Both for weight loss, which is always something that I wanted for myself—my doctor’s never said that I have to lose weight—and then to also have it be something that was helping with my diabetes management.” .

Days after her latest video, Ozempic’s makers, Novo Nordisk, obtained approval from the Food and Drug Administration to sell a new, higher dose version of the drug called Wegovy—one explicitly meant to help people with obesity, long since (and more controversially as of late) defined as having a body mass index over 30, lose weight.

They’re gone as far as to call it a “game-changer” that could usher in a new era of obesity treatment, both because it’s helped people lose considerably more weight than past remedies and because it seems to work on several aspects of our biology linked to obesity, like our metabolism.

By amplifying GLP-1, you can help rebalance the biological process that’s gone awry in most people with diabetes, specifically when it comes to insulin.

(People with type 1 diabetes no longer produce insulin, but those with type 2 and latent autoimmune diabetes can continue to produce it until their condition progressively worsens.) And because some of these metabolic problems arise in people with obesity, itself a suspected risk factor for type 2 diabetes, the hope is GLP-1 drugs will repair these problems found in people with obesity, too.

It’s formally approved for people with obesity or people with a BMI over 27 and at least one suspected weight-related condition, and it’s the first new weight loss drug approved since 2014.

But even that undersells how difficult it has been to find any treatment capable of helping people lose weight and keep it off.

And most medical treatments now marketed for weight loss only provide a modest boost, if any at all, while past treatments like Fen Phen and 2,4-Dinitrophenol (DNP) were pulled from the market for their dangerous, sometimes fatal side effects (DNP in particular could cause heat stroke by raising a person’s core body temperature too high).

The most effective bariatric surgeries help people lose 20% to 30% of their original weight on average, but they are often an expensive and life-altering option that only a small percentage of those eligible for it actually take.

On paper, Wegovy does seem to be the sort of miracle people worried about their weight dream about, particularly in the wake of scolding media coverage and research telling us that people have gained weight during the covid-19 pandemic.

Traditionally, despite the possible health benefits, approved weight loss treatments are considered cosmetic, meaning that Wegovy wouldn’t be covered through basic insurance plans provided by employers or by the government via Medicare and Medicaid.

It’s also reportedly doing a full court press in trying to convince private insurers and third party pharmacy benefit managers that Wegovy should be considered an essential treatment just like other medications taken for chronic conditions, including type 2 diabetes.

In the very statutes that established the Medicare Part D program in 2006, which provides coverage for prescription drugs, weight loss drugs are considered exempt from basic coverage.

But under the current law, a representative for Centers for Medicare & Medicaid Services told Gizmodo, basic Medicare plans will not cover weight loss drugs, Wegovy included.

But some researchers have noticed a possible connection between medullary thyroid cancer in people and different GLP-1 drugs.

All GLP-1 drugs on the market, including Wegovy, do warn people to be on the lookout for pancreatitis and warn doctors against prescribing them to people with a family history or genetic mutations linked to a higher risk of medullary thyroid cancer.

She also felt that the possibility of people using it when not indicated, including people with disordered eating patterns like anorexia, was low for the time being, given its current prescription requirements.

“I am sure that people with anorexia might want to take Wegovy, as would people who want cosmetic weight loss but don’t meet BMI criteria, but it would be hard to get it, and no reputable physician would prescribe it,” she said.

“In Brazil, the GLP-1 RAs are taken off label for cosmetic weight loss, but this has not occurred in the U.S.

The current medical consensus is that obesity is a chronic disease caused by a complex mix of not always controllable factors, including our environment and genetics—one that robs people of their good health and quality of life.

“It was immediate, these alarms in my head, because I was like, ‘There’s no such thing as a game-changer drug.’ In the past, with other medications that have been approved for weight loss, they have been extremely harmful, have had serious tolls on people taking them,“ Marquisele Mercedes, an activist in the fat acceptance movement, researcher, and doctoral student at Brown University’s School of Public Health, told Gizmodo by phone.

Some researchers have also argued that while people living with obesity do experience worse health in some ways, much of that harm can be attributed to the weight stigma and discrimination they face from others, including from their own doctors (weight stigma might even keep people from adopting healthy behaviors like exercise).

Other studies have suggested that frequently losing weight, only to gain it back, can damage people permanently and could account for some of the health risk linked to obesity.

And for many of these potential users, Wegovy won’t just represent a sure-fire way to lose weight.

Some obesity doctors and researchers argue that finally having an effective antiobesity drug on hand will help reduce weight stigma by making it clear that obesity isn’t a matter of willpower—it’s a metabolic condition that doctors now have a reliable way to manage.

Raychel Vasseur is one of the first customers of Calibrate, a company aiming to help people lose weight by pairing nutritional and lifestyle counseling with prescription medication, particularly GLP-1 drugs (Donna Ryan is one of Calibrate’s scientific advisors).

Researchers like Donna Ryan are hopeful that future studies will not only demonstrate that GLP-1 drugs help people with obesity lose weight but also improve other markers of health.

This past March, Senators Kevin Cramer (R-ND), Tom Carper (D-DE), and Bill Cassidy (R-LA) reintroduced the Treat and Reduce Obesity Act, legislation that would remove the restriction of Medicare coverage for obesity treatments, including drugs like Wegovy.

But people like Mercedes and Brown fear what will come next if Wegovy does turn out to be every bit as popular and profitable as they expect it to be (even mediocre weight loss drugs like Novo Norodisk’s Saxenda have made around $1 billion in annual sales recently)?

“It doesn’t matter, because you’re still pathologizing the condition,” Mercedes said, citing research suggesting that discrimination toward fat people, including from doctors, isn’t necessarily reduced when people believe that obesity is a disease.

“So people are not going to experience less stigma just because there’s a medication that proves that their weight is not in their control.”.