Ozempic

Summary

Maintenance Phase Podcast Summary: Ozempic Episode (Released October 10, 2023)

Hosts: Aubrey Gordon & Michael Hobbes

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Introduction

In this episode of Maintenance Phase, hosts Aubrey Gordon and Michael Hobbes delve deep into the controversy surrounding Ozempic and Wegovy, medications containing the active ingredient semaglutide. They aim to debunk the myths, scrutinize the scientific claims, and address the societal implications of these weight loss drugs.

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Overview of Ozempic and Semaglutide

Aubrey Gordon [16:04]: "Semaglutide mimics the GLP1 hormone released after eating, signaling fullness and regulating insulin production."

Ozempic and Wegovy are both injectable medications developed by Novo Nordisk. While Ozempic is prescribed for managing type 2 diabetes, Wegovy is marketed for weight loss, utilizing a higher dosage of semaglutide. Semaglutide, a GLP1 agonist, plays a crucial role in regulating hunger and satiety signals in the body.

Origins and Development

Aubrey Gordon [08:33]: "Dr. Daniel Drucker discovered GLP1 in 1984, leading to the development of semaglutide after studying the Gila monster’s unique appetite-regulating genes."

The journey of semaglutide began in 1984 with Dr. Daniel Drucker at the University of Toronto, who identified the GLP1 hormone. Inspired by the Gila monster's ability to regulate its appetite and metabolism, researchers synthesized semaglutide, aiming to create a longer-lasting version of GLP1 for therapeutic use.

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Clinical Trials and Effectiveness

Michael Hobbs [24:59]: "Approximately one-third of participants in a two-year trial lost more than 20% of their body weight, comparable to bariatric surgery."

Clinical trials, particularly the STEP trials, have demonstrated remarkable weight loss results:

• 80% of participants lost at least 5% of their body weight.
• 50% shed between 10-15%.
• 33% achieved over 20% weight loss, matching outcomes typically seen with bariatric surgery.

Additionally, these medications have shown significant health benefits, including improved blood pressure, cholesterol levels, and A1C for diabetic patients. Longer trials indicate reductions in heart attacks and strokes, positioning semaglutide as a potentially life-saving drug beyond weight loss.

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Side Effects and Safety Concerns

Michael Hobbs [25:31]: "Gastrointestinal symptoms like nausea and vomiting are almost universal, occurring in up to 93% of users."

Despite their effectiveness, semaglutide comes with a range of side effects:

• Common: Nausea, constipation, diarrhea, and vomiting, affecting up to 93% of users.
• Serious: Concerns about pancreatitis, thyroid cancer (based on rodent studies), gallbladder disease, acute kidney injury, and rare cases of suicidal ideation and ileus (a potentially fatal bowel obstruction).

The FDA has updated semaglutide’s label to include ileus after 33 cases and two deaths, highlighting ongoing safety evaluations.

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Real-World Effectiveness vs. Clinical Trials

Michael Hobbs [38:00]: "Real-world studies show that weight loss results are roughly half of what clinical trials report."

In contrast to controlled clinical settings, real-world usage of semaglutide shows:

• An average weight loss of 7.5%, significantly lower than the 15% reported in trials.
• Dropout rates in real-world settings can reach up to 70%, compared to a mere 6% in some trials.

Factors contributing to this discrepancy include the intensive behavioral therapy provided during trials and higher adherence rates due to the structured environment of clinical studies.

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Discourse and Stigma Around Weight Loss and Fatness

Aubrey Gordon [33:11]: "The stigma surrounding weight loss drugs like Ozempic reinforces fatphobia and dehumanizes fat individuals."

The hosts critically examine the societal narratives surrounding Ozempic:

• Stigmatization: Users are often labeled as taking the "easy way out," perpetuating harmful stereotypes about fat individuals being lazy or unattractive.
• Media Representation: Headlines such as "Ozempic settles the obesity debate" and campaigns like Novo Nordisk's "It's Bigger Than Me" aim to reduce personal blame but inadvertently fuel anti-fat bias.
• Economic Barriers: The high cost of Wegovy ($1,300/month) and Ozempic ($900/month) limits access, primarily benefiting those with disposable income and exacerbating inequalities.
• Social Reinforcement: Weight loss is tied to perceived virtue, leading to increased stigma for those who remain overweight and further isolation for fat individuals.

Michael Hobbs [33:33]: "Doctors prescribing Ozempic for unrelated issues, like migraines, exemplify systemic bias and lack of individualized care."

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Marketing Practices of Novo Nordisk

Aubrey Gordon [48:12]: "Novo Nordisk's 'It's Bigger Than Me' campaign leverages influential Black figures to reshape the narrative around obesity."

Novo Nordisk has employed strategic marketing campaigns to position semaglutide as a medical solution rather than a lifestyle choice:

• Campaigns: "It's Bigger Than Me" uses spokespeople like Queen Latifah and Yvette Nicole Brown to promote the drug, emphasizing that obesity is a disease requiring medical intervention.
• Media Integration: Branded segments on TV shows aim to normalize the use of Ozempic and Wegovy, though often practiced superficially without addressing deeper societal issues.
• Critique: The hosts argue that these marketing efforts mask the underlying fatphobia and shift the conversation without providing meaningful support for affected individuals.

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Conclusions and Final Thoughts

Aubrey Gordon [56:04]: "This is another round of scapegoating fat people, masking deeper societal issues with medical solutions."

Aubrey and Michael conclude that while semaglutide presents promising clinical benefits, the surrounding discourse and systemic barriers undermine its potential to address obesity comprehensively. They emphasize the need to:

• Center Affected Voices: Prioritize the experiences and needs of fat and diabetic individuals in discussions about weight loss medications.
• Address Stigma: Actively work to dismantle the pervasive fatphobia reinforced by media and societal narratives.
• Ensure Equitable Access: Advocate for broader insurance coverage and affordability to prevent further entrenchment of health disparities.

The episode underscores the complexity of using medical interventions to address societal and personal issues related to weight, highlighting the importance of a compassionate and equitable approach.

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Notable Quotes with Timestamps

• Aubrey Gordon [02:33]: "We're spending basically this entire episode talking about the narratives around Ozempic and Wegovy."
• Michael Hobbs [07:28]: "Semaglutide works by triggering your satiety hormone, making you feel full longer and helping you eat less overall."
• Michael Hobbs [25:45]: "Even if you take the weight loss stuff off the table, the health benefits are comparable to statins, which are a big deal."
• Aubrey Gordon [43:09]: "Ask a fat person. Has anybody tried to teach you how to cook? Has anybody offered you a gym membership?"
• Michael Hobbs [45:25]: "Take the fucking stairs. It's like, well, you might look thin, but you're really a fat person."
• Aubrey Gordon [55:52]: "Fat people, like, taking that message. That's horrible."

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This detailed analysis by Aubrey Gordon and Michael Hobbes offers a critical perspective on the rise of Ozempic and Wegovy, highlighting the intersection of pharmaceutical advancements with societal attitudes towards weight and health.

Transcript

[Aubrey Gordon]

Wait, have I ever told you about steakhouse or gay bar? Hang on. I want to look it up. Just because it's. Yep.

[Michael Hobbs]

Is it?

[Aubrey Gordon]

Here we go.

[Michael Hobbs]

What does it have?

[Aubrey Gordon]

Magic Castle.

[Michael Hobbs]

Oh, it's gotta be steakhouse.

[Aubrey Gordon]

Yeah. Correct. Stockyards.

[Michael Hobbs]

Oh, that's a gay bar.

[Aubrey Gordon]

Incorrect.

[Michael Hobbs]

Steakhouse. What?

[Aubrey Gordon]

Excelsior.

[Michael Hobbs]

That's either a bad steakhouse or a bad gay bar.

[Aubrey Gordon]

Oh, gay bar.

[Michael Hobbs]

Fuck yes.

[Aubrey Gordon]

Oh, Juicy Lucy's. That's a steakhouse.

[Michael Hobbs]

Thick cock in my asshole steakhouse. Wow.

[Aubrey Gordon]

Charlie Brown's.

[Michael Hobbs]

I'm not touching that. I'm not touching that. Let's move on.

[Aubrey Gordon]

It was a steakhouse.

[Michael Hobbs]

Aubrey. Why can't we do a fun episode? Why can't we just do this for an hour instead of talking about Ozempic? Welcome to Maintenance Phase, the podcast that works in the short term but has never been tested for more than two years. That's kind of true, actually, accidentally.

[Aubrey Gordon]

That is a pretty accurate thing to say about our podcast. It hasn't been tested in the long term.

[Michael Hobbs]

People go back to where they were. I'm Michael Hopps.

[Aubrey Gordon]

I'm Aubrey Gordon. If you would like to support the show, you can do [e-mail] maintenancephase or you can subscribe on Apple Podcasts. It's the same audio content.

[Michael Hobbs]

Michael Aubry, let's start with your nervousness. My nervousness?

[Aubrey Gordon]

We're going to talk about it.

[Michael Hobbs]

Your complicated feelings.

[Aubrey Gordon]

So today we are talking about Ozempic Wegovy and their active ingredient, semaglutide.

[Michael Hobbs]

Wait, I thought it was semaglutide.

[Aubrey Gordon]

I thought it was two. And then I heard a million doctors say semaglutide.

[Michael Hobbs]

Semaglutide.

[Aubrey Gordon]

Doesn't that seem wrong?

[Michael Hobbs]

Yeah, but sure, I mean, they're made up words anyway. And then on some level, every word is made up. So whatever.

[Aubrey Gordon]

Well, listen, from Mr. Denouement, it's a safe space for creative pronunciation.

[Michael Hobbs]

The thing is, so much of the fucking feedback to this show is about my pronunciations of words. No one ever wants to give me feedback on, like the content of the show.

[Aubrey Gordon]

Michael. Aubrey, this episode is actually a little different than how we usually do things.

[Michael Hobbs]

Yes.

[Aubrey Gordon]

I'm gonna walk us through the drug and its origins. You're gonna walk us through the clinical trials into this sort of class of drugs. And then we're gonna talk about what I think is the thorniest part of all of this. The discourse around those drugs.

[Michael Hobbs]

The discourse.

[Aubrey Gordon]

This is a big one. It feels like a really high stakes conversation. So I'm curious About for you, what are some of the things that you're sort of like bringing to that?

[Michael Hobbs]

I think my weirdness with this episode is the culmination of my weirdness with every episode of the show where both of us are interested in public health, in the kinds of things that are prescribed, how drugs get approved, what they mean societally. Whereas because Americans have been trained by health media for our entire lives to see everything through an individualistic lens, we are going to be spending basically this entire episode talking about the narratives around Ozempic and WeGovy. We have this new generation of weight loss drugs that as of now appear to deliver much more weight loss than any previous generation of weight loss drugs. And we've had this immediate huge wave of media being like, is this the end of obesity? Does this invalidate body positivity? And like, being a dietitian in the age of Ozempic and all this just insufferable kind of end point prediction stuff based on very little information. And what we are interested in and like, what we have been talking about behind the scenes nonstop for the last like couple of months is like how poisonous these narratives are. But what people tend to hear is like individual health advice. Mike and Aubrey think you shouldn't take Ozempic or Mike and Aubrey think you should take Ozempic.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

And like, that is just not something that we are interested in. We've said on the show before that if you want to lose weight and you want to do keto or a cleanse, you can do that. We don't. We don't have opinions on that.

[Aubrey Gordon]

Yeah, totally.

[Michael Hobbs]

And if people don't want to do that, they also shouldn't be pressured to do so.

[Aubrey Gordon]

And I just know that this is like a big topic for a lot of people. Right. For me included, both because I'm engaging with all of this media and fat people writ large are engaging with all this media that is like, could we finally be rid of fat people? Is like the framing of a lot of this conversation. But like, on top of that, I mean, we've talked about this before on the show that one of my very best friends was diabetic and passed away because she couldn't access treatment. Yeah, right. That was like facilitated by a lot of things. It was facilitated by capitalism and anti blackness and transphobia and lots of things. But it was also facilitated by our sort of cultural disregard and disdain for people who have diabetes or any health conditions that we deem as, quote, unquote, doing it to yourself. For many folks, this is Like a matter of body image, which is really tender and personal for other folks. For people who are on this medication for their diabetes, this can very literally be a matter of life and death. Right, right. We're talking about like a wide range of big feelings and it's like understandable. Right. This is one of the most intense and sort of widespread moments of body related discourse we've had in quite some time. Right. People who are taking this for weight loss are told that they're sort of taking the easy way out, which they absolute are not and which also presumes that people are fat because they don't try hard enough. Right, right. And when those people are fat, they're often being forced into this kind of weight loss in order to access healthcare treatments, surgeries, other like super basic needs. Right. This just feels like huge that way.

[Michael Hobbs]

I think a fun bit for the show would be to just do a bunch of table setting and like caveats and then just never get to the topic. Another thing we want to say right.

[Aubrey Gordon]

Off the bat, we have gotten dangerously close to an entire episod of Cave.

[Michael Hobbs]

Yeah, we're working toward it.

[Aubrey Gordon]

So for part one, we're just going to talk about the drug itself. We're going to talk about Semaglutide, which is the active ingredient in Ozempic and Wegovy. Ozempic and Wegovy are injections that are produced by Novo Nordisk, which is a big pharmaceutical company. They're part of a group of medications that are called GLP1 agonists. GLP1 helps regulate our hunger and satiety signals and production of other hormones like insulin. There are other GLP1 agonists sort of on the market, most of them approved for diabetes treatment. Those are Ribelsis Mounjaro, and there are about another dozen that are sort of coming down the pipeline. Semaglutide has been on the market as a treatment for type 2 diabetes in the US since 2018 under the name Ozempic. When it's prescribed for weight loss, it's prescribed under the name Wegovy. It's the same thing, they're just different doses. Interestingly, the weight loss one requires a slightly higher dosage of Semaglutide.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

So this drug started to be sort of studied. Its glimmers begin in 1984 with an endocrinologist at the University of Toronto. His name is Dr. Daniel Drucker. And he discovers a new hormone in humans, which is GLP1. It's called glucagon, like peptide One girl, Glucagon. As he and other researchers tried to figure out how GLP1 functioned in the human body, it starts to show real promise as a treatment for type 2 diabetes. But they have this problem, GLP1 sort of disappears from your system very quickly.

[Michael Hobbs]

Oh.

[Aubrey Gordon]

So it makes it really hard to study, much less sort of reproduce it. So they start looking for alternate sources of GLP one that might last a little longer than the human version. Right.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

And that's when the Gila monster comes in. Oh, Mike, have you ever heard of the Gila monster? Yeah.

[Michael Hobbs]

They're like a cute little lizard. They're like a kind of like a thick, like, robust lizard.

[Aubrey Gordon]

I did not know about them before this episode. I didn't know a thing about them. They're the largest lizard in North America. They're almost two feet.

[Michael Hobbs]

I've never seen one in real life, but I've seen them in zoo books, and they're really cute.

[Aubrey Gordon]

Well, listen, Dr. Drucker had one shipped to him in Toronto.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

Because it goes through long periods without food, and it has the ability to slow down its appetite and metabolism.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

And Drucker wanted to know how they were able to do that. And he discovers that those Gila monsters have genes for something called extendin 4, which, when sort of synthesized in a lab, eventually became ozempic.

[Michael Hobbs]

How ironic that a thick lizard gave us Thin women. Interesting, Interesting.

[Aubrey Gordon]

So researchers don't totally know the mechanism for what makes GLP1 agonists work the way that they do, but we do know that semaglutide sort of mimics that GLP1 hormone that is again, released after you eat. It's part of what makes you feel full, and it's part of what signals your brain that it's time to stop eating.

[Michael Hobbs]

And so it works by you end up eating less because you just basically feel full after each meal.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

So, like, it triggers your satiety hormone. So, like, ordinarily you'd be hungry again two hours after breakfast, but now it's like three or four hours after breakfast. And so over the course of a day, you just end up eating, like, I don't know, 20, 30% less.

[Aubrey Gordon]

Yes. And on top of that, it's holding that food longer in your stomach, so you are physically full for a longer period of time. Right. And it's triggering a release of insulin. And also it may help grow pancreatic beta cells, which are the cells that produce and release insulin. So it's not just that it helps you release insulin in the Short term, it's also sort of like building up your ability to release insulin in the middle.

[Michael Hobbs]

Oh, interesting. So it's like flexing a muscle. It's actually like building the muscle that secretes insulin.

[Aubrey Gordon]

It seems like it. It seems like it might be, yeah. The results for people with diabetes in clinical trials are really incredible. So for diabetic people, the most important measure of your blood glucose is your A1C. That's a measure of the amount of hemoglobin in your blood that reflects your blood glucose levels over the last, like, few months. Most guidance for people with type 2 diabetes suggests that they should keep their A1C below 7 to minimize complications. But people whose blood sugar isn't well managed can have a 1Cs that are like 10, 11, 12, 13, like, really high. It can lead to damage to that person's eyes, including possible blindness, their kidneys, including kidney failure to their nerves and to their heart. With the introduction of these GLP1 agonists, the results are kind of miraculous.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

There are stories that are told about the initial presenting of the research on these at the American Diabetes association conference, and people were weeping and gave it a standing ovation.

[Michael Hobbs]

No way.

[Aubrey Gordon]

Because what they're talking about is people whose A1Cs went from like 11 to 7. Right. From, like, really heightened, urgent risk down to, like, a pretty safe range just with this one drug. Right.

[Michael Hobbs]

I do think one of the fundamental, like, difficult things to process about any of these kinds of health conditions is that, like, we all kind of hate pharmaceutical companies. Like, under a system of capitalism, it's like, these are big global profit maximizing entities, but then on the other hand, they deliver a product that is genuinely life saving.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

I always just get kind of weird whenever people, like, praise pharmaceutical companies. I'm like, I don't know about that. But then whenever people overly criticize pharmaceutical companies, I'm also like, I don't know either.

[Aubrey Gordon]

So in the trials for Ozempic, they start noticing pretty significant weight loss, and researchers start going, well, what if we could just use this as a weight loss drug? So they created Wegovy. It's the same drug at a higher dose. It uses more of the active ingredients, semaglutide, and because of that, it costs more. Diabetic version hovers at around $900 a month, and it costs more for weight loss. It costs like $1,300 a month out of pocket, and most insurers do not cover it.

[Michael Hobbs]

Not that, like, my main purpose with the show is to, like, widen the availability of Weight loss drugs. But, like, there is something fascinating about how we've gotten all this stuff about, like, the obesity epidemic is so bad, it's, like, killing our kids. And then it's like we get a drug that ostensibly treats it, and they're like, that's too expensive.

[Aubrey Gordon]

Yeah. It is really wild that this is an issue where we talk out of both sides of our mouths constantly as a culture. In a lot of ways, the experiences of people who are taking WeGovy for weight loss or Mounjaro or Rebelsis or whatever the other ones are, that are getting prescribed off label. Right. That, like, a lot of folks are being told that they're, like, taking the easy way out.

[Michael Hobbs]

Yeah. That's really bizarre.

[Aubrey Gordon]

That's the kind of rhetoric that reveals itself to be not about concern, not about your health, just about, I want you to suffer for looking the way that you look.

[Michael Hobbs]

We're doing discourse, Aubrey.

[Aubrey Gordon]

We're doing discourse, and we're not even into the discourse section.

[Michael Hobbs]

I know we haven't, Michael. I know, I know. I'm keeping my discourse powder dry.

[Aubrey Gordon]

But here we are.

[Michael Hobbs]

We're discoursing.

[Aubrey Gordon]

So WeGovy was approved for weight loss by the FDA in June 2021. Almost as soon as Wegovy was approved for weight loss, both wegovy and Ozempic went into shortage. That impacts both people seeking the drug for weight loss and the people using it to manage their blood glucose for diabetes. Because what happens is that WeGovy goes into shortage first. Right. That's the weight loss one. And then doctors start prescribing Ozempic, the diabetes medication off label, to people who want to start to lose weight.

[Michael Hobbs]

Right.

[Aubrey Gordon]

Then that goes into shortage, too. So as we record this, WeGovy and Ozempic are both in shortage, according to the FDA's sort of drug shortage database. When a drug goes on the FDA's shortage list, the FDA then allows what are called compounding pharmacies to mix up what is basically their own version of that drug without prior FDA approval or screening. When Ozempic and Wegovy went into shortage, compounding pharmacies across the country started compounding their own versions of semaglutide. Oh, here's the problem. Novo Nordisk has patented the semaglutide molecule.

[Michael Hobbs]

Oh.

[Aubrey Gordon]

And only they can produce it until 2032. So the active ingredient simply isn't available to those compounding pharmacies.

[Michael Hobbs]

Wow.

[Aubrey Gordon]

These compounding pharmacies are prescribing something. They're calling it Semaglutide.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

It's not Ozempic and it's not WeGovy. It might be a watered down dose of those things. It could be something called semaglutide sodium. Okay, it's called semaglutide, but it's used in lab animal experiments and is not cleared for use in humans.

[Michael Hobbs]

Oh, that's like when people were taking like horse antibiotics that you could buy on Amazon because they couldn't get like human antibiotics because they're like roughly the same thing.

[Aubrey Gordon]

Well, except this is not roughly the same thing and is hazardous to humans health. Semaglutide sodium is not cleared for use in humans because it is bad for humans.

[Michael Hobbs]

Oh fuck.

[Aubrey Gordon]

And the third option is that it's something else entirely. Because this is in shortage and because there is less FDA oversight. Right. These compounding pharmacies are not required to tell anyone what's in the drugs that they are giving people.

[Michael Hobbs]

Right?

[Aubrey Gordon]

This may sound niche. These compounding pharmacies may sound niche. This is every web advertisement you see that says ozempic for $99 a month or $499 a month or whatever. All of these, all of the little startups that are like just call and talk to a doctor and you'll have it the next day. All of that stuff is powered by compounding pharmacies.

[Michael Hobbs]

No way.

[Aubrey Gordon]

So this got so bad, the compounding pharmacy stuff has gotten so bad that the FDA has issued a number of official warnings about this and, and specifically has warned against buying from these startups.

[Michael Hobbs]

This is such a bizarre system.

[Aubrey Gordon]

It's so weird.

[Michael Hobbs]

It's like there's a shortage of this drug so we're just gonna like let people buy it from like weird fly by night carnival barker ass companies selling whatever the fuck on the Internet. We're not gonna regulate it at all.

[Aubrey Gordon]

There's not an enforcement mechanism beyond these letters so far. Right? Like they're not doing more than that yet, at least not in reporting.

[Michael Hobbs]

Do you have any sense of like when this could resolve itself? Like has Novo Nordisk said that they're massively ramping up production?

[Aubrey Gordon]

Basically the goalposts just keep getting moved for when the shortage will end. You know, I checked a couple months ago, it said it would be over by the fall. I checked again, it said it would be over by the end of the year.

[Michael Hobbs]

Oh, it's like self driving cars. It's always five years away.

[Aubrey Gordon]

Right on the horizon as we're talking about these compounding pharmacies, big weight loss companies are buying up these startups. Oh Weight Watchers bought one of these and their stock price jumped almost 60% in a day.

[Michael Hobbs]

Oh, from like 12 cents to like 16 cents or something.

[Aubrey Gordon]

I mean, listen, Weight Watchers stock was not doing great, but a 60% increase is a 60% increase.

[Michael Hobbs]

You know, they've gone from a limp to a gate.

[Aubrey Gordon]

And I would say, because the discourse around this is all focused on, like, the Real Housewives are taking it and frivolous rich people and celebrities are taking it, it makes the issue seem like it isn't incredibly pressing and important, particularly for people with type 2 diabetes, particularly for people who can't access healthcare and other basic needs at their current weight. This is the other thing about this discourse that drives me utterly fucking bananas is that there's not meaningful acknowledgement of the straight up income barriers to getting this medication. That this is a shortage that is largely, presumably created by people with the disposable income to pay out of pocket for a weight loss medication that almost no insurers are covering.

[Michael Hobbs]

Right.

[Aubrey Gordon]

You and I have discussed this until we're blue in the face. Like, neither one of us wants to litigate individual behaviors, but, like, that is one that really doesn't sit right with me.

[Michael Hobbs]

My views on this are also very contingent. Honestly, like, once we get to a point where these are super duper available, if you want to take one to lose ten pounds, genuinely, I don't give a shit. In the same way I don't give a shit if you want to get a nose job. But, like, in time of a shortage, the same thing.

[Aubrey Gordon]

There's an Adderall shortage. If you're not prescribed Adderall, don't take Adderall right now.

[Michael Hobbs]

If you don't need Sriracha. I've been doing my part. I'm buying slightly less Sriracha than usual.

[Aubrey Gordon]

Dude, the Sriracha shortage has been a big topic of conversation in our household.

[Michael Hobbs]

Are you still doing it? Can I cancel you for eating Sriracha in a time of need?

[Aubrey Gordon]

We had a bottle. It was about halfway done. I got another one.

[Michael Hobbs]

Hypocrite. Totally. You're hoarding Sriracha.

[Aubrey Gordon]

One and a half bottles. Come take them from my cold, dead hand. No, I'm just kidding. So, Michael, Aubrey, this is unusual for us, but this topic was so big and expansive that you and I both actually researched this one. And I dug in on sort of the discourse side and the reporting side, and you really dug in on the research side. So can you walk us through just, like, what do we know from the research?

[Michael Hobbs]

This is A weird format break for us because ordinarily, like, one of us researches and one of us listens, but like, it would be odd to pretend that we haven't both been following this like obsessively for the last couple months. Yes, I have deliberately avoided the discourse because I find the discourse annoying. But I have been following the research and like I have a literal spreadsheet of like the various studies that have been done. And for these drugs there's actually a quite finite amount of information and I just, for the love of God, just want to like walk through what we know and what we can expect from these drugs.

[Aubrey Gordon]

Yeah, sounds great.

[Michael Hobbs]

So basically the trials of semaglutide for weight loss are all grouped under this heading of the step trials, which is the semaglutide treatment effect in people with obesity, which should be stepo, but is actually step.

[Aubrey Gordon]

Stepo. What, the fifth Marx Brother?

[Michael Hobbs]

Yeah. And. And these are sort of classic pharmaceutical company randomized controlled trials. They are Global, they comprise 5,000 people. All of them are 68 weeks long. One of them is a little bit longer. We'll get to it. They are funded by Novo Nordisk, of course, and the way that they structure these, they sort of do it like moon missions. You know, there's like Apollo 1 and Apollo 2. These large pharmaceutical trials are like there's step one, step two, step three, and they break them down into like specific things that they want to know.

[Aubrey Gordon]

And step one, step two, step three are not different phases in the same study. Right? They are separate studies.

[Michael Hobbs]

So step one is like the overall just like we're going to give fat people semaglutide for weight loss. Step two is the same thing, but on people with type 2 diabetes. Step three is semaglutide with intensive behavioral therapy BLTs and then the rest are kind of like smaller shading. So step four is they put people on semaglutide for a while and then they switch half of them to a placebo. Step five is a two year trial. Step six and seven are the same thing, but they're done on Japanese, South Korean and Chinese people. And step eight is testing semaglutide versus one of the other GLP ones. So it's semaglutide versus liraglutide.

[Aubrey Gordon]

So when you say I hate these fucking names. Step six and step seven are focusing on East Asian folks. It's worth mentioning that most of These trials for WeGovy in particular are just overwhelmingly white, as many diet studies are one of the sort of leading meta analyses of studies involving over 11,000 participants was 80% white.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

10% black and 5% AAPI.

[Michael Hobbs]

Although for diet studies, I mean, we both see diet studies that are like, 97% white fairly frequently. So, like, it's funny, like, 80% white. I'm like, ooh, not bad is in Hell, yeah. Like, by the standards of fucking diet research, it's like, oh, very diverse sample. The results of these semaglutide trials are, like, quite consistent, like, remarkably consistent. So roughly 80% of people who take semaglutide lose some amount of weight, roughly 5% of their body weight. And roughly half of people who take semaglutide lose 10 to 15% of their body weight. So, like, a one in two chance of losing, like, a moderate amount of weight. And then the biggest number. And the thing that has, like, sent the entire, like, weight loss industry into overdrive on this is that roughly one third of people who take semaglutide lose more than 20% of their body weight, which is roughly on par with, like, bariatric surgery. And then another thing that is, like, a pretty big deal about these drugs is that, like, the results seem to hold up. So there's one trial where people took semaglutide for two years, and by the end of it, 36% of people had lost more than 20% of their body weight.

[Aubrey Gordon]

So for about a third of patients, they're losing maybe three times as much weight as previous interventions.

[Michael Hobbs]

We should also note that there are pretty significant health effects of these drugs. So even in the shorter term trials, people have better blood pressure, they have better cholesterol, they have improved A1C levels. We also, with the longer term trials, we've seen modest, but also, like, kind of big deal reduction in heart attacks and strokes.

[Aubrey Gordon]

So that's really exciting.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

If there is a drug that people can take and they are less likely to die. Yeah, I am pro that drug.

[Michael Hobbs]

I actually looked this up, that it's roughly in line with the effect of statin. So this is. This is genuinely like, a big deal. Like, even if you take the weight loss stuff off the table.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

We should also talk about the side effects. The side effects of the drugs seem to be almost universal. Some studies find. I think the lowest one I found was like, 60% of people have, like, gastrointestinal symptoms. But then some of them are finding, like, 93% of people. So it's like nausea, constipation, diarrhea, vomiting, the sort of tummy stuff that you would Associate with, like, pretty significantly fucking with your, like, hunger and satiety hormones.

[Aubrey Gordon]

In addition to all of those side effects, there is sort of this whole class of side effects that get covered mostly in, like, beauty media and, like, gossip blogs. Like, Ozempic face. Have you heard about Ozempic face from.

[Michael Hobbs]

You, like, 10 minutes ago, right when we started recording.

[Aubrey Gordon]

Look, some of us were trying to keep the illusion alive, Michael. So it's basically just the appearance of aging when taking Ozempic, and it's just the result of rapid weight loss. However you did it, it's not unique to Ozempic. It's just when you lose a lot of weight really quickly, you end up with loose skin, and some of that loose skin will be on your face. And that is also the same kind of thing that happens when people age. So you look older.

[Michael Hobbs]

So Ozempic face is just like, you lost weight?

[Aubrey Gordon]

Yeah, totally.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

These ones just strike me, as we were talking about beforehand. Like, these ones just strike me as so fucking mean.

[Michael Hobbs]

It's also so fucked up because it's like our culture is telling you to lose weight all the fucking time. And it's like, you finally do lose weight. It's like, what's happened to your face?

[Aubrey Gordon]

Yeah, totally. Well, and people treat it as, like, some kind of, like, comeuppance.

[Michael Hobbs]

Right, right.

[Aubrey Gordon]

For, like, taking a drug or daring to lose weight or being too vain or what, like, whatever. Like, it's just steeped in so much judgment.

[Michael Hobbs]

Right.

[Aubrey Gordon]

That I'm like, could we just set that one down?

[Michael Hobbs]

There's also a bunch of, like, very rare side effects. So there's been some worry about pancreatitis. Some trials find that it, like, increases. But then there's a trial of liraglutide that finds that it actually decreases. There's concern about thyroid cancer, but that's based on rodent studies. And there haven't been any signs of that in the data. But we don't know kind of any longer than one and a half to two years. There's slightly elevated rates, rates of gallbladder disease, acute kidney injury. There's two cases in Iceland of suicidal ideation. And the European Medicines Agency is now looking into that. And just this week, the FDA updated the label on semaglutide to include this thing, ileus, which is basically when, like, digested food builds up in your intestine and backs up. And the only way to deal with it is surgery, and it's fatal. So we have 33 cases of this that have been reported to the Adverse events database and two deaths.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

But we don't sort of know what to make of those things because the adverse events database is like, as we've discussed on the show before, it's like anyone can submit cases. So it's basically just like a hotline.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

And so it's something that is like people are looking into more and they're. There's a study out of China last year that shows that this mechanism exists in mice where it like basically stops bowel function. And there was some kind of warning in that study of like this might show up in humans and it might show up around the sort of 18 month mark. Meaning, like after these studies would have concluded. But that's also like animal studies, super preliminary. We don't know. It's sort of like people don't really know what to make of this yet.

[Aubrey Gordon]

Yeah. And you know, two people dying is nothing to.

[Michael Hobbs]

Yeah, that's a huge deal.

[Aubrey Gordon]

That's a big deal. That's a big deal. And I think especially in the context of previous diet drugs having sort of gone this way.

[Michael Hobbs]

Right. But then one thing that really stood out to me was, you know, we have these like near universal side effects. We have these like, much more rare, much more severe side effects. But the dropout rates in these studies are like really low.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

What you find in most of the studies is, is almost everybody is getting some side effect or another. And they typically happen in the first couple weeks of the study when you're like upping your dose. It actually takes four months to get up to the 2.4 milligrams like weight loss dose. But it typically goes away as people kind of get used to the drugs. And so in the two year study there were 150 people who completed the two year trial and only 10 of them dropped out due to adverse effects, which is only 6%. So like what this indicates is that like people are getting side effects, but most, like the vast majority of people are willing to like push through the side effects and like complete these trials.

[Aubrey Gordon]

Yeah. So what you're saying is folks are more likely to stay in these studies than other studies into sort of like how folks can lose weight.

[Michael Hobbs]

Yes. So so far I've kind of been presenting like the case for semaglutide, like the way that you read about it in these clinical trials. I've been reading a lot of things from like, you know, people in like the weight loss world and like this is how they talk about the drug. Right. Is that it's delivering very significant weight Loss. The dropout rates are relatively low. And before we get to, like, complicating that picture a little bit, I think it's important to first of all just, like, acknowledge that, like, that is the data that we have. And, like, I think this new generation of weight loss drugs is like, genuinely just a big deal. At the same time, to me, the most bizarre thing about the discourse, especially recently, but since the results of these trials started coming out, is the weird victory lap that people have been doing. It's like, okay, we know we have something now that works for weight loss. We finally have an effective weight loss drug. And then there's this weird sort of second order thing where they're like, what are the fat activists gonna do now? This ruins body positivity and there's all this weird shit of like, well, now we have a cure for obesity, right? And I feel like just to sort of take these results as we've been presented with them, right? Like the quote, unquote, best possible version of these events, right? All of the weight loss, all of the benefits, everything is like, we're talking about a drug that 50% of people who take it will lose 15% of their body weight. And, like, that is not a world without fat people. This is like the aspect of the drug that drives me absolutely fucking nuts. It's not going to end the quote, unquote obesity epidemic. It just isn't. We still as a society need to work on, like, stigma against fat people, improving medical care for fat people. All of the things we say on this show are still fucking true. If every single person In America loses 15% of their body weight.

[Aubrey Gordon]

And that is a dramatic overestimation of what's even about to happen. Right? Yeah. Even if, as you say, even if they work exactly as they are projected to, even if the data doesn't change one bit with future trials. Yeah, someone my size goes from being £330 to being £280. That would take me from being an a person with an obese BMI to being a person with an obese bmi. Yeah, this whole thing about, like, you know, is this the end of the obesity epidemic? Like, A, no, it's not, as you've pointed out, but B, that is the meanest fucking thing to say.

[Michael Hobbs]

We currently have this fucking nightmare bullshit, which is like, the whole fucking show is dedicated to this, where it's like a fat person goes into the doctor for a migraine and they're like, I have a migraine. And the doctor's like, you should Go on a diet. And then it's like, you haven't asked me what I do. You haven't asked me if I eat fast food. You haven't asked me fucking anything. You're giving me this bullshit ass advice when all I want is fucking advice for my migraine. Right, yeah. We're now going into a scenario where you go into the doctor with a migraine. They're like, you should go on Ozempic.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

And you're like, well, I've already been on Ozempic three times, and I was half. I was one of the half of people who lost less than 10% of my body weight. It was costing me more than my fucking rent. I was having weird side effects. People report, like, not enjoying food anymore, which is, like, really sad to think about.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

And then the minute I went off of it, I gained all the fucking weight back. And I've done the that four times. And when I'm going in, you're giving me this generic bullshit fucking advice to go on Ozempic. You haven't asked me whether I've been on it before. You haven't asked me about weight cycling. You haven't asked me whether I tolerate the drug or if it intersects with some, like, antidepressant that I'm taking.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

We're just redoing the same fucking thing, except instead of go on a diet, it's go on Ozempic.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

And like, in the same way that it's not possible for everyone to go on a diet or they've been on a million already, it's not possible for everyone to go on fucking Ozempic and it's not going to work for everybody.

[Aubrey Gordon]

I mean, I told. Listen, I told you this off mic, but I think this is the darkest episode that I have researched for us.

[Michael Hobbs]

Yeah, it's really bad.

[Aubrey Gordon]

It is really upsetting. And I will say, like, not just on an individual level, but also, like, systemically. Like, I stopped seeing doctors for, like, eight years. I've written about this a bunch of times. And that was at the height of, like, the bariatric surgery craze.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

And that really fucking fueled how doctors would talk to me and what treatments they would offer me. And it was like a very frequent conversation of me being like, hey, I'm 24 and I have an entry level position at a nonprofit where I feel fortunate to have health coverage at all. No, I don't have 25 grand for a weight loss surgery. Right.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

But that still became a thing. Right. Amongst health care providers who we already know are more likely to think of fat patients as non compliant, as slovenly, as unattractive, as weak willed as all of these things. Right. Like, this becomes another reason for that group of people also to stop listening to fat people. Like, it's going to get harder for me to get health care.

[Michael Hobbs]

Right.

[Aubrey Gordon]

That's part of what's about to happen.

[Michael Hobbs]

This is why I wanted to go out of my way to, like, insufferably present the results of these trials as if they will hold up. Because. Because even in a world in which that happens, that doesn't call anything into question about the need for equal treatment. And at the same time, the results of these trials are extremely unlikely to pan out in the real world.

[Aubrey Gordon]

Yeah, totally.

[Michael Hobbs]

So I have three reasons why these drugs are very unlikely to pan out and deliver. Like the end of obesity or all the stuff that the insufferable discourse has.

[Aubrey Gordon]

Been telling us we're tucking into the debunk bed.

[Michael Hobbs]

Yeah. This is much more comfortable space for us. The first is that the populations that are being studied in these trials are actually relatively narrow. So step one, which is the trial that's kind of the overall, like, just normal weight loss drugs being given to people. I'm going to read you the exclusion criteria. People were not able to participate in step one. If they have a history of major depressive disorder.

[Aubrey Gordon]

Okay.

[Michael Hobbs]

They have a diagnosis of a severe psychiatric disorder. They fill out the patient health questionnaire with a score of over 15. This is one of those. One of those questionnaires that has, like, I have feelings of hopelessness, like, rank from, like, every day to, like, never.

[Aubrey Gordon]

Yeah, yeah, yeah, yeah.

[Michael Hobbs]

It's basically a measure of, like, how depressed you are. It's like, are you feeling tired? One of them is, do you have poor appetite or overeating? Which is like a funny exclusion criteria to include in this. They're also excluding people with a lifetime history of a suicide attempt, any history of myocardial infarction, stroke, hospitalization, any kind of existing cardiovascular stuff known or suspected, abuse of alcohol or recreational drugs, and female who is pregnant, breastfeeding, intends to become pregnant, or is of childbearing age, and not using a highly effective contraceptive method.

[Aubrey Gordon]

Holy shit. That cuts out so many people, Michael.

[Michael Hobbs]

Well, the thing is, I mean, with these studies, like, I sort of get why people who design studies do this stuff, because they want to start with a kind of baseline of like, quote unquote, normal people without a bunch of, like, preexisting conditions, which I get for the purpose of A trial. I get why you want to have like a clean quote unquote sample. However, once these drugs get out into the real world, they're going to be taken by people with depression. Yeah.

[Aubrey Gordon]

Like when you're designing a trial like this, I imagine you're walking a real line. Right. You want the trial itself to be safe for the people who participate in it. So you want to eliminate things like existing heart conditions, like anything, existing pancreatic conditions, anything sort of related to the mechanisms involved in this drug. I totally get that. Right.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

And you don't want it to make anything worse for anybody, like just on like a human level. That totally makes sense to me. The trick is all of that gets translated into an assumption that this is how it will play out for all people who are not being monitored in a study and provided the drug for free.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

And. And all people who have all of these other conditions that are extremely prevalent in the U.S. right.

[Michael Hobbs]

And also, I mean we. I probably should have started with this. But the second reason why it's unlikely that these are going to deliver on the results that we're seeing in the trials is because there are real world studies of semaglutide and they don't find the same results. So there's a study in the US that followed like people who went to weight loss clinics and got these drugs for one year. If you remember, in the trials of these drugs, the average weight loss was around 15%.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

In the real world trial, people are losing seven and a half percent of their body weight. And there are other real world trials, it's quite remarkable actually, that find almost the same thing that like the weight loss, you know, 80% of people lose 5% of their body weight or more. In the real world, that tends to be around 40%. So almost all of the numbers that we're seeing in these randomized controlled trials are half. Once we get to the real world, they're not zero. Right. So this still is going to be again, a big deal. But we're not seeing in the real world those results continue to show up.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

It's not totally clear why this is happening. One of them appears to be that in the randomized controlled trials, people aren't just taking the drug, they're also getting like dietary counseling. So one of the trials is like super intensive behavioral therapy where they're like meeting with dietitians once a week. But in all of the other trials they're doing monthly check ins with counselors and they're having all of these you know, biomarkers taken. And I think there's something about, like, people just being in a study, like, you really want to finish because you're like, oh, I'm part of this, like, project. And it's, like, experimental and super cool. And, like, the adherence rates for these randomized controlled trials are, like, significantly higher than we have in the real world. When you look at the real world trials, even among people who have type 2 diabetes and who, like, really need these drugs, a lot of them are finding, like, 50% dropout rates after two years. And some of them, one of them finds 70% dropout rate.

[Aubrey Gordon]

You can already see, as we're sort of, like, walking through this research, the gap between the popular claims that are being made about these drugs and what the research actually says. That's where we got to with Fen phenomena. That's where we got to with Ally. That's where we got to with, like, this is sort of a pattern with weight loss drugs is that we get out over our skis culturally with, like, this kind of magical thinking, excitement stuff.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

We then make a bunch of policy decisions based on the excitement and not the data. And then we're kind of stuck with these sort of adjusted systems that were, again, changed based on what we thought was possible, not what we were actually seeing.

[Michael Hobbs]

Exactly. And the other thing that, again, we have very good data on is that people tend to regain all of the weight the second they stop taking these drugs. So one of the step studies switched people from semaglutide to a placebo at 20 weeks. There's also a trial of another GLP1, tirzepatide. These fucking tides that did the same thing. After 36 weeks, they switched people to a placebo. And basically, it's like, people start regaining the weight very quickly, and, like, within a year, they've regained almost all of the weight. These drugs seem to put people in the same cycle as fad diets, but just with, like, more dramatic and, like, longer results.

[Aubrey Gordon]

Well, and the people that I have heard talk about taking these drugs are like, I'm just gonna take it until I get down to X weight, and then I'm gonna stop.

[Michael Hobbs]

Yeah, yeah, yeah, right.

[Aubrey Gordon]

And that is people. People's plan for how this is going to happen. And that's not how these drugs work.

[Michael Hobbs]

I'm seeing this discourse among, like, weight loss clinicians, too, where they're like, well, ultimately, it comes down to diet and exercise. And so we need to get people on these drugs and then teach them the diet and exercise stuff. And then once they know that, we can take them off the drugs. But this trial of tirzepatide, the other drug, had people on an intensive behavioral therapy program when they went off the drug. So people took it for a while, then they switched to a placebo while still doing, like, exercise and, like, cooking classes and all this stuff that everybody says is so fucking effective. And they gained all the weight back.

[Aubrey Gordon]

This is another case of pump the brakes and ask a fat person.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

Has anybody tried to teach you how to cook? Has anybody offered you a gym membership? Has anybody told you that your form was wrong while you were working out?

[Michael Hobbs]

Right.

[Aubrey Gordon]

This is ever. The reason that people think that in part, is that it reinforces our existing beliefs about fat people. Right, Right. Which is just that they're too lazy or they're too unintelligent or they're too uninformed to just do it for themselves. So they need a thin person to teach them how.

[Michael Hobbs]

This is going on my Aubrey Gordon soundboard.

[Aubrey Gordon]

Yeah, totally.

[Michael Hobbs]

Ask a fat person.

[Aubrey Gordon]

I mean, genuinely, that's gonna be my advice. Like, 80% of the time is like, have you even talked to a fat person about this?

[Michael Hobbs]

This is another, like, super fucking familiar pattern where it's like, okay, everyone should go on Atkins because low fat diets work. And then, like. Or low carb diets work. And then, of course, after like, six months, everyone gains the weight, you know, and then it's like. It's like, well, if you stayed on it, you would have kept the weight off, which is true. Fine, if you can stay on it, but no one can fucking stay on it.

[Aubrey Gordon]

Yeah, Right.

[Michael Hobbs]

We know in the real world no one can stay on these extreme low carb diets for very long. So let's move forward on that basis that no one can fucking stay on them. Right. And with this, it's gonna be the same thing of like. Well, Ozempic does work if you can stay on it.

[Aubrey Gordon]

Yeah, okay.

[Michael Hobbs]

But people aren't staying on it. We know from real world data that even when it's f free, people are not staying on it.

[Aubrey Gordon]

Well, and if you do stay on it, people characterize it as the easy way out. Yeah.

[Michael Hobbs]

And then you have this, right?

[Aubrey Gordon]

Like Oprah was just saying the other day, like, it's the easy way out. So I'm not gonna do it. And I'm like, oprah, you were in your 60s. How hard do you think you need to have appeared to have tried?

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

And then, like, listen, the discourse makes it worse because in the discourses, like, A bunch of the reporting is like, we really need to tamp down on the stigma facing people who take Ozempic. And I'm like, yeah, is that the stigma that we need to clamp down on?

[Michael Hobbs]

What's so fucking annoying to me about this discourse? You have, like, successfully radicalized me on this in like the last 72 hours. Oh, as I've been, as I've been reading this, it's like this shows up everywhere. Like, what about the stigma of taking the drugs? But the stigma of taking Ozempic is fatphobia. It's the same fucking stigma that fat people are facing. But just, yes, yes. Oh, you're taking the easy way out by using a weight loss drug. That's the connection between fatness and virtue. You should lose weight in the virtuous way.

[Aubrey Gordon]

Take the stairs.

[Michael Hobbs]

Yeah, take the fucking stairs. It's like, well, you might look thin, but you're really a fat person. You cannot muster any fucking gumption from anybody to like give a shit about stigma against fat people. But they're super chill to invoke fatphobia against people who stop being fat.

[Aubrey Gordon]

And they still do the fucking stigma against fat people.

[Michael Hobbs]

And they still do it.

[Aubrey Gordon]

It's also been fascinating, I'll say on the discourse end that like, there have been all of these bizarre hand wringing pieces from thin people. Being like was body positivity for nothing.

[Michael Hobbs]

I know. It was all a lie.

[Aubrey Gordon]

The vast majority of fat people were under no illusions about broader social acceptance.

[Michael Hobbs]

Right.

[Aubrey Gordon]

At best, people said fewer unwanted things about our bodies. It never stopped. We were never lifted up. We were never centered. We got one Lizzo out of it.

[Michael Hobbs]

Right, like, and we don't even have that anymore.

[Aubrey Gordon]

And we don't even have that anymore. Like, Right, like the degree to which this discourse is thin. People telling themselves stories that they want to hear.

[Michael Hobbs]

It's funny to me that like, we, we like meticulously like, outlined this and planned it out, but neither one of us can resist talking about the discourse.

[Aubrey Gordon]

I hate it so much.

[Michael Hobbs]

Like, fast forwarding to that section.

[Aubrey Gordon]

Okay, Michael, we've talked about the drug. Let's talk about the manufacturer of the drug.

[Michael Hobbs]

Oh, yeah.

[Aubrey Gordon]

Ozempic and Wegovy are both made by Novo Nordisk. It's a big pharmaceutical company. From Denmark.

[Michael Hobbs]

From Denmark.

[Aubrey Gordon]

And their marketing practices have really set the template for all the discourse we've been seeing since.

[Michael Hobbs]

Okay, wait, are there ads for Wegovy and Ozempic?

[Aubrey Gordon]

You haven't seen the oh, oh, oh, Ozempic.

[Michael Hobbs]

That's like the COVID songs that are in all the fucking trailers now.

[Aubrey Gordon]

The very slow, brooding cover of like, I whip my hair back and forth.

[Michael Hobbs]

I'm blue, Badu dee da du die. But it's, like, super dark. Yeah, no, as we've discussed many times, we're on very different, like, Instagram experiences and, like, algorithms and, like, I've never seen an ad for weight loss anything.

[Aubrey Gordon]

I'll tell you what, Mike, I might give you homework at one point and be like, go watch a half an hour of TV and tell me what you notice about the ad.

[Michael Hobbs]

No, absolutely not. I watch terrestrial TV like, once a year when I'm, like, visiting my grandma and I'm like, this is, like. This is, like, actively making me stupider. It's, like, shocking how bad it is.

[Aubrey Gordon]

So we're going to talk a little bit about the marketing practices at Novo Nordisk.

[Michael Hobbs]

Okay?

[Aubrey Gordon]

There is a lot here that leaves me feeling icky. A very good example of this is a campaign called It's Bigger Than Me. Have you seen this campaign at all?

[Michael Hobbs]

Is it like, billboards?

[Aubrey Gordon]

There are ads, there are billboards, There are branded segments on TV shows. There are so many things. The slogan is obesity. It's Bigger than Me.

[Michael Hobbs]

Okay?

[Aubrey Gordon]

The idea behind the campaign is, it's not your fault you're fat. Followed immediately by, it's because you have a disease, and that disease requires medical treatment, and that medical treatment can only be provided by one company.

[Michael Hobbs]

It's Bigger than me. It's $15,000 per year.

[Aubrey Gordon]

Yeah, that's right. That's right. As part of this campaign, Novo Nordisk has specifically courted black public figures, and particularly black women as spokespeople. Their first spokesperson was Queen Latifah. Their next was Yvette Nicole Brown, who was on Community. Their third was Roland Martin from cnn.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

Who ran an hour long segment on fatness in black communities that was listed as, quote, unquote, powered by Novo Nordisk.

[Michael Hobbs]

That's like, when influencers say, like, I've partnered with Nike or whatever, it's like, yeah, it's just them paying you to say words. Well.

[Aubrey Gordon]

And on top of that, the reporting around the quote, unquote, it's Bigger Than Me campaign is just rife with, like, the most garbage messages about fatness and body positivity and all kinds of stuff. So I read an interview with, with Yvette Nicole Brown with the griot. In that interview, she said, quote, being focused on your health does not mean that you're not body positive. I think it's actually the most exemplary way that you can be body positive because you need your body to continue to live.

[Michael Hobbs]

Aubry, were you just like, losing your mind? You hate this body positivity stuff already. This is like, this is reifying everything you've said about the whole body positivity thing. That it's all just like they're repackaging the same shit and selling it back to you.

[Aubrey Gordon]

The article goes on to say that, quote, Brown said, somewhere down the line, society at large developed the idea that if you're body positive, you can't care about physical health. In my notes, I wrote in all caps, who is saying this?

[Michael Hobbs]

Who fucking said this? Oh, my God.

[Aubrey Gordon]

Who is saying this? And it's like, trolls, right? It's seeding a bad faith argument to be like, we don't think that's true. Look at what all those nutty people are saying. They're wrong.

[Michael Hobbs]

This is like when conservatives are like, feminists don't even want you to get married and have kids.

[Aubrey Gordon]

It's the phenomenon that has built. Michael Hobbs, Twitter feed.

[Michael Hobbs]

You're familiar with my work.

[Aubrey Gordon]

So our third section, Michael, discourse is the part that I have realized is most troubling to me, and that is the discourse.

[Michael Hobbs]

There's been a lot of, like, garbage media about this in the last, like, year.

[Aubrey Gordon]

Here are three actual fucking headlines from coverage of this.

[Michael Hobbs]

Ooh.

[Aubrey Gordon]

One, Will Ozempic change how we think of being fat and thin? Question mark.

[Michael Hobbs]

Okay.

[Aubrey Gordon]

Life after food. Question mark.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

And Ozempic settles the obesity debate. Oh, it is bad faith proclamations and bullshit question mark headlines like as far as the eye can see.

[Michael Hobbs]

Yeah, yeah.

[Aubrey Gordon]

What I am worried about is that when we see a wave of media like we have seen around Ozempic, we also tend to see a wave of increased anti fat bias. Right, right, right. And the reporting that I have seen so far, the think pieces that I have seen so far, none of them are grappling with that.

[Michael Hobbs]

Right.

[Aubrey Gordon]

Very few people are asking fat people what they need in this moment, and nobody is asking diabetic people what they need in this moment. Like, a thing that I experientially know in every bone in my body is that when people I know start to lose weight, the vast majority of them start to see themselves as more virtuous, whether they want to or not, whether they mean to or not, whether or not they would say it out loud.

[Michael Hobbs]

Yeah.

[Aubrey Gordon]

It's very common for people to expect social reinforcement for weight loss.

[Michael Hobbs]

Right.

[Aubrey Gordon]

And I would say now, as I have said for years now, which is you have got to get People's consent to do that. The best case scenario is that you're sending a message that you're like, not a very good friend to a fat person. Right. And the worst case scenario is that you're increasing the stigma that they face and potentially also like, triggering people's eating disorders. Yeah. Like, this shit is not, not unthorny. And the fact that you're hearing it everywhere doesn't make it less urgent. I would argue it makes it more urgent to like, double up on those boundaries. Like, you have got to give fat people an out for this conversation and we've got to stop presuming that this is like a good and exciting conversation for everybody.

[Michael Hobbs]

I am, like, not all that invested in, like, the drugs themselves. The drugs are the drugs. I don't know. I mean, same, same. Maybe they'll be effective weight loss drugs, maybe they won't. I don't know. But like, given what we know now, the most likely scenario is that, like, they're going to be prescribed to millions, potentially tens of millions of people. And like, what you said to me the other day is that like, you can see the number of people who lost like 15 fucking pounds and then all of a sudden are like, really mean to fat people, just like exponentially increasing.

[Aubrey Gordon]

The other thing that I will say about the discourse around this is that every, like, celebratory story about Ozempic that comes out now, that's all going to be mirrored by future panicky think pieces on the rising costs of obesity and how fat people are bankrupting us once again. Right? This is an unbelievably expensive medication and all of that is going to come back to scapegoating fat people once again. Right? That like, right now we're saying it's frivolous housewives and whatever. When we get into the insurance conversations, we're not gonna be scapegoating rich people. We generally don't do that. We scapegoat poor people, bipoc fat people, queer people. You know what I mean? Like, we've got a list of people we scapegoat.

[Michael Hobbs]

We're also setting ourselves up for another round of excruciating discourse in another couple years when people look around and they're like, wait a minute, there's still fat people.

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

All the magazines told me a couple years ago that this was the end of, of obesity and yet people are still fat.

[Aubrey Gordon]

We should also say, like, listen, you will face serious, serious fucking stigma as a person who stays fat. Trust me. A person who has stayed fat through all the interventions. Right. Like, I've already, like, sort of started shifting socially. You know, I'm already a very homebody, indoorsy kind of lady. Mm. And I'm already restricting who I socialize with pretty dramatically because of this kind of talk and because I'm unwilling to be in spaces where this shit will come up. Right. And for me, that means functionally, like, a vast majority of people I know who are not fat and some people I know who are.

[Michael Hobbs]

Right.

[Aubrey Gordon]

Right. So I just want people to understand, like, the stakes of this as a fat person are. I feel like I don't belong in the world.

[Michael Hobbs]

Right.

[Aubrey Gordon]

When people talk about how great it's gonna be when I'm not around, that's not me being too sensitive. That's not fat people taking it too hard. That's you saying plainly, right. Everything will be better when you're gone.

[Michael Hobbs]

Right.

[Aubrey Gordon]

And then fat people, like, taking that message. That's horrible.

[Michael Hobbs]

The fact that you have been through so many rounds of this. It's like, why aren't you on fen fin? Why aren't you on bariatric surgery? Why aren't you clean eating? Like, all this is is just new packaging for, like, why aren't you thin?

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

And like, that is worth listening to. This isn't like a paranoid fantasy on the part of fat people. This is something that they've been through numerous times over the course of their lifetimes. Now we're just doing the same thing again. Even when the data does not remotely indicate that we're not going to have fat people anymore, it never has. We're always going to have fat people, and there's always going to be people, whatever the medical intervention is that can't use it or it doesn't work for them or they've tried it already. That's always going to be the case. The fact that people are so obsessed with asking the question, is this the end of obesity? Like, really early?

[Aubrey Gordon]

Yeah.

[Michael Hobbs]

Like, oh, is this gonna be the reason we don't have fat people around anymore? It's like, it's so fucking telling.

[Aubrey Gordon]

So moving forward, we're gonna continue to get these drugs. We're gonna continue to get this sort of quote, unquote, gold rush. And in that time, I think it is worth being extra skeptical and returning to the voices of fat people and diabetic people when media isn't doing that. That for us. Right. To, like, actually return to the people who are most impacted by this debate and to spend way the fuck less time speculating about Elon Musk and Courtney Kardashian and making celebrities defend themselves and, like, trying to think through how do we get these drugs to people who need them? How do we design a better discourse that isn't so wildly dehumanizing to fatigue people and, again, to diabetic people? Right. And, like, how do we just show up for people a little bit more around this stuff and interrupt some of this, like, dancing in the street kind of energy that is, like, really upsetting to see as a fat person.

[Michael Hobbs]

Okay, we've done enough table setting. Let's start the episode. Are you ready? It's been 2 hours and 45 minutes. I think we're ready.

[Aubrey Gordon]

We can dive in.

[Michael Hobbs]

Sa.