The Ozempic Era: Are We Fixing the Problem or Just Muting It?

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Issue #19: November 17, 2025

💉 GLP-1s: Miracle, Shortcut…or Scaffolding We Haven’t Learned to Use Yet?

Ozempic. Wegovy. Mounjaro. Zepbound.

These names went from medical jargon to cultural currency almost overnight. Suddenly they’re in celebrity interviews, corporate Slack channels, and conversations with neighbors you barely know.

People aren’t just losing weight — they’re losing a lot of it. Fifteen, twenty, even twenty-five percent of their total body weight. Without dieting. Without obsessing. Without the mental math of “can I eat this?” every 10 minutes.

It’s no wonder GLP-1s took off.

But somewhere between the miracle stories and the memes, the nuance disappeared.
That’s where this conversation belongs — not in the hype or the backlash, but right in the middle.

🧬 First: What GLP-1s Are Actually Doing

Forget the pharmaceutical buzzwords. Here’s the basic biology.

GLP-1 is a hormone your gut releases after you eat. It:

• slows stomach emptying

• increases insulin when blood sugar is high

• reduces glucagon (which raises blood sugar)

• signals fullness to your brain’s appetite centers

Drugs like semaglutide and tirzepatide take those natural signals and amplify them. Instead of food whispering, “maybe another bite,” your brain hears, “we’re done here.”

You don’t fight cravings. You don’t white-knuckle your way through every meal. You simply… want less.

It’s not magic. It’s neurobiology with a megaphone.

📉 The Benefits: Real, Measurable, and Undeniably Powerful

Let’s start with honesty. These drugs work — especially for people with metabolic dysfunction.

In clinical trials:

• people with obesity lost ~15% of their body weight

• people on newer dual-agonists lost closer to 20%+

• those with type 2 diabetes saw major improvements in blood sugar

• people with obesity and cardiovascular disease had fewer heart attacks and strokes

These aren’t cosmetic wins. They’re medical wins.

For someone living in a body that’s been fighting them for decades, GLP-1s can be the first time the physics of hunger aren’t stacked against them.

And then there’s food noise — something most people underestimate.

Many GLP-1 users describe, for the first time in their lives, silence. No intrusive thoughts about food. No mental tug-of-war. No constant negotiation.

That relief is not trivial. It’s life-changing.

But relief — even profound relief — doesn’t erase the trade-offs.

😬 The Underside: The Part Social Media Skips

Like anything powerful, GLP-1s come with consequences worth understanding.

You lose weight — but not always the kind you want to lose.

Fat mass absolutely drops.

But so can lean mass: muscle, bone, organ tissue.

And early data suggests muscle function may decline even faster than muscle size.

Losing fat can make you look better.

Losing muscle can make you age faster.

Those are two very different outcomes.

The GI symptoms are real.

Nausea, constipation, vomiting, bloating, reflux — these are not rare “some people” side effects. They’re common.

And for some, eating becomes less enjoyable. Food feels heavy, slow, or like it’s stuck.

It works — but it’s not effortless.

The rebound effect depends on whether you stay on the drug.

In trials where people stop taking GLP-1s, weight returns — sometimes quickly, often significantly. Appetite hormones spring back. Gastric emptying speeds up. Biology tries to reset.

But here’s the nuance:

Many people plan to stay on GLP-1s long-term, just like blood pressure or cholesterol meds. For them, rebound isn’t the issue — it’s:

• Can you afford $1,000–$1,500/month indefinitely?

• Will your insurance cover it long-term?

• What happens to muscle, bone, and metabolic health after 5, 10, 20 years?

Rebound isn’t a moral failure — it’s biology doing what biology does.

For some people, GLP-1s can be risky.

One group that rarely gets mentioned:

People with a history of eating disorders or restrictive tendencies.

For them, appetite suppression can amplify unhealthy patterns. GLP-1s are not neutral tools in every psychology.

🤔 So Why Did These Drugs Go So Mainstream?

It’s not just the weight loss.

It’s:

• celebrities quietly using them

• influencers loudly using them

• before/after photos that look unreal

• a culture obsessed with quick fixes

• pharma marketing

• decades of shame around weight

• and the intoxicating promise of effort-free change

GLP-1s hit the perfect storm: a highly effective drug + a society desperate for relief.

But there’s a difference between relief… and replacement.

🏋️ The Lifestyle Foundation Still Matters (More Than Ever)

Here’s what GLP-1s can’t do:

• build muscle

• improve VO₂ max

• regulate cortisol

• fix sleep

• strengthen bones

• teach you how to eat

• create metabolic resilience

Those are still yours to build — and they matter even more during rapid weight loss, because without them, you’re just shrinking, not getting healthier.

Think of GLP-1s not as a solution, but as scaffolding.

Scaffolding helps you build the structure — it doesn’t become the structure.

If you use the drug to support behavior change?

Great. That’s durable.

If you use the drug instead of behavior change?

That’s dependency.

Not cheating — just fragile.

🧭 My Take

GLP-1s aren’t inherently good or bad.

They’re tools — powerful ones.

For people with metabolic disease, insulin resistance, obesity, or decades of food noise, these medications can be transformative. Respectfully — even lifesaving.

For others, the question becomes different:

Are you using the drug to build the foundation… or to avoid it?

Because shortcuts aren’t wrong — they’re just risky when they replace the work that actually leads to long-term health.

GLP-1s can change your hunger.
Only you can change your habits.
Use the medication as scaffolding — not the house itself.

Until next week. Stay vital.

-Jordan Slotopolsky

📚 Sources

• Wilding JPH et al. NEJM – STEP trials on semaglutide for weight loss and diabetes management
• Rubino DM et al. Diabetes, Obesity & Metabolism – Weight regain after stopping semaglutide
• Jastreboff AM et al. NEJM – Tirzepatide (Mounjaro/Zepbound) obesity outcomes
• SELECT Trial. NEJM – Semaglutide and cardiovascular risk reduction
• van Bloemendaal L et al. Nat Rev Endocrinol – GLP-1 mechanisms & appetite regulation
• Wharton S et al. Obesity Sci & Practice – Lean vs fat mass changes on GLP-1 therapy
• Kim J et al. JCSM – Systematic review of GLP-1 impact on muscle mass/function
• Nauck MA et al. Lancet Diabetes Endocrinol – GLP-1 safety profile & side effects
• Bethel MA et al. BMJ – Gallbladder and pancreatitis risk with GLP-1 agonists
• Mitchell JE et al. Int J Eating Disorders – GLP-1s & eating disorder considerations
• Bressler R et al. JAMA Health Forum – Cost, access, and insurance barriers for GLP-1 drugs

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