A long wait for freedom

Jody Comfort sat in her doctor’s office, stunned, as she listened to her latest lab results. In years past, Comfort’s annual bloodwork had always shown she was healthy, despite being overweight. But today’s numbers shouted a ­different story: high cholesterol, high blood pressure, and most worrisome, skyrocketing blood sugar.

“I was shocked,” Comfort recalls. “I started having nightmares right there—picturing myself riding around grocery stores in those electric carts, unable to walk because of amputations from diabetes.”

As she watched her doctor write out prescriptions, Comfort says, her mind reeled. At 5-foot-6 and 284 pounds, the 61-year-old mother of three adult children and former nurse practitioner had struggled with weight all her life. But the real problem was food.

“I could never stop thinking about it—24/7,” she admits.

She’d tried everything to stop her craving, but that day her doctor suggested she try something new: a medication called Ozempic.

Sold by Danish company Novo Nordisk since 2017, Ozempic is the brand name for semaglutide, a drug researchers developed in 2012. Semaglutide mimics GLP-1, a human hormone released from the intestines and the brain. It’s been used to treat diabetes successfully since 2005.

But unexpectedly, scientists discovered that GLP-1, and the longer-lasting synthetic version, not only helped diabetics stabilize blood sugar but also lose considerable weight.

Now several companies are marketing semaglutide solely for weight loss: Novo Nordisk’s Wegovy is a larger dose of Ozempic approved for obese and overweight people.

These medications, and ones like it, are being touted as “miracle drugs” because of their effect on appetite and the brain.

Researchers say they could hold the key to freeing the U.S. healthcare system from the burden of ­expensive obesity-related diseases. But even those who see these drugs as remarkable new treatments caution they don’t nullify the need for healthy lifestyle choices about food and exercise.

COMFORT TALKS EASILY about her problems with food as we sit together on a cozy sofa in her 1920s Minnesota lake home. We’re a stone’s throw from a dock that juts into the clear water where she regularly swims.

Periodically, Comfort gestures to emphasize a point, then pushes back her blond hair. She laughs easily, often poking fun at herself. But kind eyes and a quick smile hide years of pain.

“If I can help one person who’s struggled like me, I’ll tell my story,” she says. “The good, the bad, the ugly.”

For years, Comfort tried healthy diets, exercise routines, and counseling. She invested in a decade of personal training and a lifetime of prayer, determined to conquer her self-described food addiction. Nothing helped. No matter her method or willpower, she couldn’t get unstuck, couldn’t climb out of what she calls a “loathsome, repetitive binge ditch.”

“I don’t know how many times I’ve done Weight Watchers, the 17-Day Diet, you name it. I’d have a great week, or I’d take 50 pounds off, and all of a ­sudden go back to old habits—like a freight train nothing can stop,” Comfort says. She never felt ­satiated, even after a meal.

Holidays presented extra torments. Rather than focusing on the festive occasion, she always found herself thinking about the foods associated with it. On Halloween, she’d tear open candy bars and eat nonstop. Christmas meant gobbling cookies. On Easter, she’d munch on handfuls of Reese’s peanut butter eggs.

She constantly felt like a failure, wondering where God was in it all and why He wasn’t breaking the chains that bound her. She was disgusted with her bingeing, and with lying about the bingeing when family members would ask, for instance, what happened to all the ice cream.

“The embarrassment of it. The shame. The sneaking. Sometimes I’d go to McDonald’s before dinner and eat a cheeseburger.” Comfort shakes her head.

So when her doctor recommended Ozempic, she knew she had to consider it. Her husband Tom, an orthopedic surgeon, encouraged her to give it a try. He’d seen how effective Ozempic had been in helping his patients lose weight before knee or hip surgery.

“If someone had cancer or a thyroid issue, you’d tell them to take medicine,” Tom told her.

While it’s hard to nail down precise numbers of patients on these drugs—Novo Nordisk reports over 4 million worldwide on Ozempic—new U.S. prescriptions are soaring. As of April, American doctors wrote 60,000 new Ozempic prescriptions weekly, and by May, nearly 135,000 new Wegovy prescriptions weekly.

Other drugmakers are scrambling to capitalize on what is already a pharmaceutical gold rush. Eli Lilly is waiting for the FDA to approve its diabetes drug Mounjaro for weight loss. It’s even more effective than Ozempic and Wegovy because its active ingredient mimics two gut hormones instead of just one. Some dub Mounjaro the King Kong of weight loss because research participants lost more than 20 percent of their body weight while taking it. Retatrutide, another drug Lilly is developing, promises even greater weight loss.

A COMMON BELIEF, even among the overweight, is that it’s solely their fault for being heavy and staying heavy. Words like lazy, undisciplined, impulsive, weak, and glutton are routinely used, although rarely aloud.

Until Comfort came to terms with what led her to seek solace in food, she often felt that way. Ivania Rizo hears similar stories every day.

“This is a significant societal stigma, with people not understanding the pathophysiology of the ­disease,” says Rizo, director of obesity medicine at Boston Medical Center. A first-generation immigrant from Latin America, Rizo is on a mission to educate people about obesity’s causes and treat those with it.

She wants to ensure obesity patients of every ­ethnic and economic group get help, whether that means counseling, medication, or bariatric surgery. She speaks quickly, eager to explain.

Rizo describes obesity’s etiology as multifactorial. Although someone may have a genetic mutation that causes obesity from childhood, more likely it’s driven by a combination of genes—at least 1,500 are weight-related—and environmental or behavioral factors. Some people with a genetic predisposition may never become obese.

Other elements may lead to obesity: certain medical conditions or medications, poverty, poor guidance from a family uneducated about healthy lifestyles, parents unable to monitor a child’s eating, or even exposure to toxins that interfere with metabolism.

Sometimes harmful environmental and behavioral factors shape habits. Someone raised in a family reliant on fast food might grow up to eat whatever’s easy, cheap, and fattening, like chips, soft drinks, and candy. These habits can eventually change the way genes work, precipitating obesity.

The American College of Sports Medicine has recognized for nearly 70 years that health problems, including obesity, are often associated with lifestyle choices. Today’s cultural bombardment of advertising pitched to appetites, limitless fast food, excessive screen time, and decreased physical activity has worsened obesity, says John Jakicic, an exercise physiologist and research professor at the University of Kansas Medical Center. He says where the effects of these lifestyle choices end and disease begins is unclear. But he doesn’t mind doctors calling obesity a disease if it means more people will get help.

“What’s most important is getting people to think holistically about healthy lifestyles, not just weight,” he says. “Exercise itself causes many healthy changes in people, independent of weight.”

Jakicic says the new medicines are “another tool in our toolbox,” and if they put people on a path to change, we should get them to the people who need them. But they don’t negate personal responsibility, he says.

One weight-loss conundrum: Once someone sheds pounds, metabolic changes may occur that reduce calories burned, while simultaneously increasing hunger hormones. This creates an ongoing circular battle.

Comfort doesn’t know if genetics played a role in her weight gain, but she discovered her childhood environment and behavior did.

After years of self-recrimination, counseling, Bible studies, and months attending an eating disorder nonprofit called the Emily Program, she learned why food became so important to her.

“For me, it was a control issue,” she says. She grew up with an alcoholic, emotionally explosive father, never knowing what would set him off and where he’d direct his anger. Sometimes he’d lash out at her mom, sometimes a sibling, sometimes her, sometimes even the dog.

Comfort cowered with every verbal blow. Fear, she says, is the word that best describes her childhood household: “I longed for peace.”

Eating offered a sense of comfort and safety—the one thing that made her feel better. “Food to me—whether I was happy or sad—solved everything,” she says. Overeating soon became habitual, leading to the physiological changes that are so hard to reverse.

OBESITY NUMBERS reveal a burgeoning public health crisis with huge personal and societal costs. About 43 percent of Americans are obese. Ten percent are severely obese. An additional 30 percent are overweight. Children also struggle: Nineteen percent are obese, and 16 percent are overweight.

Only about a quarter of Americans aren’t considered too heavy. The resulting health problems—and the costs associated with treating them—threaten to overwhelm the U.S. healthcare system. The World Obesity Federation has identified 28 obesity-related diseases, including Type 2 diabetes, high blood ­pressure, heart disease, several cancers, arthritis, sleep apnea, fatty liver disease, sexual dysfunction, and mood disorders.

Nearly 30 million Americans have obesity-related Type 2 diabetes—about 1 in 10. By 2050, predictions say numbers may rocket to a staggering 1 in 3.

Being diabetic can cause other health problems, including neurological troubles, kidney failure, vision loss, and the potential amputations that worried Comfort.

Excess annual medical expenditures related to Americans’ obesity top more than $170 billion, according to a 2020 study. Costs don’t account for the intangible price of bullying or strained relationships.

Comfort understands this strain. Before her eye-opening doctor’s visit, her husband Tom had already voiced concern she might soon be unable to hike, bike, and travel like they’d planned once he retired. During their 37-year marriage, they’d always been active together. He feared they might drift apart if he lost her to a sedentary life.

Reflecting on that conversation today, Comfort unconsciously folds her hands and squeezes them. Then she says God’s timing for having her start Ozempic was perfect.

LIKE ANY DRUG, obesity medicines come with warnings and potential for misuse.

More than a year ago, telehealth providers began blitzing social media with ads, then prescribing the drugs without adequate patient screening, follow-up, or warnings about side effects.

Comfort initially suffered nausea and stomach cramps. She also vomited occasionally after she gave herself the weekly injections.

While on these drugs, stomach emptying generally “takes four to six hours, instead of 1½ to two hours,” Comfort explains. “I couldn’t binge if I wanted to. All that food loads up in your stomach—it feels like Thanksgiving dinner times 10.”

Constipation and diarrhea are other possible effects of slowed stomach emptying, which is known medically as gastroparesis. Some patients claim those side effects persisted even after they stopped taking the drugs. Drug companies already face a slew of ­lawsuits related to gastrointestinal injury.

Health experts say such cases are rare and may occur in patients who already have gastroparesis. Diabetes itself, infections, or other medications can also slow stomach emptying, according to the American College of Gastroenterology. Rizo, of Boston Medical, notes these drugs have been used safely for diabetes for almost two decades, but says negative case reports must be investigated.

Comfort’s side effects diminished over time. Unless she eats greasy foods (that really no longer appeal to her) she’s mostly symptom-free. Her excitement about losing weight surpassed any problems, she says.

Jennifer Abuzzahab, a pediatric endocrinologist at Minneapolis Children’s Hospital, says she has ­prescribed obesity drugs for almost 20 years without major problems. But she emphasizes that when choosing treatments, one size does not fit all.

“I have a lot of kids on these meds with great success stories,” Abuzzahab says. “But I discuss options with families to figure out what might work best based on the child, their situation, and what caused their obesity.”

Rizo says it’s wonderful to have an effective drug treatment option for obesity. Not all patients are ­candidates for—or want—bariatric surgery, which Comfort considered but eventually dismissed because of its physical intrusiveness. Never before has it been possible to cause a similar, drug-induced weight loss.

But Rizo cautions against viewing the drugs as “cures” for obesity: “They’re treatments. Once a ­person has obesity, it’s a very difficult disease to treat. And it’s chronic. Any medication we use for it must be used chronically to maintain the benefits—like for other chronic diseases.”

COMFORT BEGAN giving herself weekly injections of Ozempic a little over a year ago. The result has been nothing short of revolutionary.

“For the first time in my life, I’m free,” she says, taking a long, deep breath and exhaling. “I don’t have binge-brain anymore. I didn’t expect to feel this way.”

That freedom enables her to make good choices.

“I’m working hard exercising and eating well, and I love it. The medicine isn’t magic. But it’s given me a chance to break bad patterns and form new neural pathways and habits.”

Rizo says that kind of lifestyle change is vital to long-lasting success. She ensures her patients get counseling, time with a registered dietitian, and encouragement for activities they can tolerate to help build new, healthy habits.

Comfort never received such counseling from her doctor, but having researched healthy lifestyles for years, and being active, she knew what to do. She eats smaller quantities—mostly lean proteins, fruits, vegetables, yogurt, and whole grains. She stays hydrated and skips diet sodas, often drinking iced and green tea. She limits fats and sugars. But she doesn’t completely deprive herself of treats.

“If I’m walking through the store and can’t stop thinking about a food I love—like doughnuts—I use a three-bite rule … take three bites and get rid of the rest,” Comfort says. Her voice rises a notch with excitement as she begins to tell me why this strategy works now: In years past she would have eaten not just one doughnut but a dozen.

Some worry these drugs foster undisciplined eating—that a person can have their cake and literally eat it too. Or rather, have their injection and eat the cake anyway. But Comfort attests the drugs actually decrease unhealthy cravings. She’s now content with small amounts.

She describes it as turning off the part of her brain that was never satisfied, leaving her free to think about and enjoy activities and people without constantly dwelling on food.

Scientists are still exploring the mechanisms of how these drugs work. But decreased cravings make sense, they say, because GLP-1 in the brainstem affects impulse control and reduces the brain’s reward response to dopamine—the pleasure hormone.

Others on these drugs report the same “brain ­quieting” Comfort immediately noticed—the removal of relentless internal chatter telling them to eat.

Through the combination of a slower-emptying stomach, stabilized blood sugar, and calming brain effects, food no longer physiologically or mentally commands the same attention or attraction.

PATIENTS AREN’T the only ones benefiting. Drug manufacturers are reaping enormous financial ­windfalls, outpacing the rest of the pharmaceutical industry, as millions of patients like Comfort report successful weight loss. Analysts estimate global ­obesity drug sales will rise to $77 billion by 2030, up from $2.4 billion in 2022. They may eventually exceed $100 billion.

Insurers usually cover drug costs for diabetes, but not always for obesity, despite FDA approval. The drugs can cost between $800 to $1,300 a month if not covered. After paying her insurance deductible and using coupons, Comfort pays $33 a month out of pocket for Ozempic.

Medicare also covers the drugs for diabetes, but not yet for obesity. As demand soars, insurers will have to weigh the long-term benefits of covering medicines for obesity against the overall burden on the U.S. healthcare system.

Novo Nordisk and Eli Lilly are developing pill forms of their drugs, which might decrease costs by about 70 percent.

Already, demand for the drugs has strained ­companies’ ability to make enough, creating shortages. People taking the drugs for purely cosmetic ­reasons are also fueling shortages. Rumors abound of entertainment-types going on them briefly to fit into slinky awards ceremony outfits, though few acknowledge it.

Real Housewives of New Jersey actress Dolores Cantinia admits she started on Mounjaro to look good for an upcoming reunion, and Elon Musk says he’s on Ozempic to stay trim. Some new moms ask for prescriptions simply to drop post-pregnancy pounds quickly. But experts warn the drugs have only been researched on diabetic and obese patients, and weight seems to return once patients stop taking them.

Other startling benefits like decreased strokes, heart attacks, and heart failure are boosting demand, proving why the drugs are being called one of the ­biggest health boons in decades. The drugs may eventually be used to treat alcohol, drug, and nicotine addictions—even bulimia.

But this isn’t the first time doctors have tried to use drugs to control weight. In the 1890s, use of thyroid extract revved metabolism and helped people lose weight, but it also revved heart rates precipitously and caused muscle loss. The 1930s brought dinitrophenol, but it caused all sorts of physiological problems. Then amphetamines in the 1940s and variations in the 1960s helped people lose weight, but proved toxic.

In 1996, the FDA approved dexfenfluramine, one half of the chemical combination known as fen-phen, an appetite suppressant. But less than 17 months after it hit the market, drug companies pulled it because of reported cases of potentially fatal pulmonary hypertension and valvular heart disease.

Although GLP-1, which the Ozempic and Wegovy active ingredient mimics, has been used to treat diabetes safely for nearly 20 years, all eyes are on the continuing research to see if the drugs’ current hype proves valid for the long haul or is just more, well ... pie in the sky.

COMFORT BELIEVES God used this new treatment to answer her prayers, that He’s turned her mourning into dancing—and biking, walking, swimming, water aerobics, and weight lifting. The drug has been so successful she’s willing to stick with it forever. Now that she’s no longer obsessed with food, she’s able to focus on the people and events around her. Comfort’s health numbers are normal again, bolstering research showing diabetes and weight-related diseases can go into remission or be controlled by weight loss and a healthy lifestyle.

She came off blood pressure medication in September and is on only a low-dose cholesterol pill. She’s sleeping better and no longer needs naps like she did when her blood sugar routinely spiked and plummeted. She’s dropped 90 pounds with a goal to weigh about 170. “I’m not trying to be skinny,” she says with a smile. “Tom and I want me to be healthy.”

This story has been updated with additional information about the drugs’ costs and insurance coverage.