You’ve probably seen celebrities with “Ozempic face,” featuring cheekbones and chins that have become sharply defined as a result of recent weight loss. It's a good example of what makes GLP-1 agonists a unique category of drugs—yes, they have medical benefits for heart disease, diabetes and potentially many other conditions, but they also cause significant weight loss.
In a wide-ranging discussion moderated by Associate Director of NYU Research Communications Rachel Harrison, two NYU faculty experts shared a conversation about the singular nature of these medicines, discussing both their harms and the ways they are transforming society. “I wouldn’t lump these drugs in with other cardiovascular treatments because there’s a key difference: much of the demand is driven by aesthetics,” said Dr. Virginia Chang, Associate Professor of Social and Behavioral Sciences and Associate Professor of Population Health. “People want to lose weight so they look good. No one can feel their cholesterol or see their hypertension, but weight loss is visible. That makes this a very different conversation.”
The cosmetic component driving both desire and demand by people without diabetes or cardiovascular illness can lead some of them to dismiss potential risks, explained Dr. Angela Godwin, NYU Rory Meyers College of Nursing Clinical Assistant Professor. In her bariatric practice in the Bronx, some individuals have found ways to procure the drugs from compounding pharmacies, which are cheaper—but there is less oversight on quality and consistency, leading to safety concerns. “We see more side effects and improper dosing,” she said.
The popularity of these medications for cosmetic reasons has also contributed to serious socioeconomic inequities in access for people who would benefit most from them. “Pharmaceutical GLP-1 agonists cost around $650 a month, but Medicare and Medicaid don’t cover them right now,” said Godwin. “There was a study of pharmacy refills in NYC, and the highest number per capita is on the Upper East Side, where diabetes and obesity are lowest,” Chang added. “So they’re not going to where they’re most needed; they're going to people who can afford them.”
The aesthetic nature of these compounds has also impacted the way medical professionals interact with patients. “All the things we’re taught about interacting with and evaluating patients are out the window. It's not holistic and that's what really bothers us,” said Godwin. “People see this medication as the be-all and end-all, but it's meant to be a tool, and because that conversation is not fully happening, a lot is being lost.”
GLP-1 agonists are not only changing how we interact with doctors – they’re also transforming societal perceptions of our bodies. “Obesity has long been this back-and-forth around accountability. But if suddenly one’s behavior is easy to control, it can create more pressure around people to do so. If obesity becomes less common, will it become less stigmatized over time?” reflected Chang.
Although we can’t predict the future, we can learn from the past. “These drugs are a quick fix, but we're not addressing the social, political, historical and structural aspects that got us here,” said Chang. “From a cardiovascular disease standpoint, it's not that different from taking a hypertensive medication forever, or taking statin forever for your cholesterol. But does it mean that we've decided to chronically medicate people for a problem that has social causes?”
To learn more about the debate surrounding GLP-1 agonists, watch the Revolution or Risk? Weighing the Impact of Obesity Drugs on Societal Health event recording.
