The Next, Episode #51

What's the deal with Ozempic and other GLP-1 Agonists?

Feb 02, 2024

Hi there, and welcome to The Next - my take on health, wellness, and company building.

In the last few years I’ve founded 3 health brands (Kettle & Fire, Perfect Keto, Surely non-alc wine), which do tens of millions in revenue. I’m now working on TrueMed, which allows health and wellness brands to accept HSA/FSA funds. Previously, I worked in tech and had no experience in CPG, DTC, or any other 3-letter industries.

If you missed past episodes, I recommend checking out Episode 42 on finding work you love and why I’m worried about environmental toxins. Otherwise, let’s dive in!

🆕 What’s new

Instead of multiple topics, I want to dig into something you’ve probably heard about: Ozempic, and their class of GLP-1 agonists.

If you haven’t heard about Ozempic, you will. The drug is billed as a solution for everything: from obesity to kidney disease, from gambling addiction to alcoholism. Airlines are estimating lower fuel costs due to lighter passengers, and grocers are expecting lower sales from customers buying less food. Ozempic’s parent company, Novo Nordisk, recently surpassed fashion conglomerate LVMH to become the most valuable company in Europe.

It’s not hard to understand the hype around this miracle obesity drug. With nearly 80% of American adults (and 50% of teens) classified as overweight or obese, Ozempic — active ingredient semaglutide — has the largest target market of any drug.

In August, a bipartisan group of lawmakers re-introduced the Treat and Reduce Obesity Act, a bill still making its way through Congress that would allow Medicare and Medicaid to cover (currently prohibited) anti-obesity medications. With this bill, we’re on track to fund Ozempic injections to treat obesity. But the truth is, making Ozempic the standard of care for our obesity crisis would be one of the costliest mistakes in American history.

Ozempic Doesn’t Address the Issue

Like any animal, our health reflects the health of our environment. There’s no such thing as an obese giraffe in the wild, but there are obese household dogs.

Our environment is making us sick. The average American gets over 60% of their calories in the form of ultra-processed foods, and 11 of the top 12 killers of Americans are directly tied to our unhealthy environments. Today, 6 in 10 Americans have some kind of chronic condition. Rates of cancer, heart disease, kidney disease, fatty liver disease, and autoimmune conditions have reached record levels, all at the same time.

The Ozempic argument is that we can improve health by curbing obesity. Unfortunately, Ozempic is just another example of modern medicine’s tendency to silo chronic diseases into “treatable” conditions. This paradigm has been a universal failure: heart disease has risen as we prescribe more statins, diabetes has risen as we’ve prescribed more metformin, and depression has skyrocketed as we’ve prescribed more SSRIs.

Today, healthcare is the largest and fastest growing industry in the United States, producing worse outcomes for each extra dollar we spend. Healthcare costs are approaching 20% of GDP today, and 85% of healthcare costs go towards managing — not treating — chronic disease.

Now, there’s a lot about the healthcare system that’s obviously broken. But fundamentally, healthcare costs are soaring because the average American is sick.

The Ozempic lie is that the way to reverse health trends is to drug our way out of the problem. The fact that nearly 80% of Americans are overweight or obese is a metabolic disaster and should be a red alarm sign. However, a metabolically healthy population does not produce profit for the country's largest industry. Lifetime injections do.

Ozempic Makes You Fatter

Even if Ozempic worked perfectly, it doesn’t address the root cause of our metabolic health crisis. But there are increasing signs that it works far from perfectly, and is actually a medical disaster being rushed through approval.

Semaglutide is a GLP-1 receptor agonist sold under the brand names Ozempic and Wegovy: an anti-diabetic medication used to treat type 2 diabetes. It’s exploding in popularity due to its weight-loss properties, as consumers lose an average of 12% of their body weight on these drugs. However, they work the same way starvation diets “work”: by lowering caloric consumption.

Ozempic is in essence medicalized anorexia. Take the shot, be less hungry. And — like all starvation diets — the weight comes back when you stop the injections. If you told an obese person to “consider developing an eating disorder” you’d get canceled. But somehow, if you suggest the solution is taking a pharmaceutical that biologically mimics anorexia, you’re all good.

Worse than the weight coming back, over 35% of weight loss on these drugs comes from muscle and bone density loss, as opposed to fat loss. As Dr. Peter Attia has pointed out, Ozempic routinely makes patients fatter (as a percentage of fat to overall weight), even as they shed pounds. Since muscle is the key hormone-secreting organ for longevity, I’m convinced this loss of muscle will drive poor health outcomes, and get worse as people stay on these drugs for decades.

We’re also starting to see other concerning side effects associated with these drugs: gastrointestinal events, suicidal ideation, pancreatitis, bowel obstruction, and stomach paralysis. In rats, semaglutide has been shown to cause thyroid cancer, though it’s unclear if this happens in humans as well because there are no long-term human studies on it. In fact, it’s partly due to these side effects that nearly two-thirds of patients who go on these drugs come off them within a year.

These drugs don’t get to the root of why people are tipping the scales at historic weights. Even if someone faithfully takes their weekly shots, if they still are eating a diet full of processed, inflammatory foods — but eating 25% fewer calories — they’re still not healthy. Obesity is a symptom of a broken metabolism, and the result of the highly-processed, toxin-riddled food system most Americans experience daily. Ozempic and the like may address one symptom (obesity), but do nothing to treat the underlying issues that create the sickest population of Americans ever. Yes, Ozempic will help many lose weight, but what will it do to the record levels of chronic disease, inflammation, anxiety, infertility, and depression we see today?

Corruption and Opportunity Cost

If this were just a run-of-the-mill weight loss drug that some who’ve struggled with weight loss were encouraged to take, I’d be fine with that — God knows there are many more issues with our health and food systems worth prioritizing. What I’m really concerned about are the millions of overweight young Americans who will be targeted for the drug by the same old players in our captured, food-pharma-FDA cesspool if Ozempic is approved for taxpayer funding.

Ozempic would cost taxpayers thousands of dollars (estimates of $15,000 per patient), per year, for life. The US government, by law, doesn’t have the authority to negotiate drug prices, so prices would not go down with volume. In fact, if taxpayer funding is approved, Ozempic would immediately become the highest revenue-generating drug in history, with billions flowing from the US Treasury to pharmaceutical industry coffers over the next decade.

If the goal of healthcare policy is to keep Americans healthy, there are far better things we can do with $15,000 per person. But Novo Nordisk has executed a masterful public affairs campaign to convince Americans otherwise. For starters, the company paid $22 million in direct payments to obesity doctors in 2021. One of these doctors, Dr. Fatima Stanford, went on 60 Minutes to say that obesity is genetic and cannot be treated with exercise or diet. If obesity is genetic, it’s not under a patient’s control. And if it’s not under a patient’s control, treatments for the disease will get covered by Medicare and Medicaid (i.e. the American taxpayer).

The bought-off medical community is claiming it’s an urgent national priority to cover Ozempic and similar drugs with taxpayer money. The pharma-funded American Pediatric Association has even begun recommending semaglutide (Ozempic, Wegovy, etc) for overweight kids 12 and above, based solely on a 16-month trial with just 134 teens (and no long-term follow-up). This same organization remains silent when they have the opportunity to remove soda from schools, protest bills mandating chocolate milk, or argue that just maybe, Lunchables should not be included in school lunches.

If the medical community successfully convinces our regulators that these drugs are the solution to the American obesity epidemic, it would be the most expensive drug in history, potentially adding up to hundreds of billions of dollars per year to the government budget. This is why Wall Street is salivating over how profitable these weight loss drugs can be. An overweight patient who comes to a clinic, learns healthy habits and stops eating poison is not a profitable patient. On the other hand, a 13-year-old who starts on Ozempic will be on that $15,000 per year regimen for life.

GLP-1s are set to be among the most profitable classes of drugs ever. We’ll be fed lines about how obesity is genetic, or due to your special brain chemistry, and that our record levels of obesity have nothing to do with our environment. Never mind that Japanese people in the US are more than three times as obese as their (genetically similar) counterparts living in Japan. Genes, huh?

It makes no sense from a public policy standpoint to wait for our kids to get sick, and then pay through the nose to drug them. Public policy should be working to prevent the root cause of our health disaster, not pay for “treatments” once the majority of the country is sick. We've been brainwashed to believe that the solution to rampant metabolic dysfunction is tax-payer-funded weekly injections for life. We’re being told that laundering money from taxpayers to pharma is a simpler solution than figuring out how to feed people healthier food.

95% of “experts” on the nutritional guideline committee have known conflicts with Big Food or Big Pharma companies. Only through regulatory capture can pizza be a vegetable, sugar be okay for babies, and can Lucky Charms be healthier than steak.

In today’s America, the more we spend the worse our health outcomes become. The question for all Americans should be what policies can encourage a healthy America? If we have $15,000 per person per year to spend (as these drugmakers are claiming), well then, we should spend that money on solutions that work.

Obesity is not an Ozempic deficiency, it’s a problem with our environment. And between the lack of long-term studies, the cost, the early signs of cancer, pancreatitis, gastrointestinal issues and more, it is increasingly clear that Ozempic is not the answer to the US health crisis. The answer is to stop subsidizing toxic food, stop recommending toxic food, and start incentivizing healthier food and lifestyle practices. These solutions are simple and actionable, though I guarantee you’ll hear the opposite in the years to come.

😌 Dope stuff on the internet

Some of my favorite things since the last newsletter (note: I don’t get paid to recommend anything here):

📰 Article - This post on the teenage mental health epidemic is fascinating, and digs into the startling rise in mental health issues as seen across the entire Western world since 2010 (when smartphones were introduced). Concerning, fascinating, important - I’d recommend giving this a read.
Or, if that’s not your cup of tea, this post on the outstanding evidence for the seed oil hypothesis is - in my opinion - very compelling.
📚 Book rec - I’ve been trying to listen to the universe a bit more. Well, just last week I ran into Noah Kagan, author of Million Dollar Weekend, twice in the same day. Noah is great at finding ways to test and launch business ideas, and wrote a book about how to do just that. I’d also recommend checking out his recent interview with Tim Ferriss for more on the topic!
⌚ Cool product - I am very excited to try my friend Andrew Wilkinson’s new product Mateina, an organic yerba mate that I suspect is amazing. Since being in Japan last month, I have cut down my coffee consumption 80% and opted for tea most mornings. I’m excited to give Mateina a shot, and have been really enjoying my Ippodo Tea straight from Kyoto.
🎵 Music - I’m on my 5th or 6th listen of this set from All Day I Dream. Enjoy!
🏀 Random - Pretty interesting, but men in long-term relationships seem to have their testosterone levels plummet. Good? Bad? I’m not sure, but it is definitely interesting.
🔥Hot take - The IVF industry has done an almost criminally good job of marketing their services. The “freeze your eggs, get IVF” marketing touts the service as a way to invest in one’s career and have kids later. What they don’t say is that - even for under 35s - the success rate of each embryo transfer is around 40% (link). I see so many healthy friends struggling to get pregnant right now, and suspect that this fertility issue will be one of the defining issues of the next decade.
🙋‍♂️ Ask - I’ve been digging far more into environmental toxins, and have a friend who is interested in helping people test their toxin levels and try interventions to remove PFAS, microplastics, phthalates, and other compounds from their bodies. If you’re interested in getting your toxin levels tested, fill out this form and he will get in touch to help you test, run interventions, and test again to see if you reduced your toxin burden!