^{By Brittany Sue Hines}

No, but really. How should we?

The breakneck rate at which weight-loss drugs such as Ozempic, Wegovy, Mounjaro, and the like infiltrated our media, our vernacular, and our everyday lives was astonishing.

Before we could ask questions or receive the proper educational tools about such medications, semaglutide injections and pills were everywhere—including in the hands and in the minds of young people. Though we cannot turn back the clock and demand medically-accurate and culturally-competent education on such drugs before they sunk their teeth into our society, we can look ahead. We can recognize that, despite their many pros and their many cons, these drugs are not going away anytime soon. We must find a way to navigate the incredibly nuanced conversation about semaglutide products and their societal impacts with the young people in our lives.

Do we approach the conversation from a media literacy angle? A gender and class angle? A body image angle? There are so many routes such a discussion can take.

As always, here at Response for Teens, we want to provide caregivers and their young people with as much information as possible to make informed and meaningful decisions. So, before we go down all those conversational paths and more, we should first know what we’re talking about. Let’s cover the basics.

So, what is semaglutide?

Semaglutide belongs to a class of medications previously approved for the treatment of type 2 diabetes. These drugs mimic a hormone called GLP-1, which helps stimulate the pancreas to make insulin so blood sugar levels lower. One of the medication’s side effects is weight loss since GLP-1 gives brain receptors the feeling of fullness. The emptying of the stomach is slowed, and people feel fuller for longer, encouraging them to eat less.

You can view a fantastic, easy-to-read diagram explaining how semaglutide works in this Time article.

Do semaglutide injections work in helping people lose weight?

The short answer is yes, but not for everyone. According to UCLA Health, an early study of 2,000 obese adults compared people using semaglutide plus a diet and exercise program with people who made the same lifestyle changes without semaglutide. After 68 weeks, half of the participants using semaglutide lost 15% of their body weight, and nearly a third lost 20%. Participants who incorporated only lifestyle changes lost about 2.4% of their weight.

More recent studies show similarly dramatic results. But they’ve also revealed that participants tend to regain the weight lost when they stop taking semaglutide.

Are semaglutide products FDA approved?

According to the FDA’s website, there are currently three FDA-approved semaglutide products:

• Ozempic injection and Rybelsus tablets are approved to lower blood sugar levels in adults with type 2 diabetes, in addition to diet and exercise. Ozempic is also approved to reduce the risk of heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.
• Wegovy injection is approved to help adults and children aged 12 years and older with obesity or some adults with excess weight (as determined by BMI or body mass index), who also have weight-related medical problems, to lose weight and keep the weight off, in addition to diet and exercise.

Such drugs are only available with a prescription from a doctor, though some people get prescriptions at medical spas or online. There are no approved generic or compounded versions of these drugs, but counterfeit and illegally marketed semglutide has been found all over the United States. Medical experts discourage getting the drugs outside of a licensed physician's supervision and care.

Wait, so semaglutide products are available to young people?

Yes, but as of now, only the Wegovy injection for young people 12 years and older.

The American Academy of Pediatrics (AAP) guidelines say that “weight-loss medications, including semaglutide, can benefit children with severe obesity, particularly those who have already developed complications related to their weight. Medication should always be accompanied by lifestyle changes, like nutrition and exercise plans, and family and physician support.”

As mentioned, most people regain weight when they stop using semaglutide, so someone who starts the medication as a teenager might be on it for many decades. The drug has been shown to be safe in the short-term, though it can come with gastrointestinal side effects. However, according to Shellie Yussman, chief of adolescent medicine at the University of Rochester Medical Center, it’s not clear how long-term use affects the body or the brain. Additionally, it remains unclear how the impacts of going off the drug affect body image or risk for disordered eating overtime.

How much do injectable weight-loss drugs cost?

According to the Peterson-KFF Health System Tracker, injectable weight-loss drugs can come at a high cost.

Ozempic, for example, is covered by insurance when it's prescribed for type 2 diabetes but for off-label use for weight loss, it’s approximately $930 per month out of pocket. Rybelsus tablets have a similar price tag. Wegovy is typically covered by insurance but, if not, costs roughly $1,350 each month. Mounjaro injections are a little over $1000 per month.

So, with all of that said, what’s the simple way to describe weight-loss drugs to young people?

As we will discuss, it’s a much more nuanced and intricate conversation but here’s a start:
Medications like Ozempic were originally designed to help people with type 2 diabetes, a disease that occurs when your blood glucose, also called blood sugar, is too high. People found that one side effect of these drugs was weight loss. Now people all over the world— some with diabetes and some without—are taking them to lose weight and, hopefully, improve their health. Though these drugs don’t work for everyone and can be very expensive, people who use these medications under the supervision and guidance of their doctors and dieticians can find them to be helpful.

When talking about semaglutide products and their impacts on weight with young people, be sure to:

• Withhold judgment
• Emphasize their contribution to health, not body image
• Have resources at the ready

Perfect. Easy as that, right?

Wrong.

Now that we have the basics securely pocketed in our tool belt, let’s get into the minutiae of the varying directions a conversation about Ozempic, weight, and society could go with the young person or young people—especially teens—in your life.

We invite you to ask your young person or teen what they know and what they think about semaglutide products. Find out what they’ve heard about them on social media, advertisements, or from their friends. Then, perhaps, dive into one or more of the following offshoot conversations.

The Magic Bullet Conversation

The nature of semaglutide products goes against everything we teach young people about media literacy. We urge them not to believe everything they see or read, and that if something sounds too good to be true, it probably is. We tell them that there is no “magic bullet” for anything, but yet, there seems to be one in drugs like Ozempic.

It is important to remind young people that these weight-loss medications may be powerful but they are not perfect. Without placing judgment on the medications or anyone who uses them, you can remind young people that they do not work for everyone and they can cause serious side effects in others. They require a long-term commitment to either taking pills or self-injecting needles as well as paying to get such pills or shots.

Moreover, and most importantly, they are not the be-all, end-all solution for weight loss. Using these medications also requires a holistic approach; exercise, healthy eating, and addressing the “emotional and behavioral factors that contribute to health and eating patterns,” are all necessary additions according to Joseph Trunzo, Ph.D., Psychology professor and associate director of Bryant University’s School of Health and Behavioral Sciences.

Reminding young people to continue fact-checking everything they see, hear, or read— especially health-related information on social media—is incredibly important.

The Gender Conversation

Take a moment to think about the celebrities that you know who have publicly shared their experiences with weight loss drugs like Ozempic and Wegovy. Perhaps Kelly Clarkson or Oprah Winfrey come to mind. Maybe then you think of Amy Schumer, Sharon Osbourne, or even Billie Jean King. After a little more thought, you might remember that Tracy Morgan said he used the drugs, but I highly doubt he came to mind first.

It’s clear in Hollywood and beyond that these drugs are predominantly used by women.

According to a study from this past July from the Annals of Internal Medicine, the current users of semaglutide medications were disproportionately female, white, and non- Hispanic. Moreover, a poll from the nonpartisan health policy research group KFF, found that 51 percent of women said they were very or somewhat interested in taking these drugs, compared with 38 percent of men (this poll did not receive enough nonbinary respondents to break out their level of interest in taking these drugs).

Looking at this data might provoke some questions with your young person or teen. What does this data say about our society? How does this contribute to the long history of people assigned female at birth being more pressured to care about their body and to be concerned about weight loss?

Including this information regarding gender differences in your conversations with young people is important, particularly as they navigate the gendered marketing and media campaigns such weight loss drugs promote.

The Class and Access Conversation

As just mentioned, celebrities are using weight-loss drugs, and such medications are incredibly expensive. Medicare and most employee-sponsored insurances will not cover weight-loss medications. As of 2022, about 28,000 patients per year was the “max or likely threshold that insurance would cover overall” for new weight-loss medications in the U.S; that’s only 0.1% of the 142 million overweight eligible population.

So, you might ask the young people or teens in your life, why are weight-loss drugs so inaccessible despite their potential to benefit tens of millions of Americans? If people who live in the most poverty-dense communities are the most prone to obesity, why are these drugs currently catered to the rich? Who benefits here?

Additionally, the spike in popularity of these drugs originally intended to treat diabetes has led to a year-long shortage of Ozempic. This shortage, caused by an increase in prescriptions for weight-loss purposes, has left patients with type 2 diabetes in limbo, often resulting in missed doses. Missed doses can lead to uncontrolled blood sugar for people with type 2 diabetes, and that can snowball into kidney and eye complications.

Invite your young person to think about this issue of access. Which patients should get priority? How would they solve this problem? Will new factories and ramped up production bring about more equity?

Challenging young people to look deeper into any given trend can open doors to better understanding the overarching societal impacts.

Perhaps the Most Important: The Health vs. Body Image Conversation

Ozempic has, without a doubt, changed the landscape of weight and how we talk about it. After years of focus on body liberation and body acceptance—leading to more inclusive advertisements and models, larger size ranges for clothing, and a larger push for people to accept themselves at every size—drugs like Wegovy and Ozempic came crashing through the door, promising people a path toward thinness.

Now, let’s be clear. Semaglutide medications were created for the purpose of health and are FDA-approved for a very specific subset of people. The use of drugs like Ozempic has “opened up people's eyes to obesity as a disease [that now has an] effective medication for it,” says Marc Bessler, MD at Columbia Surgery. He believes that such options may help shift societal perceptions about obesity away from personal blame and more toward medical treatment and intervention.

Additionally, these medications do have major health benefits for many users. Losing weight can lead to improved physical movement and thus increased exercise, reduced risk of heart attack or stroke, and the minimalization of weight-related chronic pain. “I was losing loads of weight, my back pain went away, all sorts of good things happened,” said journalist Johann Hari about his first few months using Ozempic.

We must celebrate the assistance toward higher qualities of health and life that semaglutide products have brought a great number of people.

However, to be frank, these drugs are also being used in unapproved ways that highlight cosmetic changes over health. And those means of use are being talked about much more frequently than the more healthful means of use. The focus is on thin people using it to get thinner, not on people who are using it to address a medical issue. The focus is on how these drugs alter people’s bodies; people are visibly shrinking, and young people are taking notice.

To many, drugs like Ozempic reintroduce the idea that a person’s body size has a value attached according to Doreen Marshall, PhD, CEO of the National Eating Disorder Association. This, naturally, has broad implications for one’s mental health, body image, or eating habits—especially that of teenagers. While it’s important to remember that weight and worth are not the same, the messaging and advertising of products like Ozempic seem to make that water murky.

Such messaging can also be triggering for people with eating disorders. “It is probably both triggering for people in eating-disorder recovery and encouraging folks who are vulnerable to developing an eating disorder,” says Jessica Saunders, an assistant professor of psychology at Ramapo College of New Jersey who studies eating disorders.

Ultimately, weight loss for the sake of health is important but weight loss—especially weight loss as a means of cosmetic alteration—isn't always the miracle many people assume it will be. It can be a distraction from the real issues.

In a recent NPR LifeKit episode, Dr. Mara Gordon wisely says, “We need more holistic approaches to health and wellness. We also need to end the shame of being fat, which makes it so much harder for people in bigger bodies to do the very things that keep them healthy: exercising, socializing, living life free of self-hatred.”