The Weight-Loss Revolution People Didn’t Want – Grey Enlightenment
Skip to content
Most of the criticisms and rebuttals in this post are applicable to before 2024. By 2025, GLP-1 weight-loss drugs had become thoroughly mainstream and many skeptics have come around to the fact that these drugs are highly effective and that the side effects are manageable. But with the upcoming FDA approval of the potent triple-agonist Retatrutide, there has been renewed interest and skepticism, although less compared to pre-2024. A lot has changed since 2024. Eli Lilly’s tirzepatide portfolio (sold as Mounjaro for diabetes and Zepbound for weight loss) overtook Novo Nordisk’s Ozempic/Wegovy to become the top-selling drug globally. The tirzepatide and semaglutide shortages ended in late 2024, which was a big problem for diabetics. The class divide issue is mostly gone too, as the upper-middle class has embraced these drugs on social media, especially in tech after initial skepticism in 2022-2023. Often you’ll still see people conflating "lean mass loss" with "muscle loss", but not nearly as often as earlier.
The past few years have witnessed a revolution in highly-effective weight-loss treatments, namely Semaglutide and Tirzepatide, which originally were used to treat diabetes but have been rebranded and repurposed to treat obesity under such brand names as Wegovy, Ozempic (originally for diabetes but also prescribed for weight loss), and Zepbound. They are often referred to as "GLP-1 drugs" for their mechanism of action of activating the GLP-1 receptor, triggering fullness and delaying gastric emptying, subsequently leading to weight loss. Given that worldwide over a billion people are overweight or obese, as to be expected there is a lot of enthusiasm and demand for these drugs. Much of the coverage is positive, and many people on social media report success at losing a lot of weight.
But there is a lot of skepticism too, which is understandable. These drugs are not without potentially serious side effects, and huge demand has led to shortages of the compounds for diabetics. The main focus of this post is to address the non-pecuniary objections, although the cost factor cannot be ignored. Expanding Medicaid coverage to include these drugs will impose a burden on taxpayers, as will employer-sponsored coverage on employers. But aside from costs, there are the same tired criticisms about how it’s "taking the easy way out" or concerns about unforeseen health risks. I will address these.
There is also an interesting class dynamic at work. I have observed that the strongest support is from celebrities and wealthy businessmen, such as Elon Musk, an early Ozempic user whose endorsement on Twitter helped propel the drug into the mainstream–or on the other socioeconomic extreme–middle to lower-middle-class people who are able to obtain these drugs despite the high price tag and sing the praises of their newfound weight loss on social media. Yet somewhere in the top 2-5% of the wealth pyramid are among the strongest critics. Sure, some of this may be due to the social bubble I inhabit , but it’s like the opposite of the Covid vaccines, in which opposition was strongest from working-class or religious types, whereas credentialed, upper-income people in that same bubble or strata overwhelmingly supported the vaccines. But with GLP-1 drugs the intellectual-class is much more divided or reticent in support. The typical megachurch congregation is more likely to be on these drugs or express approval of them compared to attendees of a tech conference.
I am at a loss as to why so many well-educated people who subscribe to the credo of "science and progress" in so far as treating conditions as varied as Alzheimer’s disease, ALS, or cancer, that the frontier of human ingenuity insofar as weight loss is concerned must remain stuck in the past. Or much more nuanced skepticism or reservations by journalists, who also fit this profile. Journalist Johann Hari wrote a whole book about the possible risks of these drugs, although also praising them, after a year on Ozempic and losing 20 kilograms. Would he feel equally concerned or conflicted if he took antibiotics and his infection went away? Or from the New York Post: Child Ozempic use soars 600% in three years — but is it safe? Sure, but less safe than weighing 315lbs as a 17-year-old?
Why so much trepidation when being at the frontier of science necessitates taking the unbeaten path? My point is that the skepticism directed at these drugs is undue and even irrational, especially compared to other drugs for much rarer conditions than obesity, which are equally or more expensive and much less effective. It’s as if science "need not apply" in so far as effective weight loss treatments are concerned.
It’s like: "A mouse model shows promise at extending ALS or Alzheimer’s disease survival by 1-3 months if successful on humans. The drug may cost $30k/month, though." Response: "Amazing! This...