I’m a doctor on Ozempic—it’s effective under one condition

I struggle with my weight. As a physician, I understand the science of gaining and losing pounds. I speak often about culinary medicine. And yet, even with knowledge and resources, I have lost and regained the same 25 pounds for nearly 30 years. Sound familiar?

This is why even doctors are personally intrigued by the hype around obesity “wonder drugs.”

I started my journey with Ozempic in 2023. I was at my heaviest, with signs of pre-type 2 diabetes and challenges with weight-related sleep apnea. Today, I am 35 pounds lighter. I have normalized my A1C and no longer require CPAP, but I suspect I may never be able to come off these drugs without reverting to old patterns and regaining weight.

In the absence of carbohydrate cravings, I’m left instead with questions: Did I need this drug in the first place? Have we found a panacea, or are we opening a Pandora’s box? I’m not the first, and won’t be the last, to ask. Answers may be years away.

In the interim, I offer some food for thought from the vantage point of a board-certified physician and confessed yo-yo dieter who is, for now, stuck on Ozempic. This is not medical advice—please consult your doctor before starting any medication or treatment program.

First, some science. Every obesity researcher and clinical specialist will tell you that obesity is a multifactorial disease—meaning its inputs include genetic, psychosocial, environmental, and behavioral factors, all interacting in complex ways.

But obesity is also governed by physics: calories in vs. calories out. If we consume more calories than we expend, we will gain weight over time. The inverse is also true: contestants on shows like Survivor and Naked and Afraid almost always begin visibly shedding weight when thrust into caloric restriction. These concepts must be able to coexist in our minds. Obesity is both complex and simple.

After a year, with excellent outcomes from a clinical perspective, I attempted to wean off Ozempic. When the drug was out of my system, my appetite returned and I regained eight pounds in two weeks.

About 40 percent of American adults and 20 percent of U.S. children are obese. If you’ve ever fallen into this category, you’ve surely heard valid but unhelpful advice ad nauseam: exercise, control portions, avoid certain carbs, eat lean protein and healthy fats, and so on.

We may succeed temporarily, but some experts believe that 80 percent to 95 percent of us will gain back whatever we lose. Researchers describe this pattern as “near-ubiquitous”: “early weight loss that stalls after several months, followed by progressive weight regain.”

Obesity is deeply personal but also affected and exacerbated by forces beyond individual willpower. Metabolic evolutionary traits compel us to eat, while the food industry has systematically increased our intake of “empty” calories, or those that add weight but provide little or no nutritional value.

To break the typical pattern and maintain lasting weight loss requires almost superhuman willpower, and maybe an ability to outwill hormonal regulatory systems. I had to acknowledge this was beyond me.

I decided to restart Ozempic, not only to preserve my health improvements but also because of sunk costs. I had spent about $200 out of pocket on each pound I’d lost, and I was not going to give up easily on my investment.

A new side industry is sprouting around Ozempic off-ramping, as others balance the budgetary implications of an effective but expensive obesity treatment that may require long-term maintenance.

Although we are pioneering new ground with wider usage of GLP inhibitors like Ozempic, their efficacy and safety for treating type 2 diabetes is well documented. Expenses aside, what if ongoing treatment for obesity is the most preferable option? How can we know what further conditions I may have developed had I stayed at 247 pounds?

Consider other chronic and multifactorial diseases such as essential hypertension, cardiovascular disease, lung cancer, and COPD. Although willpower and self-discipline can be important inputs and determinants of these disease states, we don’t stigmatize patients who seek treatment with medication, even if said medication requires ongoing usage.

If you stop taking antihypertensive medication, your high blood pressure will generally return. Chronic diseases often require chronic medication.

I understand the tradeoffs involved in using Ozempic and similar drugs to treat unhealthy weight. At the individual level, I am both a testimonial and a cautionary tale.

Even so, from a clinical perspective, I believe we ought to focus on the bigger picture—obesity is a widespread and deadly chronic disease, and we have now found an effective treatment.

We’re right to discuss and debate the implications of these new-ish wonder drugs, including thorny questions around overuse and potential off-label uses for various lifestyle conditions.

But the pop culture phenomenon shouldn’t distract from important questions like cost, supply, and equitable access. The answers will have profound implications for millions of patients and may reshape the healthcare system and wider economy for a generation.

Jay S. Feldstein, DO, is president and CEO of Philadelphia College of Osteopathic Medicine (PCOM). He is board-certified in occupational medicine and is a fellow of the American College of Preventive Medicine.

All views expressed in this article are the author’s own.

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