What will the Ozempic World Look Like? Part 2

The recent posts in this blog hypothesize about changes in our relationship with food and our bodies after the advent and proliferation of GLP-1 agonists like Ozempic and Mounjaro. To be clear, many beneficial purposes for these drugs exist: diabetes and metabolic issues, to name two important ones.

But this new class of drugs also lands squarely in the camp of life enhancers, not just medications to treat illness. What I mean by this term is drugs with benefits people deem attractive but not necessarily therapeutic. Stimulants like Adderall are a good example of a drug people use for extended hours of focus or appetite suppression and not always for the medical indication, ADHD.

Right now the craze for these drugs is largely based on how new they are and how inaccessible they can be. Over time, they’ll become cheaper and more available. Doctors will prescribe them even more freely. Like it or not, GLP-1 agonists are going to be part of our culture.

We need to expect and accept that people won’t have clear hunger cues, will lose and gain weight easily and repeatedly and will raise children who, in a post-GLP-1 agonist world, believe hunger and weight are malleable and controllable factors of life.

Granted, we all have been living in a world trending in this direction for years. There used to be room for changing norms of body shape and size. Industry and capitalism have hardened the glorification of thinness in ways that are going to be next to impossible to undo. With these new drugs and doctors’ obsession with weight loss, the pharmaceutical and medical industries mean these norms are here to stay.

A concomitant result is the permanence of eating disorders. The nature of these disorders will continue to grow and change in cultural ways as they have in recent decades. Eating disorders caused by GLP-1 agonists are the new frontier.

Since dieting and food restriction are the primary risk factors for eating disorders, we collectively have decided to allow the overvaluation of thinness to continue to condemn people to develop eating disorders.

Going forward, the goal is to catch and treat eating disorders early and aggressively. The clinicians who treat these illnesses can’t contain external factors but can increase education and awareness.

What will the Ozempic World Look Like?

Hunger is one the most powerful and essential ways our bodies communicate with us. Put simply, hunger prioritizes the need for food as sustenance and for survival.

The meaning of hunger has changed greatly due to a transformed food supply for many countries in recent decades. After centuries of food scarcity as the obstacle to survival, humans created societies with bountiful food, more than can be eaten and often with a huge amount of waste.

We aren’t designed to know how to handle excess food. Hunger is an acute feeling intended to focus all senses and thoughts on procuring food. Subtle hunger cues can be harder to assess, but the plentiful food for many people obfuscates hunger cues altogether.

The new world of excess food opened the door to many new approaches and industries aimed at manipulating our dulled hunger cues with the supposed intention of improved health but mostly aimed at weight loss.

These factors include diet culture, the obsession with thinness, unsubstantiated nutrition suggestions and ill-researched medical recommendations. Almost all of these ideas infer that our hunger cues are actually misleading. Instead, these new guidelines purport to show us the best way to eat.

Even though medications have suppressed hunger cues for decades, the new GLP-1 agonists practically turn off hunger for prolonged periods of time. No previous intervention has been so powerful. The advent of the medications—in addition to the over-valuation of thinness and limited attention to adequate nutrition—is posing new hazards to our well-being.

Typically, suppressed hunger led to significantly increased appetite, binging and weight gain. The body overreacts to long periods of undereating with a strong hunger response meant to promote survival. Older medications, Bariatric surgery and dieting all triggered subsequent increased and often uncontrolled hunger. Although people experience this reaction when going off these new drugs, what happens if they stay on them indefinitely?

The jury is out at the moment about long-term outcomes. If there are no unforeseen side effects that lead to pulling these drugs off the market, the GLP-1 agonists and the even more powerful medications coming down the pike are here to stay.

As physicians, we are likely to see people with similar medical consequences as with Anorexia or with other appetite suppressing interventions. Slowed digestion and gastrointestinal functioning is an inevitable and often a permanent result of decreased eating. Chronic malabsorption of various minerals and micronutrients can cause a host of diseases rarely seen in medicine and thus hard to diagnose. Slowed cognitive functioning almost always results from decreased nutrition. And this is just to name a few.

My best guess for the results in a society using this new medication routinely is a generally thinner population with chronic medical and psychological effects from the long-term effects of malnutrition. As much as medicine continues to conflate weight and health, we as a population will talk about getting healthier while in many ways we get sicker. It will be up to the country at large to decide if the sacrifice is worth it.

Hunger in the Ozempic Era

People with eating disorders are usually afraid of hunger. The advent of the long acting GLP-1 agonists like Ozempic and Mounjaro not only reinforce this fear but create an environment for a more widespread aversion to this basic human function.

Hunger cues represent one crucial way our bodies can communicate with us. The cues can be subtle like a feeling of emptiness in our stomachs or an increased interest in food, moderate like feeling a bit weak or irritable or strong like lightheadedness or a gnawing need to eat now to the exclusion of any other thoughts or desires.

No matter the level of urgency, hunger cues allow our bodies to tell us what they need. Hunger increases our cognitive focus on food and, historically, ensures an increased likelihood of survival.

If society values thinness over many other necessities of life, hunger takes on a very different meaning. Hunger can feel like a nuisance, a weakness, a temptation or even a sign of loss of control. People very focused on weight will attempt to find ways to tolerate, avoid or negate hunger without eating.

To an even greater degree, people with eating disorders seek any way to neglect and ignore hunger cues at all costs. As I have written many times in the blog, people with eating disorders eat what and when they are allowed by the illness, not according to hunger cues.

There have been many pharmacological and surgical attempts to mitigate hunger, but none of have been nearly as successful as the GLP-1 agonists. Thus far, this new class of medications can suppress hunger for long stretches of time leading to periods of undereating and weight loss without allowing our biology to override the medication with rebound hunger. The jury is out about long term effects, but these medications have introduced a new dimension of medical intervention into modulating hunger.

Although there are many ways our attitudes about hunger, food and weight will change in this new world, my concern in this post is about hunger. The idea that hunger cues can no longer play a large role in daily life for many people is a monumental shift in daily functioning and in eating disorder recovery. Tolerating hunger and learning to read body cues have both been critical parts of eating disorder recovery. Many people may now choose medication over an essential part of recovery.

Just as concerning, children brought up in the world of GLP-1 agonists will believe hunger is a feeling that can be medicated away, not a physical sign that the body needs food.

Fear of hunger is very different from the ability to medicate hunger away. Is it safe to ignore signs of hunger? What are the risks of ignoring such a fundamental aspect of being human? That will be the basis of Part II in the next post.