Ozempic, Obesity, and the Return of a Familiar Medical Mistake
Ozempic’s rise mirrors fen-phen fiasco: aggressive marketing, market expansion to kids/elderly, severe side effects, lifelong dependence, ignoring obesity’s root causes.
Over the past few years, few drugs have risen as rapidly—or as controversially—as Ozempic (semaglutide). After a major pharmaceutical industry conference three years ago, which effectively signposted the future direction of drug development and regulation, it became clear that semaglutide was about to be pushed far beyond its original use. What followed felt eerily familiar: aggressive marketing, regulatory endorsement, and a widening of indications that echoed earlier medical disasters. That prediction proved accurate, as Ozempic and related GLP-1 drugs quickly became household names, promoted not only for diabetes but as near-miracle solutions for obesity.
Expanding the Market at All Costs
Once the commercial potential of Ozempic became obvious, efforts to expand its market accelerated. Messaging and lobbying campaigns targeted multiple groups simultaneously. Advocacy organisations such as the NAACP were financially supported to frame criticism of the drug as discriminatory. Children became another focus when the Food and Drug Administration approved semaglutide for adolescents aged 12 and over, despite a lack of long-term safety data for lifelong use starting in childhood.
The elderly represent perhaps the largest prize. At a monthly cost often exceeding £800 (equivalent), Ozempic remains inaccessible without insurance. Yet legislation such as the Medicare Modernization Act of 2003 explicitly prohibited coverage of weight-loss drugs. That restriction exists for a reason—one rooted in historical experience. Today, however, intense lobbying aims to reverse that rule, potentially saddling public healthcare with billions in annual costs while committing millions of older adults to lifelong drug dependence.
History offers a sobering parallel. In the 1990s, the combination of phentermine and fenfluramine—known as fen-phen—was hailed as a breakthrough in weight loss. Individually, both drugs had shown limited success. Together, they seemed to work. Demand exploded, clinics became pill mills, and prescriptions soared. Within a few years, fen-phen was linked to heart valve damage and pulmonary hypertension, leading to its withdrawal and massive legal settlements.
What is often forgotten is how preventable that catastrophe was. The combination was never properly evaluated for safety. The enthusiasm to medicalise obesity overwhelmed basic caution. The current Ozempic boom mirrors that same pattern: rapid uptake, off-label use, commercial pressure, and regulators aligned with industry rather than acting as a brake.
Short-Term Weight Loss, Long-Term Problems
Initially, many clinicians viewed such GLP-1 drugs favourably for diabetes. Used conservatively, they appeared helpful. But once higher doses were approved for weight loss—often several times those used in diabetes—new problems emerged. Patients began presenting with severe gastrointestinal symptoms, extreme appetite suppression, and in some cases a cachectic, unhealthy appearance popularly dubbed “Ozempic face.”
Clinical trial data reveal another uncomfortable truth: weight loss is not durable. When the drug is stopped, weight is rapidly regained, often in proportion to what was lost. In effect, patients are locked into indefinite use. This is not an accident. From a commercial perspective, a drug that must be taken forever is ideal. From a public health standpoint, it is deeply troubling.
Serious Adverse Effects Are Not Rare
GLP-1 drugs were engineered to resist breakdown in the body, giving them a half-life of roughly seven days compared to minutes for natural GLP-1. This prolonged action slows digestion dramatically. Large real-world studies now associate these drugs with markedly increased risks of pancreatitis, bowel obstruction, gastroparesis, and gallbladder disease—many severe enough to require hospitalisation.
These are not fringe outcomes. Less severe side effects such as persistent nausea, vomiting, fatigue, and abdominal pain are even more common. Lawsuits are emerging over long-term gastrointestinal injury and vision loss, while animal studies suggest structural changes to the intestine that may impair nutrient absorption.
Of particular concern is the interaction with psychiatric medications. By delaying gastric emptying, Ozempic alters the absorption of antidepressants and other psychotropic drugs. For patients already sensitive to dose changes, this can trigger destabilisation. Some data now suggest an increased risk of suicidal ideation, especially among those taking SSRIs—a chilling echo of earlier pharmaceutical failures.
What Actually Drives Obesity?
The central problem is that obesity is treated as a simple failure of willpower or appetite. Yet its rise over recent decades points to systemic causes. These include ultra-processed diets, endocrine-disrupting chemicals, metabolic and mitochondrial dysfunction, gut microbiome imbalance, and environmental pollutants. Each of these factors has credible evidence behind it. None are addressed by suppressing appetite with a weekly injection.
By ignoring root causes, we are offered a narrative in which lifelong drug use is the only answer. This framing benefits industry far more than patients.
One of the most effective ways populations are controlled is through monopolisation of essentials—food, medicine, and energy. When cooking skills vanish and whole foods become harder to access, dependence on processed food and pharmaceutical fixes grows. Relearning how to source, prepare, and cook real food is not nostalgic romanticism; it is a practical act of health sovereignty.
No injection can substitute for metabolic resilience built through nutrition, movement, and environmental awareness.
A Turning Point?
The Ozempic phenomenon may represent a pivotal moment. Public trust in regulatory bodies has eroded after repeated failures to protect health over profit. Increasingly, people are questioning why medical guidelines align so closely with corporate incentives. Encouragingly, there are signs of a broader awakening—one that recognises cleaning up the food supply and addressing environmental drivers of disease as far more effective and economical than medicating symptoms indefinitely.
If the fen-phen era taught us anything, it is that enthusiasm and profit can drown out caution until harm becomes undeniable. The difference today is that resistance is no longer confined to a few sceptics. It is being driven by an informed public unwilling to accept that the solution to a broken food and metabolic system is a lifetime prescription.
In that sense, Ozempic is not just a drug. It is a test of whether we have finally learned from history—or are destined to repeat it once again.
The above is by Alastair Jessel is the founder of Battersea Park Clinic in London. Based on a longer article by A Midwestern Doctor www.midwesterndoctor.com
Tom
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Most of medicine is a mistake and quite a costly one too.
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