Like so many of us, Beth Rubin, a Wall Street compliance director in her 50s, gained the Quarantine 10. “I wasn’t walking to the subway, the swimming pool in my building was closed, and my husband and I would split a bottle of wine every night. Everything was working against itself.” The problem, says Rubin, who lost 40 pounds 15 years ago and had, until lockdown, been able to keep it off, was that she was hungry all the time.
Then, in December, a miracle solution came in the form of a tiny needle. Rubin’s doctor, Katherine Saunders, an assistant professor of clinical medicine at Weill Cornell Medical College who specializes in medical strategies to counter obesity, put Rubin on Wegovy, a weekly injectable that was approved by the Food and Drug Administration in June 2021 to treat adults with obesity.
Wegovy’s approval was big news, but it didn’t get much attention in the popular press; some physicians suspect that it was overshadowed by the attention given to the pandemic. But it has become a popular topic of conversation in Manhattan, especially its toniest enclaves like the Upper East Side, where weight loss remains a chronic fixation.
Since the end of last year, Rubin says, she’s lost 15 pounds. “I haven’t been this weight—125 pounds—since my 20s,” she says.
The superpower of Wegovy is that it takes away your appetite. “Wegovy mimics a hormone called GLP1 that tells the brain that we have eaten and helps us feel full for longer,” Dr. Saunders explains.
That tracks for Rubin, who says her portions are smaller and that she is consuming less wine. (Drinking is not verboten while on Wegovy, but Dr. Saunders says excessive alcohol use could increase the risk of pancreatitis while on the drug.)
“If you overeat, you will throw up,” says Rubin. What is also game-changing about Wegovy, whose side effects can include nausea, reflux, and constipation, is that previous anti-obesity drugs were associated with a 5 to 10 percent weight loss. In clinical trials, Wegovy has shown to help people lose up to 15 percent of their body weight. (With bariatric surgery, the weight loss is more significant, averaging around 20 to 25 percent, according to Saunders.)
Dr. Amanda Velazquez, the director of Obesity Medicine at Cedars-Sinai Medical Center in Los Angeles, says that, anecdotally, she is seeing about 10 to 15 percent weight loss in her patients, which takes around three to six months. Wegovy helps with what clinicians call “meaningful weight loss,” which can have a positive impact on other health problems, such as high blood pressure and high blood sugar.
But the weight can creep back on once the medication is stopped and caloric intake increases. In other words, some patients may continue taking the drug indefinitely.
“The only shortcoming of Wegovy is the price tag. If you don’t have insurance, a 30-day prescription would be about $1,500 and $2,000,” says Dr. Velazquez. At its current price, it would cost $323,000 to stay on Wegovy for 20 years.
But some insurance companies cover anti-obesity medications, such as Wegovy, for adults who qualify and have a body-mass index (B.M.I.) of more than 30, or who have a B.M.I. of more than 27 but also have weight-related medical problems.
But, wait, isn’t this cheating—just the American way of taking a pill to shortcut all the hard work of shedding pounds? In the same way that telling someone who is clinically depressed to “just cheer up,” telling someone who suffers from obesity to try this diet or that exercise program doesn’t track with what the science says: that weight regulation is multi-factorial in origin and has to do with epigenetics, or how the environment affects your genes.
Rubin, for one, says she is very disciplined and that she knew not to eat certain things, but if you’re hungry, as anyone with those pangs can you tell you, it’s very difficult (impossible?) not to eat.
“The only shortcoming of Wegovy is the price tag.”
In this way, Wegovy has the potential to advance the conversation around treating obesity. Namely, by making clear that diet and exercise aren’t magic bullets and by dispelling harmful and dated stereotypes that people who suffer from obesity simply lack willpower. “People are more aware that it [obesity] is a disease, which is why people don’t have success solely with diet and exercise. Obesity isn’t a lifestyle problem, something many medical studies have acknowledged for a long time,” says Dr. Saunders, who has helped thousands of people lose weight and maintain weight loss and who was one of the first obesity-medicine fellows in the country.
That could be an inconvenient truth for the $71 billion diet industry, which stays afloat by selling the promise that certain ways of eating will result in permanent, sustainable weight loss. (Incidentally, 95 percent of diets fail.)
“There’s stigma with weight-loss drugs,” says Dr. Velazquez. “People say, ‘Oh, they aren’t doing enough.’ But it’s an active disease. There are actual biological factors that take you back to your set weight. People see taking long-term medication as challenging, but wouldn’t it be better to be on one or two weight-loss drugs instead of dealing with all the co-morbidities of obesity, like diabetes and sleep apnea?”
Velazquez says patients cry in front of her when they learn there is relief that doesn’t involve doing punishing hours of exercise or a constant drip of chalky protein shakes. Wegovy adds another treatment to the anti-obesity toolbox.
Currently, there are only six on-label and 10 off-label medications to treat obesity, a shockingly small number considering that 40 percent of the U.S. population suffers from obesity. And some of those drugs, such phentermine, or “fen-phen,” which has been around for decades, is only F.D.A.-approved for a 12-week course. (Velazquez says phentermine has gotten a bad rap but has never been shown to have long-term medical issues when studied in the form of of Qsymia, the combination pill of phentermine-topamax ER.) But someone could ostensibly stay on Wegovy for life. And many will.
The biggest challenge right now regarding Wegovy is that there isn’t enough of it—demand is outstripping supply. “It’s very hard to get new prescriptions, and priority is being given to people who are already on it,” says Dr. Saunders.
However, there’s a work-around. Wegovy is the exact same medication as Ozempic—which is mostly commonly used to treat diabetes—but F.D.A.-approved at a higher dose. A patient of Saunders in her 40s who was already on Ozempic recently increased her dose, thereby crossing into Wegovy territory. “I eat nothing, and I have had no side effects,” the patient, who asked not to be identified for privacy reasons, said. She estimates that after she upped her Ozempic, she lost three pounds in 10 days. Given the rapid weight loss, the new Wegovy patient cautioned that “it’s important to maintain constant contact with your health-care provider, given the potential for misuse.”
And if you can’t get your hands on a Wegovy prescription, don’t fret. Wegovy watchers and those patiently waiting will be happy to know that another “miracle” drug could be just around the corner. A few weeks ago, Eli Lilly released preliminary data in a peer-reviewed medical journal about their anti-obesity drug tirzepatide, which helped people lose about 22.5% of their body weight.
Hannah Seligson is a frequent contributor to The New York Times, Town & Country, and the Daily Beast. She is based in New York, and her most recent book is Mission: Adulthood: How the 20-Somethings of Today Are Transforming Work, Love, and Life