In 2023, weight loss drugs are having a 'revolution'. But there's a lot we're not talking about.

It's 2023, and we're in the midst of a weight loss 'revolution'.

While the body positivity movement has exploded over the years, on the flip-side, weight loss medication has swiftly become more in demand than ever before.

The force behind the shift? The use of a drug called 'semaglutide'.

It's what doctors are calling the 'miracle cure' for obesity. The magic bullet. The 'medical breakthrough'.

Studies now tell us that things like calorie restriction and dieting do not work for long-term weight loss. In fact, 95 per cent of individuals end up regaining the weight, if not more. We know this for a fact.

With this in mind, the possibility of a weight loss drug that experts say is actually effective almost does make it seem like a 'magic pill'.

Designed for people suffering from diabetes, it's now being used off-label to restrict hunger and lose weight.

But is it a one time 'cure', and what are the long-term effects? All questions that need answering - but we've only just begun to scratch the surface.

Dubbed 'Botox for weight loss', celebrities, influencers, models and those in Hollywood's elite social circles have made the popularity of the drug - popularised under the brand name Ozempic - go mainstream.

As stated by The Guardian, it's 'Hollywood's worst-kept secret'.

Chelsea Handler was on it. Elon Musk as well. Khloe Kardashian denies taking it. So too does Kyle Richards from The Real Housewives of Beverly Hills.

To meet overwhelming demand, the weekly injectable is now slowly multiplying under different manufacturers, with pharmaceutical companies scrambling to become part of the race (*insert dollar signs here*).

In the US, brands like Wegovy, Mounjaro and Reybelsus have cropped up among others. 

And these new drugs are only the beginning. We're currently sitting on the cusp of a new wave of medication for weight management.

In Australia, the Therapeutic Goods Administration (TGA) has recently approved Wegovy for weight loss for those with a body mass index (BMI) over 30. Though it's not yet available.

Globally, there's been a shortage of the drug for the past year - meaning people with diabetes have struggled to access it. This is simply because the demand exceeded the capacity to produce it, by quite a large margin, making the supply constrained. 

However, with a massive injection in the drug's manufacturing, experts are saying the supply crunch will ease very soon.

It's predicted that not only will the drug become more widely available, but soon, we're also going to have a variety of choices for weight loss medication. 

In fact, within the next five years, experts say we'll see a slew of new drugs aiming to combat unwanted weight gain.

So, what will this look like?

More weight loss drugs are coming. Is it a good thing?

Doctors in Australia, desperate to treat what is widely seen as an “obesity crisis” (obesity currently affects two out of three adults), are widely on board with the drug. 

As Dr Brad Mackay told podcast host Claire Murphy on The Quicky, the medical profession has been promised a miracle weight loss drug for decades.

Listen: Is Ozempic Really A Weight Loss Wonder Drug? Post continues below.

Dr Mackay said: "I've been waiting for medication like this to come along my whole career, even at university."

"My university lecturers promised that just around the corner, we would have amazing weight loss drugs - and we'd be able to make a big dent in helping the obesity crisis that was starting around the world many, many years ago."

Of course, weight management pills, programs and treatments have cropped up throughout the decades, some gaining massive popularity - but according to Dr Mackay, semaglutide is unlike any weight loss medication we've seen in the past. The evolution of this medication has been a game-changer.

The reason is that up until now, medications that suppress appetites have been limited, and have historically had very negative side effects.

In the late '90s, Fen Phen diet pills were THE answer to weight loss. Until they were linked to heart damage. Then there was DMAA in the early 2000s - which was removed from the market due to fatal health risks.

"We've had medication that works as stimulants - it speeds up your metabolism, but also increases your blood pressure and gives people anxiety. So, it's not a great drug for a lot of people. There have been other medications that stop you from absorbing fat in your gut - meaning you just end up with fatty diarrhea, which isn't the best for anyone." 

"We've had other medication that's been taken off the market because it was causing heart attacks to occur. This class of medication that we're using for diabetes doesn't seem to be causing those other problems. There's a high safety profile on it - they need to go through rigorous studies to make sure that they're not causing any adverse effects."

However, is there then good reason to believe that other side effects will surface in years to come?

We already know that the main side effects are things like nausea, vomiting and diarrhea. We also know that once you stop injecting the medication, it stops working. 

Meaning? It's something of an indefinite prescription.

So then, as we don't really know what the effects are until long-term users grow, is it possible there's a whole list of other complications? 

Mamamia spoke to dietician, TV nutritionist and author of Your Weight Is Not The Problem, Lyndi Cohen, who thinks we are severely underestimating the long-term side effects of these drugs.

She said, "There is research to say that these drugs can increase tumour growth, that they can result in acute kidney failure - this is a huge deal."

"We have this whole trend in wellness culture of compromising one part of you so that you can fit in more aesthetically. A lot of the buzz surrounding these drugs is around people who are trying to lose the last few kilos. I feel like there's such potential for misuse, where people who don't need to fix their body are going to be taking long-term lifelong drugs, with huge financial and physical costs, simply to achieve this ideal." 

As it becomes more widely used, will we see underlying issues we couldn't see before? Not just physically, but mentally and socially, too?

What are we willing to sacrifice as a culture to get the number we want to see on a scale?

While some people are calling this a 'miracle drug', others, like Cohen, are questioning the medication for weight loss issues.

As Cohen tells Mamamia, for people who suffer from eating disorders and disordered eating behaviours, these kinds of 'quick fixes' don't help to heal a person's relationship with food.

"I find it really problematic. And I'm worried about early future generations coming through with this kind of culture."

"Of course, there are going to be use cases where someone has a clinical need to use a drug like this. However, I feel like for years we've been trying to treat eating disorders with a kind of physical BandAid," she shares.

"It's a bit like giving someone gastric banding, but not treating the underlying cause of the issue, which is a deeply unhealthy relationship with food, compounded by years and years of dieting."

"Instead, we go and give them a physical solution without fixing the fundamental psychology that's driving them to eat compulsively and feel out of control around food."

"For me, it feels a bit like we're trying to place a BandAid on a headache. There's a mismatch between the way we're trying to treat the problem. Like gastric banding - you have someone who still has the exact same disordered relationship with food, but now it's even trickier for them to eat. I query whether we are making this problem worse than it already is."

While the drug has been approved for patients with a body mass index above 30, as Dr Crowley told Claire Murphy on The Quicky, "doctors can prescribe what we call off-label, which is outside the TGA approval - if they believe it's in the patient's best interest."

Now, this is where it gets murky. Because the question that arises is, who should be allowed to use it?

"Is the decision to prescribe this drug in the patient's best interest? I think we know that weight loss is beneficial for people who are obese and overweight," said Dr Cowley.

"Where the line comes - we don't know whether weight loss from a BMI of 25 is beneficial. I think the question is, are doctors prescribing it for people who are not overweight? And I would hope not."

While medical professionals in Australia are saying there isn't a lot of evidence of it being used off-label in Australia at the moment - in America, it certainly is. 

In a recent Instagram post, actress and presenter Jameela Jamil very explicitly blames this drug for the return of 'heroin chic'.

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She said that it's now become a mainstream craze in Hollywood, widely being used by influencers and celebrities to whittle themselves down.

She writes: "Slim women in my industry are buying it off prescription for 1k, to 1.5k and using it to get super skinny to conform to FASHION DESIGNERS WHO JUST WON'T MAKE THE SAMPLES WE HAVE TO WEAR FOR WORK BIGGER. The samples are getting smaller post pandemic, and coincidentally "heroin chic" is "back in"."

However, the predicament seems to be this: Should the influencer or celebrity, or someone who is abusing the drug, be thrown in the same basket as the person who has been struggling with their weight for their entire life? 

As Dr Mackay shared on The Quicky: "In my experience, the people who have been inquiring in Australia are morbidly obese. They are really struggling with their weight. And they know that the medication can reduce their weight and it can be life-saving in its own way."

"So if you're able to reduce your weight, you're able to exercise a lot better, you're able to decrease your cholesterol, you're able to decrease your blood pressure - these are all longer-term gains."

"I'm a little bit empathic for people who are using it for weight loss. Because people are often desperate, they've tried every diet under the sun, and it hasn't worked. We know that metabolism is just self-sabotage. Your body wants to keep you fat. Often people will need to go on medications to help them get to a much safer weight for their future."

Does transparency around it make us feel better?

Undoubtedly, one of the major differences between what we're seeing today compared to ten years ago has a lot to do with the transparency we now see on social media.

For example, years ago, you didn't hear or see celebrities talking openly about their gastric band surgery. Or sharing what procedures they have on their face or bodies. It was just not the done thing.

Fast forward to 2023, and you'll find celebrities and influencers alike sharing everything from what they eat in a day to the different cosmetic treatments they've undergone.

But are we happier that some influencers and celebrities are now opening up and discussing the use of weight loss drugs? 

Does transparency around weight loss actually make us feel better? 

Well, it's a double-edged sword.

On the one hand, we can find comfort in knowing that celebrities aren't 'perfect' - that they too can battle with their appearance and weight. 

"They're just like us!"

However, on the other hand, it still makes us feel like we have to be a certain way. To fit in with another standard or ideal.

Further to this, the normalisation and accessibility of the drug – particularly once it becomes more widely available – adds an extra layer of pressure. Will it just become the 'done thing'?

Because eventually, these drugs will be everywhere.

As Mia Freedman asked in a recent episode of Mamamia Out Loud, how do we feel about the fact that someone we know might want to 'just lose five kilos'? Will it eventually become like the actual Botox of weight loss?

Similarly to other weight management solutions, these drugs can be seen as further exacerbating the issue of weight discrimination - instead of removing the stigma around weight, they're essentially just adding to it.

Are we moving from discriminating against overweight people for their body composition and eating habits, to now telling larger people to just take the 'magic cure'? And blaming them if they don't?

Then, there's still that stigma around "cheating" weight loss. The idea of not losing body fat "the old-fashioned way" through diet and exercise.

No matter what way you want to look at it, one thing rings true: In 2023, the future of weight loss might feel different - but it sure looks and feels a lot like it did in the past.

What are your thoughts? Where do you see our relationship with weight loss medication going? Share your thoughts with us in the comment section below.

Feature image: Getty