The Ozempic effect

Jill Lynn built a YouTube following by doling out beauty advice. She does it in the glow of a ring light, her face leaned close to a screen as she tries out new lip liners and lace-front wigs. It’s the sort of thing that’s delighted her fans for nearly a decade, but in recent months Jill Lynn has moved on from hair toppers. Her target audience—menopausal women with middle-age spread—has a new preoccupation. They want the lowdown on her latest weight loss experiment, the injectable drug tirzepatide. They’re after numbers, straight from her scale, down to the decimal point. And she provides them.

“I was 152.9, so almost 3 pounds this week,” the licensed cosmetologist announces, then moves on to her current dosing predicament. Another 5 milligrams, or up to 6?

“I’m still on the fence,” she says with a shrug. But before the video concludes, she acknowledges a new side effect, dry mouth. No worries, though. She’s upping her water intake.

Like so many on YouTube and Instagram, Jill Lynn is part of the growing phenomenon surrounding GLP-1 (glucagon-like peptide-1) drugs, the class of injectable weight loss wonders that includes Ozempic and Wegovy. Influencers spike interest by documenting their own weight loss journeys. Some even offer codes to get discounts on compounded, lower-priced versions of GLP-1s. The latest development in the craze, one of particular interest to the needle-averse? An oral GLP-1 option—a pill that’s just as effective as the injectables—is primed for full-scale release next year.

America has welcomed the new drugs with open arms and open pocketbooks. It’s not surprising, with more than 70% of the population considered either obese or overweight. But is it really in our best interest to take an expensive drug with common side effects—nausea, diarrhea, fatigue—to lose weight? What if it’s just 20 “vanity” pounds? Is it OK to take a drug to fit a certain size of jeans?

America’s infatuation with all things Ozempic is rife with issues a jab just can’t cure. The new pills may mean even bigger problems for a culture—and Christians—wrapped up in weight.

ROOM 23 at Ochsner Medical Center in Monroe, La., is pragmatic by design. Vinyl covers the exam table, and rubber baseboards outline a floor made of square, commercial-­grade tiles. There are no windows, no special lighting. Just the bare essentials, plus family physician Amy Givler and her 11 o’clock appointment, 66-year-old Charles Norman Jr.

Norman, a new patient, has diabetes. He’s been fighting the chronic disease since 1995, when he first noticed his vision clouding. For decades, his all-­important A1C level hovered between a risky 8 and 9. These days he posts an admirable 5.7, making him a poster boy for the diabetes drug Mounjaro.

“You’re not on insulin at all,” Givler remarks, glancing at his chart.

Norman shakes his head.

“That’s really good,” the doctor says, marveling at Mounjaro’s powers. Givler, a trim woman with a kind smile, took her time warming up to the medication. She waited to see the studies, and now she’s convinced of its benefits. She prescribes GLP-1s for many of her patients, most of them on Medicaid. She says it’s impossible to get Medicaid to pay for a drug like Mounjaro or Ozempic unless you have diabetes. “The cost is absurd. Very, very high. We’re talking $1,100 a month.”

Mounjaro is the brand name form of tirzepatide. It’s the same drug that Jill Lynn talks about on her YouTube channel. While it works to produce more insulin for a patient like Charles Norman, it also helps users like Jill Lynn lose weight. It does this by mimicking a hormone in the body that controls the rate food gets processed. Slowing this process reduces appetite and helps people eat less.

Even though doctors noticed the dual outcomes as early as 20 years ago, the first GLP-1 drug aimed at weight loss didn’t hit the market until 2014. It took time for GLP-1s to get into the hands of the masses, but once they did, the floodgates opened. Last year’s data show 1 in 8 adults in the United States has taken a GLP-1 drug. That’s more than 33 million people.

Hazel Sanders is part of that crowd. She’s on staff at the clinic where Amy Givler practices. But even with 40 years of nursing under her belt, and all the medical knowledge that goes with it, Sanders couldn’t control her weight. It was a lifelong battle, and whenever she neared 290 on the scales, she knew she was in trouble. “The alarms went off. My body started to shut down. Shortness of breath, heart palpitations, couldn’t move, high blood pressure.”

Although Sanders would lose the pounds necessary to get her breathing back to normal, she wouldn’t lose enough to toss her three blood pressure prescriptions. Her blood sugar levels remained dangerously high, too. Sanders describes her desperation in terms of physical exhaustion rather than dress sizes. “Carrying that weight. It’s hard, carrying the weight.”

Peter Byrne / Press Association via AP

Last year, Givler put Sanders on Mounjaro to manage her diabetes and her weight. She lost about 50 pounds. Studies show that losing just 10% of excess body weight can make a major difference. It can lower the risk of high blood pressure, high cholesterol, and diabetes. It can reduce symptoms of depression, arthritis, and sleep apnea. Givler says it can even quiet the internal chatter known as “food noise.”

“That message constantly playing in your head that says you need to eat, and your brain saying, ‘No, no, no.’ That is a hard thing to fight.”

Success like Sanders’ has led Givler to believe medicine, in many cases, is the right choice for treating obesity. She wishes a GLP-1 drug had been in her toolbox years ago when one of her patients, a young mother, suffocated under her own weight.

“There are many instances where we help people who are struggling with a personal failure, a bad habit, a besetting sin,” Givler contends. “I have patients who love Jesus yet are on antidepressants. We live in a fallen world.”

Like many, Givler places much of the blame for America’s obesity problems on the environment, with its “proliferation of fast food and cheap food.” She watched that diet wreak havoc in Kenya, too.

Givler and her physician husband, along with their three children, spent most of 2003 at a mission hospital in Kijabe. “We hardly saw high blood pressure then. Very few people were overweight, let alone obese. Very little diabetes,” she remembers. But on subsequent trips to Kenya, the Givlers noticed a change. Junk food had flooded the country, bringing obesity and its laundry list of chronic diseases along with it. Instead of focusing Kenya’s limited medical resources on injuries and infections, doctors now had to train people to take daily medications for high blood pressure and diabetes.

Dr. Amy Givler talks with new patient Charles Norman Jr. about his diabetes. Photo by Kim Henderson

METABOLIC SCIENTIST BEN BIKMAN is known as the “Guru of Insulin Resistance” by audiences across the world, even in Singapore, where he spoke just two days before our interview. Bikman agrees with Givler’s point: Processed food is a big part of the problem. He calls it one of the “plagues of prosperity.” But he’s concerned about the use of GLP-1 drugs to combat the consequences of a poor diet. Ozempic and its counterparts are linked to muscle and bone mass loss, which can lead to physical frailty, a particular risk for middle-aged or older women. Bikman thinks that can’t be ignored: “In the likely event they want to get off the drugs—and 70% of users do get off at two years because they’re sick of feeling sick—the fat mass will come right back, but the lean mass may never come back.”

Bikman also believes an increased risk of what he calls “mental fragility” is a possibility. That’s because GLP-1 drugs act on the brain by affecting dopamine regulation. Not only do they dull cravings for food, but also the desire for other pleasures like sex, personal accomplishment, and drive for life.

As a professor at Brigham Young University, Bikman says he can easily identify an Ozempic user among his students: “It’s the gaunt gal who’s falling asleep in class and asking for deadline extensions. That’s the trifecta.” He goes as far as describing instances of lean, healthy people taking Ozempic as drug abuse and proof of eating disorders. He’s certain students aren’t getting GLP-1s on their own. “There’s a parent who’s helping, there’s an enabler. I get extraordinarily incensed about the whole thing.”

Incensed but not totally against. Bikman is for flipping the script on how GLP-1s are administered—a change to microdosing and cycling. He says the key is learning how to control carbohydrate consumption. “Start at the lowest possible dose for a couple of months. Are you learning to eat differently? Cycle off the drug now. If you can still manage your cravings, you’re done. If not, cycle back, get habits in place, and start weaning off again.”

That approach leaves the onus on patients, many of whom could be mired in emotional and compulsive eating disorders. But is disorder even the right word?

In his book Seven Daily Sins, Midwestern Baptist Theological Seminary professor Jared Wilson cites gluttony as “the big fat elephant in the room of the evangelical church.” He maintains gluttony is idolatry. By orienting our behavior, thinking, and affections around food, Wilson says, we seek to find in food what can only be found in God. In other words, food shouldn’t be a substitute for intimacy with God. Or a pleasure beyond its design.

A diabetic woman injects Ozempic. Lee Smith / Reuters / Redux

THE WONDER-WORKING POWER of GLP-1 drugs is their ability to mitigate the desire for food. But are those desires merely hormonal triggers, or is something more at play? The Christian life is characterized by learning to direct desires, even squelching them when necessary. Appetites, then, are as much moral as they are biological.

And they’re a gift, according to Christian body image coach Heather Creekmore.

Creekmore, 50, spent most of her life trying to make the world’s current take on correct eating habits her own. Sitting in her home in Austin, Texas, she sums up decades of diet science as fads, an “eggs are good, eggs are bad, fat is bad, fat is good” thing. And don’t get her started on bread. “We’ve demonized bread, and Jesus calls Himself the bread of life,” Creekmore quips. “Why have we bought into this?”

She brackets her question with smiles, but the pastor’s wife and mother of four is serious. For the last 10 years, Creekmore has counseled hundreds of women through body image and comparison struggles. She knows many have been looking for a miracle cure their whole lives, and Ozempic appears to have cracked the code. Creekmore has her doubts.

“I have great compassion for people who are in a really hard spot and need an answer,” she explains. “But we’ve actually convinced ourselves that the healthiest thing is to not eat, even though God designed us to eat.”

She believes Christians are adopting beliefs about food that aren’t Biblical. She points to the huge banquet awaiting believers in heaven. “We won’t be eating because food is fuel. We’re not going to need food as fuel then.”

Creekmore can speak the language of diet culture. As a child, she attended Weight Watchers meetings and drank SlimFast. In college, she subsisted on plain bagels. She spent 20 years as a certified fitness instructor, trying to exercise her way to that “perfect look.”

Then, in her mid-30s, Creekmore realized she’d made her body an idol. She says her heart was worshipping a body image she had yet to attain. “I believed if I looked a certain way, I would never be rejected. Everyone would love me. My husband would love me more. Doors would just open for me.”

Ridiculous, Creekmore admits, but she believes it’s the very message that has women grabbing Ozempic to lose 20 pounds. And the endgame isn’t pretty. “A woman will see a number on the scale that she was sure would make her happy, but it doesn’t. So she says to herself, ‘It must mean I just need to lose five more pounds.’ I hear this story over and over again.”

For Creekmore’s clients, the challenge is understanding their issue isn’t just physical, it’s spiritual. She wants them to know they were made for a purpose, and it’s more than chasing a number on the scale. “I’ve lived that way for too many decades, and now what’s important for me to do is to get after what Jesus has called me to do, and that’s not to transform my body.”

BACK IN LOUISIANA, it’s lunchtime. Amy Givler has left her white coat behind at the clinic and is studying the menu at JAC’s Craft Smokehouse, a ­popular barbecue spot on the Ouachita River. She asks for a brisket plate with water, no sides. It’s a hard choice in a place with sweet tea on tap, but Givler has been making hard choices for eight years. That’s when she got serious about her weight and a body mass index that put her in the clinically obese range. After Givler found success on a keto diet, she never looked back. “It was like my body said, ‘Oh, thank you,’ because I felt so much better. Not only did I lose 70 pounds, I just felt better.”

What if years ago, back when she was yo-yo dieting, Ozempic had been around? Would she have gone that route?

“Yes,” Givler answers, even as she dutifully eats her brisket. “One hundred percent.”

But there has to be a reason for users to get the drugs, Givler insists, a “clear indication,” as she calls it. And that’s whether they’re injected or they’re ­swallowed, as soon will be the case. Prescribing a GLP-1 for a patient who wants to be thin for the sake of appearance, well, Givler can’t imagine doing that. “It’s just not responsible medicine.”