Hollywood’s “Skinny Shot” Goes Mainstream

To understand our nation’s cosmetic trends, there is only one place to look: the Pacificside enclave of the sisters Kardashian, whose preoccupations of the self soon become our own. What have the ladies been up to lately?

Kourtney is wearing the bob she has worn since 2021. Kylie is trying as many different bangs as she can, at a pace that suggests she is going for the world record. Kim and Khloé have been looking stunning as per usual, even if not everybody is happy about it: Kim’s revelation earlier this summer that she crash dieted to fit into her Met Gala dress was widely criticized — which made it only a little ironic that she was the one to express concerns about Khloé’s weight loss, on behalf of her sisters Kylie and Kendall, during a recent episode of the Hulu show that documents their lives.

One week later, on an episode of The Blonde Files Podcast, host Arielle Lorre and the anonymous celebrity gossipmonger Deuxmoi speculated about the Thinning of the Sisters. After cautioning that she knew absolutely nothing about the Kardashian family nutritional habits, one of them said: “Obviously, you know, the shot Ozempic is really, really popular right now.”

Ozempic, a brand name of semaglutide injection, was introduced in 2018 by pharmaceutical company Novo Nordisk after getting FDA approval for glycemic control in adults with Type 2 diabetes. Before its clinical trials were finished, a study funded by the company found that weekly shots of semaglutide could result in substantial weight loss. The FDA approved Ozempic to reduce the risk of cardiovascular disease in patients with Type 2 diabetes in 2020, and the company introduced Wegovy, the same medication at a larger maximum dose of 2.5 milligrams, last year.

So far, Wegovy is the only semaglutide injection FDA approved to treat chronic weight management “in adults with obesity or overweight with at least one weight-related condition (such as high blood pressure, Type 2 diabetes, or high cholesterol),” according to the press release. Demand quickly outstripped expectations, and Novo Nordisk has stalled the drug’s advertising and new patient prescriptions, but it has been unable to control the fierce word-of-mouth campaign that has inflated the drug’s profile beyond its supply. Recently Elon Musk credited Wegovy (and “fasting!”) as the engine behind his own plodding yassification, perhaps inspiring a slice of his 109 million followers to Google it for the first time.

According to Google Trends, most civilians have only found out about this stuff recently: Searches for “semaglutide” hit their all-time high the first week of October. Our nation’s celebrity population, for whom losing weight is often a part of the job, has known about it for at least a little while longer. The headlines have been juicy, as they should be: “Hollywood’s secret new weight loss drug,” “the talk of Hollywood, Tech and the Hamptons.” Without Type 2 diabetes, hypoglycemia, or garden variety weight-related comorbidity, the prescription of semaglutide or a similar drug qualifies as off-label. In other words, it becomes a cosmetic product — one that many people have been waiting for.

Doctors who treat diabetic patients are enthusiastic about this new class of medicine, which provides a small factory of mechanisms for the regulation of blood sugar. They are less enthusiastic about acknowledging the possibility that people might go on this medication with the foremost goal of fitting into a particular garment or looking #snatched in a sponsored post, but unfortunately for them, this is a rapidly growing use-case. Sooner than we think, it may be possible for noncelebrities everywhere to ask ourselves: If we could stomach a weekly injection in exchange for losing 10% of our body weight, would it be worth the shot?

Mia, a 34-year-old from the West Coast, is a semaglutide evangelist. She speaks knowledgeably about her health because she in fact owns her own health business, which is also why she preferred not to be named here; doing so would tank her personal brand.

She found out about the drug from a roommate. “She was dating this guy who put her on it, and she lost 18 pounds in like a month,” she said. “I’m like, ‘What the hell are you on? You look insane.’ And she wasn’t even big. She was like, ‘It’s semaglutide.’”

Mia adores her semaglutide. Even the word, crude but clinical, alights off her tongue with affection. She arrived to the medication with an athletic build that would certainly not qualify for obesity management, and yet she saw results after the first few weeks. In two months, she’s lost 15 pounds.

There are side effects, of course. A doctor described the possibility of “gastrointestinal phenomena” to Town and Country; a Hollywood publicist responded, “Who cares? Everyone who works in this business has IBS, anyway,” to Variety. Ozempic’s website lists less-common side effects that range from pancreatitis to gall bladder issues. Mia experienced bouts of nausea for the first month, and despite categorizing her prior relationship with food as “great,” sometimes felt total disinterest in eating. At a birthday dinner, she only ate a quarter of her plate before she found herself stuffed.

“Honestly, it’s changed my life. It’s so good,” she says, using two expletives. Then, she cheerily adds: “If you have a chance, you should go on it!” Two days later, she introduces me to her doctor with an email — “so you can chat!”

“This is part of the future of weight loss,” Dr. Neil Paulvin tells me. “It’s not just about crash dieting anymore or working out six times a day.”

Paulvin is a doctor of functional medicine, which is to say alternative medicine, in New York City. His practice encompasses various forms of healing, including IV vitamin drips and a somewhat vague offering called “brain optimization.” His website features stock imagery of athletes lunging across breathtaking vistas.

Paulvin also treats patients for weight loss, for which there is nothing better than semaglutide. “It’s effective because it works on multiple mechanisms,” he explains. “And it does all of them well.”

Semaglutide and its sibling GLP-1 agonists work by disguising themselves in the body as insulin-boosting peptides. They slow the rhythm of the GI tract, keeping stomachs fuller for longer, as well as react with chemicals in the brain to induce feelings of satiety. And, because your insulin levels are balanced, digestion is easier, and you manage to extract more energy from less food. The medicine basically programs portion control into the software of a person, with the small caveats that it has to be repeated every week in perpetuity.

Jennifer Trujillo, Pharm.D., a professor in the University of Colorado’s Department of Clinical Pharmacy who specializes in diabetic medication, outlines three groups that she feels are good candidates for GLP-1 agonists. The common denominator is that they all have Type 2 diabetes, but the attendant benefits of the medicine also make it a good option for those with cardiovascular disease or increased risk of hypoglycemia.

But she doesn’t discourage nondiabetic patients who struggle with weight loss from looking into it: “[For some people], a 5% to 10% weight loss has pretty significant benefits in terms of disease prevention and disease management,” she says. And in patients who don’t need to moderate their blood sugar, the medication automatically suppresses that benefit. “It tells the pancreas to do that only when your blood glucose levels are elevated,” Trujillo explains. “So if you don’t have diabetes, and your levels aren’t elevated, then that part of its mechanism isn’t really functional.”

Cleveland, Ohio-based dietitian Amanda Liptak has a family member on Janumet, which is functionally similar to semaglutide but sold as a pill. She argues that a very small, metabolically challenged segment of the population would benefit from semaglutide, but there is a danger in most people taking it without nutritional guidance. “I think they’re supportive for a certain population. But I think that they’re also being overused,” she says. “I had somebody in the middle of Target pass out because they were on the shot, and they were taking in such little food because they were so nauseous they couldn’t eat.” They were rushed to the hospital and treated for dehydration.

Injectable semaglutide is an “adjunctive” therapy, meaning the shots are prescribed along with lifestyle modifications — dietary changes, more exercise. Success also depends on regular administration. Some medications, like Saxenda, are injected daily, while others, like Wegovy and Mounjaro, only require weekly doses. But in all cases, the results are sustained by taking the medication chronically. Studies on Saxenda and Wegovy have shown rapid weight regain upon stopping the shots; testimonials from the subreddit r/Semaglutide appear to confirm this to be true.

The irony of Wegovy’s approval for “long-term weight loss” is that its newness prevents anyone from really knowing its long-term effects on the body. “Tl;dr: Take it as long as you can,” wrote a Redditor. “It’s anyone’s guess thereafter.”

“It’s more detrimental for somebody to actually lose the weight and gain it back than it is for somebody to stay at a slightly higher weight,” Liptak says. Dieticians like Liptak see weight loss as a nutritional issue that semaglutide and other appetite suppressants complicate. “The answer is learning how to re-feed your body [through eating nutritious foods],” she says. “The answer is not getting on a weight-loss drug.”

It’s not that nobody wants a weight loss drug that works. But past attempts, created with the best of intentions, have turned out to have monstrous effects on the human body.

Take fen-phen, the adorably named abbreviation for the one-two punch of the appetite drug fenfluramine and the amphetamine phentermine. “The drug combination, which seemed a magic pill for the national epidemic of obesity, soared to popularity on the basis of a single study involving just 121 patients,” the New York Times reported in 1997. “Eventually, an estimated 6 million Americans took fenfluramine or dexfenfluramine, most of them women, not all of them obese.” It had been on the market for two years after doctors discovered the medication could cause heart valve defects in a third of patients.

There’s Contrave, a prescription weight-loss pill which is made of the same stuff as the antidepressant Wellbutrin. There used to be Belviq, but in 2020, the FDA requested a recall after a review of the original clinical trial results revealed a higher incidence of cancer when compared to the placebo group.

GLP-1 agonists, by contrast, appear to be safe and not so brain-melting (at least at this point). It’s easy to see the excitement surrounding them, especially when beholding the kaleidoscope of medications now available. The primary drug names include liraglutide (Victoza, Saxenda, daily), dulaglutide (Trulicity, weekly), semaglutide (Ozempic, Wegovy, weekly), and tirzepatide (Mounjaro). They’re all more or less the same, with differences in dosage and frequency, but the word on the street is that Mounjaro has the mildest side effects and the best results — and will probably be approved by the FDA as a weight loss treatment for obesity soon.

There are a few hurdles to actually taking the shots. A convivial relationship with a primary physician is not strictly necessary but is usually helpful when requesting an off-label prescription. Getting it covered by insurance is more challenging. A month’s supply of injectable GLP-1 agonists can cost $900 to $1,500 at full price. Federal payers won’t cover these drugs because they’re considered cosmetic, while other plans need to see proof of prior weight-loss treatment. Insurance companies might also be unwilling to underwrite one of the most common health conditions of all time. “With obesity, there are just so many patients,” says Krista Mistovich, Pharm.D., a pharmacist who works in managed care. “It would be a complete waterfall, you know?”

Even with a prescription and a reasonable co-pay, supply has been strained by a sudden increase in popularity. Novo Nordisk is backordered on Wegovy, and Glamour recently reported a similar hold up on Ozempic prescriptions for diabetic patients. Not since the dawn of Botox has a 32-gauge needle been so warmly embraced by the general public. Botulinum toxin A was famously discovered while treating eye muscle disorders, and last year, the cosmetic injectable netted more than $600 million in sales. Novo Nordisk has already reported sales jumps for its semaglutide products Ozempic, Rubelsys, and Wegovy, the latter of which is being prescribed at the rate of some 22,000 injections a week to patients — 70% of whom are new.

A 60-year-old woman I spoke with, who for more than two years has used injectable semaglutide and liraglutide for weight management, was able to get insurance to cover the shots. She pays $30 for a month’s supply that would cost her $1,600 if not covered. She had to call pharmacies far and wide until she found one that had stock. She told me where it was, and then she changed her mind.

“Don’t put that in there,” she said, only half-joking. “I don’t want anyone taking my Wegovy!”