For as long as she can remember, Marissa Mastellone, a public relations executive living in Naples, Fla. had battled her weight.
Over the years, she tried everything, often to unhealthy extremes. “I would restrict eating, I would over-workout, I would binge and purge,” she recalls. Five-to-seven days a week of brutal exercise and militant calorie counting accomplished little to nothing. Says Mastellone, 46, “I worked out so hard and I could not move the scale.”
In early 2023, she began seeing a doctor who raised the subject of semaglutide treatment. Simply put, semaglutides are a class of medications that, “mimic a hormone released from the digestive tract called glucagon-like peptide (GLP-1), which helps lower blood sugar and promotes a feeling of fullness,” explains Dr. Samuel Szomstein, MD, FACS, FASMBS, Associate Chairman of the Bariatric and Metabolic Institute at the Cleveland Clinic in Weston, Fla. Semaglutides were originally approved by the FDA in 2017 to help manage blood sugar instability in patients with Type 2 diabetes. Because semaglutides also diminish hunger and regulate satiety, they effectively treat obesity as well. In 2021, they were approved by the FDA for weight loss and one year later, a 2022 study by the National Institute of Health showed that weekly semaglutide injections resulted in as much as 10.9% total body weight loss over a six-month period.
Samuel Szomstein
In late 2022, Ozempic, a semaglutide from the pharmaceutical company Novo Nordisk, caught fire in the national discourse. It started with rumblings from Hollywood that it was the worst kept secret in town, a go-to among celebrities looking to shed weight quickly.
Before long, Ozempic and other name brand semaglutides like Wegovy and Mounjaro were being debated, discussed and sensationalized by nearly every major news outlet in America. Media cycle after media cycle breathlessly covered its remarkable weight loss potential.
Then came tales of its purported downsides. Users took to social media complaining about severe gastrointestinal side effects. The New York Times reported on patients who, once they went off semaglutides, regained much of the weight. And then there was “Ozempic Face,” a jargonish term coined to describe the potential sagging, sunken-in appearance semaglutide weight loss can have on the face, for which some doctors recommended dermal fillers or plastic surgery to fix.
At first, Mastellone was skeptical. “I had animosity about the whole thing because it felt like cheating,” she explains. Her initial reaction is understandable. Although far from true in most cases, a 2010 article in the National Library of Medicine found that “society regularly regards obese persons not as innocent victims, but as architects of their own ill health, personally responsible for their weight problems because of laziness and overeating.”
Fat-shaming is a form of disease stigma and an unacceptable cultural problem that needs addressing in its own right. With regard to semaglutides, however, it’s important to note they were not developed as replacements for nutrition and moderate exercise, but as one possible component of an overall treatment plan.
Mastellone ultimately decided to start semaglutide treatment in February 2023. The 30 pounds she’s lost since have recast exercise from a burdensome obsession to an enjoyable form of self-care. “I go to yoga now,” she says. “I got to TRX and Pilates. I’ve wanted to work out like that my whole life. But because I was fat, I always felt like I had to be running or lifting weights, so that when people looked at me, they would say, ‘Well, she’s trying her best.’”
Amplified by the media, the message that semaglutides yield significant weight loss in relatively short amounts of time sparked such an intense nationwide clamor for them, it led to reported shortages. Patients in need of Ozempic and other semaglutides for chronic illness found themselves in competition with those seizing them for cosmetic, short-term use. It prompted a debate that remains ongoing: who should and should not be taking these medications?
From a medical standpoint, Szomstein is authoritatively clear. “Semaglutides should not be taken for short-term weight loss. Obesity is a chronic disease and anti-obesity medications are, for most people, medications you stay on for long periods of time.” In other words, no, they’re not meant for someone looking to drop a quick 10 to 15 pounds to squeeze into a smaller-sized outfit for an important event, even if that event is their wedding.
Berberine
Still, that hasn’t deterred many, especially those who can afford to pay thousands of dollars in out-of-pocket costs without a prescription. For others, the prohibitive price tag of semaglutides has impelled untested and potentially unsafe attempts to mirror their effects. Months ago, the plant-based, over-the-counter supplement berberine trended on social media as “Nature’s Ozempic” for supposedly offering similar weight loss benefits at a much lower price. Szomstein points out berberine, like all supplements, is not monitored by the FDA, should never replace professional medical treatment and must be approached with caution. Frighteningly, some have tried another so-called natural weight loss supplement, Nuez de la India. Sold as “Indian diet seeds,” and also touted as “Nature’s Ozempic,” its reported side effects can be poisonous and fatal.
Even with a prescription, semaglutides can be expensive. According to a May 2022 New York Times report, most insurers will cover them for the treatment of diabetes, but not for weight loss alone. The report featured an interview with an obese patient whose doctor prescribed a weight loss medication that her insurance refused to cover, rejecting her claim and classifying it as a “vanity drug.” Without coverage, her pharmacy charged $1,500 a month.
Kahlin Grant’s weight loss journey
“It bothers me so much that it’s hard for people who really could use this medication to get access to it because of the cost,” says Kahlin Grant, 41, a social marketing agency owner in Daytona Beach who first started semaglutide treatment for weight gain related to chronic polycystic ovarian syndrome (PCOS).
“Weight loves your body with PCOS,” Grant explains. “Women with PCOS tend to be overweight. So I’ve struggled with obesity pretty much off and on my whole life.” Her PCOS not only caused uncontrollable food cravings, but fertility obstacles as well. Fortunately, Grant was able to have children, but continued to face serious health issues because of her weight. She had high blood pressure, high cholesterol and was at risk for both cardiac arrest and Type 2 diabetes. “I didn’t want to be in a situation where, God forbid, something happened to me and now my two young children are without a mom,” she says emotionally. “I was like, I have to do something.”
Semaglutide treatment, she states, has been nothing short of transformative. Like Mastellone, she had tried nearly every fad diet and fitness trend that came along and struggled with the public misconception that she just wasn’t trying hard enough to lose the weight.
Now, semaglutides not only regulate her cravings, they quiet what she refers to as “food noise.”
“I always felt ravenously hungry,” Grant recalls. “Now, I still get hungry, but it’s not like it used to be, which was, ‘I’ve got to eat something before I stab someone.’ This is the first time I’ve not only lost a significant amount of weight but have been able to maintain it long-term. I’ve held the 90 pound mark for almost a year now.” It’s a journey she’s proudly shared on social media.
Staying healthy for her children is paramount, but Grant admits the treatment numbs her enjoyment of eating to a certain extent. “As you start to increase your dosage, it does kind of take away the pleasure of food,” she says. “You can go out to your favorite restaurant and order your favorite meal, but after a few bites, you’re just not hungry anymore. I’ve had that happen. I was looking forward to a meal and I just couldn’t eat it. I have no appetite.”
Mastellone, on the other hand, says she’s actually more at ease in social settings. “I’m able to go out to dinner and I just feel safe. I never felt safe before. I can’t eat as much as I used to. I have leftovers now every single time. That never happened. And I don’t eat those leftovers at 11:30 later that night. I eat them the next day.”
While semaglutides are still relatively new and therefore do not have a long-term track record of success at this point, they’ll undoubtedly remain at the core of any conversation around weight loss — as will the deliberations surrounding them — for the foreseeable future. The increasingly high demand has pharmaceutical companies making them more widely available at lower costs. But having access to something and actually needing it are two different things.
Says Mastellone, “I wish there could be a stronger set of rules around it.” Her own doctor monitors her weekly to ensure her weight doesn’t dip too low. “My body would migrate to 175. I’m 146 now and it’s a considerable difference, but I wouldn’t want to go any lower. I know people that are on it and they just don’t eat and they look like bags of bones.”
“I’ve seen people bragging online, I can eat whatever I want,” adds Grant. “There’s this one TikTok of a girl eating cookies and then taking a [semaglutide] shot, acting like, ‘Hey, now I can do whatever, because I can just take the shot and be skinny.’ That’s awful and that’s not how it should be used. You have to do the work to change your whole mindset.”
Semaglutides, in Grant’s opinion, are “for people like me who struggled basically their whole life, who tried everything and for whom diet and exercise alone weren’t cutting it. They’re a game-changer. They can give you a whole new life. And for me, they have.”