neurotransmitters, which allows them to deactivate those neurons crucial for processing reward and motivation. The brain only has one reward system – there’s no special reward system for food and another system for sex, or drugs. So if GLP-1s are dialling down food cravings, it’s not surprising they’re dampening all kinds of desires. We need more solid evidence from trials, but my concern is that we’ll need to start watching patients for signs of anhedonia – a lack of interest and enjoyment in life.”
What all this means is that these medications could ultimately transform our relationship not just with eating but with all sorts of habits. The bigger picture will surface if these treatments become mainstream, as they likely will.
The investment bank Morgan Stanley reports that in July last year, there were 79,000 Australians using Ozempic. It predicts that number will leap to 2.4 million by 2030 – equivalent to nine per cent of our population.
All this comes amid fears that US rivals are eating into the market share of Danish pharmaceutical giant Novo Nordisk (which makes Ozempic and Wegovy) in this fast-evolving area.
New products on the way include a monthly injection, MariTide, made by US firm Amgen, which is now undergoing phase 2 trials; users report shifting up to 20 per cent of their body weight, which stayed off for five months after injections ended.
Then there’s the GLP-1 Orforglipron, due to be licensed in the US next year as a daily tablet. Ready access to drugs we don’t understand is only growing as analysts forecast the weight-loss drugs market could be worth as much as $150 billion by the early 2030s, according to Reuters.
The history of medicine shows a few drugs towering over all others. Statins for lowering cholesterol. Prozac for depression. Viagra for sexual dysfunction. Ozempic and its GLP-1 friends and descendants have the potential to eclipse them all.
The origins of this medicament were discovered in the venomous saliva of a species of lizard known as the Gila monster, native to the southern US. Biochemists identified a substance in the saliva that regulated the lizard’s blood sugar during hibernation, and became convinced a synthetic version might help diabetics.
Marketed under the name Byetta in 2005, its early users reported a welcome side effect: speedy weight loss. By 2017, Novo Nordisk had developed an even more efficient type of GLP-1 drug called semaglutide, approved under the brand name Ozempic in 2017.
In Australia, even GPs reluctant to prescribe GLP-1s for weight loss are beginning to see them as potential game-changers for blunting all kinds of corrupting desires.
“I’m seeing some striking findings,” says Dr Mike D’Arcy-Evans, a Perth GP with a special interest in obesity.
“This year, 50 per cent of my Ozempic patients – people who really like a drink – are suddenly going off alcohol. GLP-1s could absolutely change the way we live. When you see even physicians jabbing themselves, you wonder if this might be the most exciting – and controversial – drug of our generation.”
But while many patients appreciate how the drug helps to rein in their drinking, others are uneasy about its wide-ranging effects.
“I crave nothing and my libido has bombed,” a girlfriend tells me.
“You know me. I’m into wine and cheese. That’s my thing. Now I can’t stand the stuff. Brie? Ugh. A glass of chardonnay? You couldn’t pay me to drink it now. I feel physically repulsed by the thought of alcohol. Even the sound of my husband chewing makes me nauseous. The other night, he and the kids were eating those sticky pork ribs and I had to leave the room. Who am I? I used to love ribs.”
Morgan, a 25-year-old Ozempic user from Bayswater in WA, tells me she has stopped baking – a lifelong love of hers – because it no longer gives her pleasure.
“That hobby has gone out the window. I used to make really good almond croissants and cinnamon scrolls. It makes me a bit sad. I’ve lost 17kg in the past year, but I think Ozempic is changing the way my brain works,” she says.
All but one of the six GLP-1 users I interview for this story say they’ve lost their taste for alcohol. Ozempic user Anthony, a 63-year-old lawyer from Melbourne, has lost 14kg in a year.
“I can still bash the bottle if I want to,” he says, “but I don’t seem to want to. Ozempic has completely cut my appetite for booze.”
Early human trials are giving hopeful glimmers that GLP-1s could also revolutionise treatment for other addictions. GPs say patients are reporting diminished compulsions for smoking, gambling, online shopping and even shoplifting.
A six-month trial at the Texas Health Science Centre in Houston in 2021 found 46 per cent of smokers who wore nicotine patches and received a weekly GLP-1 injection quit smoking, compared to 27 per cent who relied on the patches alone.
Desire is a fraught notion. It drives otherwise rational people to intense, irrational feelings. Pleasure-seeking is good, we’re told, because it motivates, but too much desire is the seed of addiction. Most food cravings operate on a level well below conscious awareness, and beyond self-control.
Who can resist the lure of a pile of potatoes roasted in duck fat? Force 10 willpower is required to say no to warm sourdough and a wodge of butter. Why can’t we be comforted by chickpeas instead of chocolate?
The urge to overeat is a malfunction of our mesolimbic system – the reward pathway in the brain facilitated by dopamine. Trained over time by our individual wants, it learns how to compel us towards that second wedge of mudcake, a third glass of red, the roulette table at the casino, another half-hour scrolling on TikTok.
Binge-eating reveals another of the brain’s secrets: what we crave doesn’t always reflect a physiological need. Ozempic has shown us that the wiring of desire can be surprisingly easy to manipulate.
In laboratory trials in 2020, researchers at the University of Michigan found that rats would compulsively – and repeatedly – press a switch that delivered both dopamine and electric shocks to them.
The experiment demonstrated that dopamine can goad the brain into “wanting what hurts” – the strongest evidence yet that desire overrules willpower.
Then there was the study published last year in the International Journal of Impotence Research that found men aged 18-50 taking Wegovy or Ozempic for weight loss were more likely to develop erectile dysfunction and testosterone deficiency.
One of the authors, Dr Joseph Sonstein, an assistant professor of urology surgery at the University of Texas, was surprised.
“We thought that weight loss had a positive effect on testosterone levels and sexual desire. As it turned out, the data showed the exact opposite,” he told Australian Men’s Health. The research into cause and effect here is young, so for now, the fine print lists sexual dysfunction as a “possible” side effect.
Weight-loss drugs are also altering the dynamics in relationships. First, there’s the obvious consequence of a sudden life-change. In an interview with The Times, Dr Jack Mosley – son of the late Dr Michael Mosley, and author of a recent book on weight-loss drugs – likened it to so-called “bariatric divorce”, where patients who undergo drastic weight loss start to experience marital tensions. GP D’Arcy-Evans adds that it’s not uncommon for marriages to buckle after newly thin spouses rediscover their confidence.
“I know of a patient who lost 30kg and said to his doctor, ‘I’ve got something to tell you. I’m gay. My wife and I have separated’. It was the weight loss that allowed him to come out of his shell.’”
Compounding the effects of sudden, newfound self-esteem are what’s been referred to as “Ozempic personality” – or, as The Times put it, “the change in outlook that turns a former bon viveur into a pleasure-avoidant zombie”.
Tracy Silbert, 57, from Perth’s City Beach, was not prepared for the upheaval that weight-loss drugs would create in her 20-year marriage. Ozempic “and hard graft” helped her lose 40kg, the last 15kg dropped in three months flat.
But the drastic changes to her body – and the mutiny of her appetites for socialising and entertaining – has forced a renegotiation of her relationship with husband Joel.
“I don’t want to go to parties or out to dinner,” she says.
“I don’t want to drink alcohol and I don’t want to eat food. And they’re the two things my husband loves, except for me. I’ve gone from 109kg to 60kg. I’m no longer dependent on Joel for my self-esteem, for my security. It does make it difficult. Joel wants to taste and talk about wines and now he’s got no one to do that with.
“That’s hurtful because he says, ‘Why can’t you just do that for me?’, but I just can’t. I won’t even take a sip. Booze makes me feel queasy. The thought of red meat makes me sick. If we’re at the footy, I can’t stomach the junk food, so sometimes I’ll say, ‘Just take someone else’. I’m sure Joel would say getting skinny has changed me. But I wonder if this is a side effect we’re not talking about?”
Tracy’s weight issues began with polycystic ovary syndrome in her twenties, gestational diabetes in her thirties, and a diagnosis of type 2 diabetes in her forties.
“I was the sporty chick who ate too much and paid the ultimate price. In the end, my weight made me diabetic,” she says.
“I could eat an entire packet of Tim Tams, a whole cheesecake in one sitting. When I was really fat, I loved being in the pool with Joel because it was the only place he could hold me. For once I was weightless.”
Food has been her enemy as long as Tracy can remember.
“Give me a year and I’ll tell you what I weighed,” she says. “I’ve done the Scarsdale diet, the cabbage soup diet, the cigarette diet.”
She lists off on her fingers, “Weight Watchers, Jenny Craig, Lite n’ Easy, intermittent fasting, paleo, keto, a dietitian … I’ve taken Xenical – you’ll need spare undies in your glovebox; Duromine – I was a bitch on that stuff from lack of sleep; Farxiga – genital infections is the first side effect on the box.
“The diet industry thrives on failure,” she continues.
“Mum was always on at me about my weight – ‘You’ll lose your husband,’ she said more than once. The one person you don’t want to hear that from is your mother.”
Tracy, a spirited golfer, once played in an international tournament weighing 100kg. At her best (and her heaviest), her handicap index was 8.8.
“The weight never stopped my golf, but my feet were killing me,” she says.
“My knees were killing me. The 18th hole at my club is called Cardiac Hill and I’d ask everyone to hit their ball first because I was gasping by the time I got to the teebox. Weirdly though, losing the weight meant losing my game. My balance went and I’ve had to learn to swing again. My handicap is now 11.”
She grimaces. “But at least I know I’m not going to die on Cardiac Hill.” Then she adds: “Ozempic is life-changing.” How positive are those changes?
For those who’ve lost control of the body beautiful, the humiliation of being overweight is a scar worn on the soul. “I can almost pick which couples are going to split when one of them becomes suddenly thinner,” says Professor Jeff Hamdorf AM, a bariatric surgeon and Professor of Surgical Education at the University of Western Australia.
“Empowerment is an interesting concept. You need a really supportive partner when you’re going through rapid weight loss because deep down, many of my patients despise themselves. Their loss of self-worth creates shame and guilt. These are patients who feel beaten up every day.”
So into the suburbs arrives Ozempic, here comes Mounjaro and Wegovy – white horses all – galloping across the pharmaceutical landscape to rescue us from our surplus flesh, our beer bellies and barge-arses, our jiggle and wobble, chins and jowls, promising us the holy grail of “thin and in”, the streamlined physiques we were meant to live in, the admiration doled out to the svelte.
“We found that often, our bariatric patients were using food as an emotional tool,” says Hamdorf. “But once they’ve lost a lot of the weight, what do they use for comfort when food is no longer an option? Some respond by compulsive exercising, or sex addiction, or drinking or gambling. If GLP-1 drugs turn off desire, where do these patients turn to for rewards? We may have to start telling our patients to expect personality changes.”
We asked the TGA if it knew of any evidence linking the use of Ozempic with a decrease in addictions of any kind, but in particular for alcohol, smoking and gambling. The regulator responded to say: “We are unable to comment on the use of a medicine outside of its approved use. The TGA evaluates applications from the pharmaceutical company responsible for the medicine (otherwise known as the sponsor) for specific indications.”
The consequences of the Ozempic revolution will be economic and social, as well as medical. Airlines are salivating at the prospect of a fast-slimming population. A 2023 analysis by US investment bank Jefferies estimates United Airlines would save $124 million a year in fuel if passenger weights dropped 4.5kg.
Nick Cusack, a 55-year-old fund manager, tells me Ozempic has freed him from the ungainliness of air travel. At 170cm tall, he hit 112kg and got a “kick up the bum” from his GP. “Away from home, I had no routine,” he says.
“I was eating out every night, my diet was rubbish … I kind of wore my weight as a badge of honour, the product of a successful career.” Two years ago, Nick was diagnosed with type 2 diabetes.
“My GP read me the riot act. I dropped 8kg on the diabetes drug Metformin, but then got slack again. The weight went back up, the sugars went back up. Seven months ago I started on Ozempic. I’m down 15kg. Last week my blood sugars showed I’m back in non-diabetic range.
“I’ve gone from six drinks after work to one. Sure, the habit’s still there, but the physical desire? It has lost its edge. But the first couple of months on Ozempic, I felt weird. I can’t explain it. It’s such a relief not to be ruled by food, but some days I realise I haven’t eaten since the day before, and then I think, ‘I’m hungry, but I don’t know what to eat.”
Not everyone who struggles with their weight will declare GLP-1 drugs their saviour. Hamdorf urges prudence: “Some bodies will always defend their weight, even after surgery. We know five per cent of GLP-1 users will find themselves classified as non-responders. Then what? You’ve failed to get your weight under control and now you’re a failure on Ozempic? And let’s not forget, plenty of non-diabetics can’t afford the minimum $250 a month for the privilege of trying. Many are already finding the nausea and stomach upsets intolerable. And we know that one major downside of these drugs is that if you stop taking them, you’re likely to regain the weight.”
GPs like Mike D’Arcy-Evans say Ozempic “syndrome” will take a while to show up in the population: “I’m starting to see patients losing twice as much muscle as fat in a short space of time. That’s a question we need to answer: why do you lose muscle so easily on this drug? And we need a better understanding of how these drugs work on the brain as well as the gut. We don’t want them working so well they crush our patients’ enjoyment of life.”
The soaring popularity of GLP-1s is already causing a rift between the rallying cries for body positivity and those “selling out” for their own vanity. No wonder Ozempic enthusiasts are often coy about disclosing how they crossed the border to Thinness. But as more becomes known about Ozempic personality challenges, how many will risk dulling their joie de vivre for the chance to look better? Granted, you’ll be thinand abstemious. But what does it mean if you’re joyless?
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