The dream was always take a pill, lose the weight. No more fussing with cottage cheese and protein shakes.

Is that where we are now with drugs like Ozempic (semaglutide)  and Mounjaro (tirzepatide)?

These are two of an emerging class of “miracle” drugs known as glucagon-like peptide receptor agonists (GLP-1).

Scientists are excited about the impact these sorts of drugs might have on cardiovascular disease and other chronic illness, but their rock star status is all to do with weight loss.

So the big question is: Is Ozempic the end of dieting?

The short answer

In effect, the drug works like a diet, effectively doing the calorie counting for you.

But it’s more complex than that too. For one thing, it helps with weight loss, but a healthy diet and exercise remain part of the story.

Also, for many people undergoing bariatric surgery, Ozempic is prescribed in order for them to drop down to a safer weight before going under the knife.

In other words, it serves as a first step.

Participants in clinical trials have lost up to 20 per cent of their body weight on semaglutide, Ozempic’s active ingredient.

But in the real world, it hasn’t proved quite that successful for most people.

A major study published in May found that after two years about 44 per cent of participants lost about 10 per cent of their body weight.

Nearly a third those in the study – which focused on Wegovy, which has the same active ingredient as Ozempic – lost less than five per cent of their body weight.

Those levels of weight loss could mean different things to different people.

But as I said, it’s more complex than simply taking the drug.

What the experts say

Dr Emma Beckett is a biomedical and nutrition scientist. She’s Adjunct Senior Lecturer UNSW and science communicator with FOODiQ Global, a food and nutrition science hub.

She’s also the author of a new book, You Are More Than What You Eat.

In an email answering questions, Beckett said she was “not pro or anti Ozempic, but I am pro-informed decisions and anti-unkindness”.

Dr Emma Beckett, nutrition scientist.

And the Ozempic phenomenon has, most obviously in the celebrity sphere, and presumably in the real world, led to unkindness.

“Fat people”, she said, “are constantly told to lose weight for their health, but then when they want to access weight-loss medication they are told that’s cheating …”

Beckett believes society’s focus should be on health rather than a person’s weight or shape.

However, in a recent Conversation piece, she made a case for why Ozempic and similar drugs should be subsidised by the PBS for weight loss. We’ll get back to that.

The question at hand

Beckett says Ozempic – which works powerfully to suppress your appetite – “isn’t a silver bullet”, and does not herald the end of dieting.

“Because it kind of is biologically creating a ‘dieting’ scenario,” she said.

“If someone was to use Ozempic long term to stay healthy, they would need to be ‘on a diet’ for the rest of their lives, just like people who have weight-loss surgery’.”

Being on a diet isn’t all about losing weight. In fact, if you’re having weight-loss success with a drug, the question of diet becomes all about good nutrition.

“Once you suppress appetite you need to be very careful with what you eat to make sure you get enough nutrients,” Beckett said.

“You can’t just suppress your appetite, eat less and be done with it if you want to have healthy bones and other organs, and live well into old age.”

Ozempic, she said, “makes you feel full. It stops you craving foods full stop. It doesn’t make you crave healthy foods, so it’s only part of the healthy eating equation addressed”.

Some other issues

Another reason why Ozempic isn’t the end of dieting is “because it’s not inclusive or accessible to everyone”.

Some people won’t be able to use it, she said, “due to cost or side effects, and some people just won’t even lose weight on it”.

And that’s a point rarely discussed in all the media excitement.

“We focus on the average losses a lot but some people just won’t respond because of their unique biology or other influences in their lives,” Beckett said.

There’s another problem lurking for Ozempic users in the future.

“We also won’t likely be able to use these medications forever,” she said.

“Over time, the effects will plateau, which always happens when you try to trick biological receptors by adding a signal in.”

The effects therefore “become less and doses need to keep increasing, but this can only happen to a point”.

Not to mention that going off the drugs brings back the weight again.

The money question

Professor Nial Wheate is a medicines scientist and biomedical researcher of 22 years standing. He’s professor and director of academic excellence at Macquarie University.

Wheate echoed Beckett’s reasons for why Ozempic is not the end of dieting.

He said one of the problems with Ozempic is that people will think it’s an easy way out.

“You still have to eat better and exercise.” he said. “You can’t just take Ozempic and forget about dieting.”

Professor Nial Wheate, medicines scientist.

The consequences of being on these drugs and continuing with a high-sugar, poor-quality diet is yet to be explored.

The use of glucagon-like peptide receptor agonists (GLP-1) is still relatively new.

Wheate believes it won’t be feasible for people to remain on these drugs for life.

This isn’t so much because of fading efficacy – it’s likely the drugs, head-spinning money makers, will become more efficacious.

The problem will be because of cost.

Long-term use of Ozempic,” he said, “is simply not going to be feasible, particularly when it’s not PBS subsidised”.

Ozempic, when prescribed for type 2 diabetes is subsidised: The cost per prescription for people with diabetes is $30 (or $7.30 for concession card holders).

For people with a private off-label prescription, a single injection pen (like an Epipen) is $160. Usually people give themselves one injection a week. So the monthly costs is more than $600. Not easy in a cost-of-living crisis.

People dropping out because of cost

Research published in July last year, reported that two out of three people on GLP-1 drugs like Ozempic stop within a year. The cost of the drugs was cited as a major reason.

Wheate was one of five experts asked by The Conversation if Ozempic or Wegovy should be subsidised. He was the only one to say no.

“At this time there is not a case for it to be subsidised. And that’s simply because people don’t die from being overweight,” he told The New Daily. 

“They die and get sick from the complications that come from being overweight, such as cardiovascular disease and diabetes.”

What’s required, he said, is evidence that using Ozempic “to reduce your weight will result in lower incidence of these diseases”.

In other words, “will it lower other health costs? This is all about cost-effectiveness”.

Wheate could see that in five to 10 years, the evidence might come to hand.

“We haven’t been using Ozempic long enough to know that it will reduce those diseases.”

The case for a subsidy

Beckett told The New Daily that weight-loss drugs “shouldn’t become yet another example of a tool just for rich people”.