I am not morbidly obese. I am not anorexic. I am not bulimic. But I am a binge-eater, and I am sick and tired of it. I am fed up with being sick to the pit of my stomach with shame; this year I vomited twice from overeating, something I haven’t done since childhood. It’s enough now. I am sick and tired of being sick and tired.
I am also curious. I am intrigued by the fact that I consider myself to be intelligent, yet repeat the same pattern over and over, each time vowing never to do it again – only to do it again. I gained 7kg in the past year, for instance. So, for my next weight-loss-attempt iteration, I am changing my goal. Instead of focusing on kilograms lost, I will try to understand the pattern and unlock the secret of the cycle, perchance to interrupt and even reverse it. I am also including Ozempic in my strategy for the first time. It is a decision that was made with a sense of embarrassment and failure, but maybe not quite as much as eating till you puke.
I was hooked when I heard Dr Rocio Salas-Whalen, a top obesity specialist, speaking on the Mel Robbins podcast, the biggest podcast in the world. Dr Salas-Whalen is a triple board-certified physician and has helped thousands of patients with obesity, using the prescription of semaglutide as part of the regime. “Weight loss should not be a full-time job. Weight loss should not consume your life mentally or physically,” she said. I thought: “Hell, yeah.” It spoke to the constant internal dialogue people with weight issues have, in a real and compassionate way. The ‘food noise’ dominates our self-image and a relief from that would be a liberation.
Salas-Whalen positions obesity and weight issues as a “disease”. It was declared such by the AMA (American Medical Association in 2013. It is a problematic positioning for me because it does not acknowledge the subtle and complicated systems of subconscious and psychological levers that go into repeatedly reaching for the second piece of cheesecake. A disorder and a disease are not quite the same. She places obesity in the same category as diabetes and cancer, conditions caused by genetics, environment, hormones, ageing and some lifestyle elements. “It is not your fault,” she says. “It’s okay to receive help. It does not mean you are a failure, it means you are human.”
The message of external locus of control resonates. Bloomberg estimates that Ozempic and Wegovy made $65 billion for Novo Nordisk in 2024.
Potentially huge
The implications for healthcare on a national level are potentially huge, at least according to the manufacturers and investors. Ozempic is already being credited with causing a shift in fast-food consumption habits in the US, and the argument is that this one pharmacological intervention could shift diabetes and hypertension figures by the mechanism of bringing weight down.
Elon Musk is quoted as saying: “Nothing would improve the health, lifespan, and quality of life of Americans more than making GLP inhibitors super low cost to the public. Nothing else is even close.” It’s a terrific sales pitch for someone who knows how to get a good government contract. I wouldn’t be surprised if someone was lobbying the ANC right now, suggesting free Ozempic for all as a cheaper alternative to NHI. Salas-Whalen herself has said: “I’ve said it before, and I’ll say it again: this is the best (medical) discovery of our lifetime unless a cure for cancer is found.”
What can go wrong? The side-effects argument is a necessary first step and entry-level due diligence. As someone currently with semaglutide in my system I can assure you that whatever you understand as a journalist when researching this topic feels completely different as a visceral expression in your actual body. I experienced significant symptoms during the first weeks of using Ozempic: nausea, dizziness, fever, indigestion, lethargy, and an odd disconnection from myself. These effects are a natural consequence of a drug that decreases appetite, influences insulin regulation, and slows stomach emptying, causing a metabolic cascade. While interviewing other users for my research, these symptoms appear to be common.
As a result, though, I did eat less. I started a WhatsApp group for people interested in my journey on this quest, where I described it as such: “Feel shit, eat less! The Ozempic method?” For many users, these symptoms are transient, and a fair trade-off for the potential weight-loss benefits. It does mean that the food noise now gets replaced with Ozempic noise: “Will I vomit this time? How am I going to handle the high tea with my friends tomorrow when they act surprised that I am not eating as much cake as usual? Must I tell them I am on Ozempic and then there is that whole discussion and judgment again?”
Deftly sidestep
My issue is not with the (side) effects or the ongoing discussion, but that Salas-Whalen seemed to deftly sidestep the side-effect discussion on the podcast. She didn’t acknowledge it as a reality at all, deflecting it as a problem that only occurs if drugs are prescribed incorrectly.
It is reminiscent of the Oxycontin scandal, where the manufacturers blamed patients for taking the drug incorrectly, as opposed to the damaging effects being a direct consequence of the drug. In Salas-Whalen’s case, she is pointing a finger at the doctors themselves. “I’ll say it again for as often as it takes so I don’t have to say it again: The efficacy and safety of this medication is going to depend on who is prescribing it to you.” Robbins came at the side-effect angle a few times but was met with the same pattern of deflection.
I am not sure how a physician prescribing the medication can be responsible for the pharmacological action of the drug, as listed on its packaging. I find her position on this baffling, and in that, she has gone from being the green light to taking the drug to the biggest red flag simultaneously. The Covid era, for all its learnings, has also alerted the consumer to how a phrase like ‘safe and effective’ can be turned into a propaganda or political tool.
The tendency of pharmaceutical companies to list ‘side’ effects of the drugs, as opposed to ‘effects of the drug we would rather not happen’ is a neat trick to absolve themselves from blame and lawsuits. There are physical consequences in taking any medication, not all of which you might enjoy, but they are still direct effects of the substance. Perhaps the phrase ‘side effects’ should be replaced with “unintended consequences” as a more honest way of phrasing it, but to blame the physician for the unintended consequence is outrageous.
The GP who prescribed my doses for me warned me of the side effects and said that if they felt overwhelming, I should stop taking the medication immediately. He informed me that he had a patient who had to stop because the effects were so severe. More serious side effects of semaglutide include pancreatitis, hypoglycemia, dehydration (due to diarrhoea and vomiting). Even deaths have been reported.
On my WhatsApp group, I share my experiences and side effects honestly, as well as in the interviews I conduct with doctors, psychologists and case studies. Predictably, people have different experiences and positions. I spoke to two doctors, for instance. The first said: “I’d recommend Ozempic to anyone. Both my wife and I have used it.” The second held the opposite view. “No, I don‘t recommend it. My Hippocratic oath says: First, do no harm.”
This is very interesting to a journalist, but confounding to a consumer. By the end of my three-month quest, I will hopefully have reached a more informed and holistic way to approach my problem and come to peace with my problematic behaviour if I can’t change it outright. Ozempic has a part in it. I shall move on to the higher dose shortly, as that is where the ‘magic’ weight loss is said to occur in your body. I am apprehensive about that and share my concerns openly. Part of the problem-eater’s universe is hesitancy to speak out, because of the inevitable judgement that follows. The power of Ozempic is that it allows you some respite. It feels like hope. It feels like progress.
Unpicking the puzzle
There is however a second mechanism of Ozempic which becomes crucial to understand when you are unpicking the puzzle. Ozempic dulls the reward centres in your brain which respond to the hedonistic pleasures of food and alcohol. It makes bingeing less satisfying physically. This a double-edged reward for a comfort eater, because the sub-conscious consolation you got from food is no longer there. It cuts both ways. The hole you are trying to fill with food is still there.
From my short exposure to the literature and the drug, I can see that weight and obesity are multifactorial and complex issues in which, for many of us, food is only a proxy. There is a hunger for a void to be filled, but it is not a physical craving. I have been deeply aware of entrenched eating patterns as an adaptive response since childhood. Salas-Whalen, by positioning weight problems as a biological “disease” disregards a possibly more meaningful component – the psychological. Ozempic is a helpful way of sidestepping the potholes in your soul; yet in that process, you may not only be ignoring them but decorating them with icing.
[If you want to be part of my journey and join the WhatsApp group, send an email to info@vivienne.co.za or send a WhatsApp to +27 83 755 7602 for info on how to join the experience.]
[Image: Florian Jacob from Pixabay]
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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