I'm a Pharmacist - This Is What I think About Ozempic

When fashion and pharmaceuticals combine...Enter: Me.

When it comes to having a complicated relationship with body image, suffice to say that I get it. Finding new and interesting ways to be critical of the body I inhabit, despite it continually serving me well, is one of my pastimes. Of course, in The Ideal World my self esteem would remain intact independent of my weight, shape, or size. In the same ideal world, body neutrality would be commonly practiced across society, and no one would comment upon or care about anyone else’s shape or size; being described as skinny wouldn’t be perceived a compliment, and we would all recognise that “feeling fat” makes no sense, as fat isn’t an emotion. (Not a state of mind, baby, but body).

In this Ideal World, cheese wouldn’t contain these pesky calorie things, and these calories wouldn't, in surplus, lead to excess fatty body tissue. And while we are here, murderous dictators would take well to a casual “have you considered being less of a murderous dictator?” and just change.

But The Ideal World, as lovely a place as it may be, is but a fantasy.

I should know. I’m just back from a holiday where I frolicked with women whose bums were high and toned. They’ve worked for them. They have discipline, and have implemented routines that make looking after their bodies a way of life, and, what’s more, they enjoy it. I watched on as the outside world appreciated the fruits of their lifestyle labour.

I can see why those whom, through choice or circumstance, don’t put in the intense effort to build the lifestyle required to achieve and maintain these bodies, long for them.

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Semaglutide - the drug in Ozempic - was originally researched and developed for people living with diabetes. The medication makes the patient - note patient, in this case - feel fuller for longer, and tricks the body into thinking that it needs to produce insulin, which leads to weight loss. Earlier iterations required daily administration - these drugs have been around for longer than you may think - and it took more research and development to formulate the long acting, once weekly preparations that are now market leaders. For patients with diabetes, the prescribing of these medicines represents a worsening of illness. I was often struck, when counselling these patients in my past life, by the devastation that accompanied the realisation that they would have to routinely self inject - much more invasive and disruptive to their routines than popping their daily tablets.

So how has it become so mega, with people on waiting lists to shoot this stuff up? Firstly, America (where around 70% of the population is overweight) and New Zealand are the only two countries in the world where prescription only medicines can be advertised directly to the public. The rest of the world restricts this direct advertising to healthcare professionals only, with ethical considerations at the heart of this decision - can it really be argued that promotion of prescription medicines to consumers encourages the safe and rationale use of the medicine? Perhaps it be said that it encourages consumers to prematurely adopt a patient mentality? Is it right that cheaper, more efficacious medicines risk falling off the market, simply because of a weaker promotional campaign? There aren’t easy answers to these questions, and a weight loss preparation serves as a perfect test case. The complicated relationship many of us have with with self is one ripe for exploitation. Our vulnerabilities about our bodies, our shame at a lack control over weight management, leaves us susceptible to poor judgement, and regulation or law should be sufficiently stringent to leave no room for corruption of medical ethics.

Semaglutide manufacturers are currently suspended from the Association of British Pharmaceutical Industry due to rogue advertising practice that breached the code of practice. Its is unlikely to bother the Pharmaceutical company - the product is such a money spinner, that the fines and reputational damage incurred won’t cause such stress that they will be driven to comfort binge eat, shall we say.

Anyway, compound the direct to consumer advertising, in America, with the power of a celebrity endorsement. And compound that with the modern day phenomenon of going viral.

And finally compound that with a worldwide obesity epidemic. And that is how Ozempic cemented its status as a cultural phenomenon.

Them’s the facts.

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Ozempic is effective for weight loss. There is no doubt about it. So far, it has a favourable safety profile, when used safely, although side effects such as nausea and vomiting can be severe. When not used safely, as when used by those who are of a healthy weight but want to drop a few kilos, side effects include death. Not to forget that there are potential side effects still to be realised - already, and unexpectedly, we are seeing “Ozempic Pregnancies” as women, especially those suffering from PCOS, are becoming more fertile as they regain insulin control. And of course “Ozempic Face” - although this is a by product of fast weight loss under any circumstance, really. As for the other indicators of health - cholesterol, lung function, hormone regulation, immune responses - the metrics ascertained by blood work and careful examination - the effects of this class of medication is neutral. And they certainly have no direct effect on self esteem.

It is also expensive. As are diet programmes and gym memberships. Might being thin soon become a paid for privilege in the UK? Similar goes for oral care: as dentists flock to leave the NHS due to poor conditions, and set up private clinics, we are already paying the price for upkeep of dental hygiene and a healthy set of gnashers. Only those who can afford it proactively seek dental treatment. These prohibitive price tags exclude many, and potentially deepens the already rampant class divide.

Lastly, the use of these weight loss products abandons the requirement to adopt a lifestyle that leads to a thin body, therefore foregoing so many additional health benefits - not least those to mental health.

Them’s the arguments.

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But the popularity and demand for Ozempic proves, if proof were needed, one thing: that we are not, as a society, as far down the road towards “body positivity” as we thought. There are true champions of the movement - tip of the hat to

Farrah @Substack

(newly awarded MB freaking E - get it girl) deftly handling a scrappy Piers Morgan in this clip, years ago - but fashion is fickle, and too often those parroting, or profiting from, what the true pioneers say, amounts to little more than virtue signalling. It’s a nice theory, for other people to be or to accept “fat”, but too few of us are really open to challenging our own accepted norms and recalibrating our thoughts and words to replace them with something fresh. It is fashionable to endorse the movement, but the notion has never really been taken to the bony bosoms of the fashion pack, or girl circles - more they consider it a niche arms length minority group that it felt reassuringly generous to champion for a while. It is easy to support body positivity, but another thing entirely to reserve judgement, or call out reductive behaviour towards someone who is fat.

Promotion of weight loss products perpetuates the myth that skinny, or thin, is superior. And that, I am sick of. I am sick of womens bodies STILL being talked about, and being equated to their worth. I’m even sick of my inner critic’s - a regular around here - comments on my own. Back to The Ideal World: a place with no more patronising congratulations to the big girl unabashedly rocking the skimpy frock - either on a magazine cover, or in da club. No more celebrations of weight loss, or false concern with murmurs of “is she ok?”, behind her back when she “takes it too far”. Body positivity is about AN individual feeling good in THEIR body, and absolutely nothing to do with anyone else’s idea of what looks good.

And for those who say a slim body is a healthy body - and I do play the health professional card on this - size is not the best indicator of overall health, and, unless you love them, their health is none of your business. Read that again.

Lifestyle diseases need addressed, but lets not all pretend it is without sensitivity and vulnerability, as in The Ideal World.

Them’s the opinions.

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In 100% unrelated news, I want to talk about a bloody fantastic linen suit I have eyed up, only to discover that it is roughly a bajillion pounds, and then the #journey to finding an alternative - so that is coming your way on Wednesday. I’ve finally got to the bottom of my emails, and am feeling human again after retuning from Montenegro, and feeling ON IT.

As ever, thanks for being here.

Big love

Una

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