Some users of GLP-1s for weight loss are conflicted about ‘miracle drug’

The pressure was crushing—like an elephant sitting on his chest. Frightening thoughts raced through his head. His father died of a stroke at the same age. Two colleagues experienced strokes in the last two weeks. Overweight. High blood pressure. Type 2 diabetes. Would he suffer the same fate? It was then that Andrew’s co-workers told him he didn’t look good. The 55-year-old went home, told his partner they needed to go to the emergency room, and passed out once through the hospital doors.

“When I came to, it was ER doctors scrambling,” Andrew remembered, noting they performed multiple tests to determine if he was having a heart attack. He thought this health episode could be related to Ozempic, a GLP-1 drug he recently started taking upon his doctor’s recommendation to help improve his worsening physical condition. Andrew, who lives in Los Angeles County and preferred to use only his middle name, said doctors still don’t know what caused his medical event. “But, they said it wasn’t related to Ozempic,” he told Prism. “Two cardiologists said the same.”

He believed them. Still, the wide range of side effects reported by GLP-1 users—some severe enough to disrupt daily life—cannot be ignored. For many Americans, the promise of weight loss makes the gamble feel worth it. But are these drugs breakthroughs in treating metabolic diseases, such as diabetes and obesity, or simply the newest front in America’s longstanding weight war? And, as their popularity explodes, what does it mean for people navigating health, stigma, and a culture that equates thinness with worth?

“The weight war”

GLP-1 receptor antagonists—drugs such as Ozempic, Wegovy, and Mounjaro—mimic the naturally occurring hormone that slows stomach emptying, reduces appetite, and helps regulate blood sugar, leading to weight loss and improved glucose control. These so-called miracle drugs, originally intended to treat Type 2 diabetes, are now widely used for obesity management and have come to dominate American culture.

“This is not the first time something has been called a miracle drug or a miracle cure,” said National Association to Advance Fat Acceptance Executive Director Tigress Osborn, noting other weight-loss fads such as the cabbage soup diet or Fen-Phen—a combination of the seizure medication fenfluramine and the stimulant phentermine first used in 1992 to suppress appetite. The combination drug, linked to serious heart and lung complications, was withdrawn from the market in 1997. 

“We have a short memory about that, especially when the victims are fat people. I’m 51. I lived through Fen-Phen. So much of what has driven some of the media frenzy around [GLP-1s] is social media and younger users who did not live through it and do not remember that history,” Osborn said. 

Andrews’s father died in 2001 with a high level of Fen-Phen in his system. Still, he said the benefits of taking a GLP-1 outweigh the potential side effects and health risks. The National Institutes of Health (NIH) in 2024 published a list of the medication’s adverse drug reactions—with varying frequency and severity. Some of those include gastrointestinal (GI) and digestive issues such as nausea, vomiting, diarrhea, constipation, and gastroparesis—a condition when the stomach muscles contract too slowly, leaving food and liquid for a prolonged period of time. The medication is also known to cause GI bleeding, pancreatic inflammation, gallbladder and kidney injury, and a heightened risk for developing thyroid C cell tumors.

“I am very fortunate. I fall into a weird percentile where I have zero side effects—just a tiny little pain sometimes in my right stomach,” explained Andrew. “I’ve lost weight incredibly fast. It definitely tunes out all food noise for me, and I can feel it rewiring my brain as far as what I reach for when I do eat. It keeps food in your stomach longer so you feel full. It’s a miracle drug for me.”

Andrew’s Type 2 diabetes is now in remission, and so far he’s lost 30 pounds from his 6-foot-4-inch frame. He said his doctor wants him to lose another 50 pounds—which would bring him to 210 pounds—before either weaning him off the drug or using a microdose for an indefinite period of time. Andrew said his doctor told him that he’s likely to gain some of his weight back once he stops using the medication or lessens his dose. 

The message from Andrew’s doctor is one of the many reasons fat liberationist activists who advocate for the social, political, and cultural liberation of larger-bodied people are concerned with GLP-1s being used for weight loss alone. Research shows that once these medications are discontinued, many users regain a large portion of their lost weight and experience a reversal of metabolic benefits. 

Virgie Tovar is a weight-based discrimination expert in the San Francisco Bay Area. She said a “crisis is already brewing” among people convinced GLP-1s are “miracle drugs,” often because they do not understand that these medications could cause metabolic damage.

“They’re gonna be in a bigger body than they’ve ever been before and now they’re gonna feel like, ‘Holy shit, the miracle—the thing that said it was gonna fix everything—can’t even fix it now. I’m in a larger body than I’ve ever been in, and maybe I even had the experience of passing in the world and not having that discrimination, and I’m on the other side of it because I can’t take the medication anymore, or I choose not to live the lifestyle that you have to live to be on it,’” Tovar explained.

Fifty-seven-year-old Chris Peffley knows all too well how extreme weight loss negatively affects metabolism. The Indiana mom has spent years fighting “the weight war,” as she calls it. This includes opting for a vertical sleeve gastrectomy (VSG) in January 2024 and participating as a contestant in 2012 on the defunct weight-loss competition television series, “The Biggest Loser (TBL).” 

The reality show was built on caloric restriction and punishing workouts for contestants to produce dramatic body and health transformations. NIH-funded research later found severe metabolic slowdown and rapid weight regain in 14 former contestants who participated in the long-term metabolism study.

“Our metabolisms were greatly affected by ‘TBL,’” Peffley said. “Losing weight has become so much harder because our bodies don’t metabolize like others. Historically, since being on the show, it didn’t matter which doctor I saw. If I tried to bring up my ‘TBL’ experience and how it affected my ability to lose or even maintain a weight, I was treated as if I were just making up excuses and just being lazy.” 

Peffley’s VSG surgery was unsuccessful because she “found a way to eat past” her sleeve. She  started using a GLP-1 from an online provider in September. She’s about 20 pounds away from her goal weight and said she believes a maintenance dose will be required to keep her from regaining. The nausea, headaches, and vision issues she experiences after taking her GLP-1 injections is not enough for her to stop. 

“Something that shuts off the food noise switch in my brain is worth the side effects. Weight concerns are a personal choice,” Peffly said. “My own expectations revolve more around my own health than my physique. One look at my sagging skin would tell you it’s not about the physical for me. I look like a shar-pei puppy. It’s about longevity.” 

Like Andrew, Peffley’s father died at the age she is now from issues related to morbid obesity. She reiterated to Prism that health is her primary concern, but the high costs and hard-to-access procedures or medications in the U.S. make it difficult to maintain.

“Everything I have done has been out-of-pocket. The resistance within the medical community and even more so the unreasonable control insurance companies have with making final health decisions makes me want to puke,” she added.

Justified discrimination  

Peffley also expressed frustration at the weight discrimination she has faced throughout her life when going to the doctor for totally unrelated health issues—including infertility in her 20s, plantar fasciitis in her 30s, bad knees in her 40s, and menstrual problems that began in her teens and continued through menopause. 

“I have likened my experience with health care as being treated like cattle,” she said. “Absolutely no voice. I am the subject and physicians push me through the process with no personal input. At times, I just felt like I should’ve started mooing to get my point across.”

It was only recently, with her current health care provider, that Peffley said she’s being treated like an individual. The doctor seems to understand “the reality of food noise” and how it can amplify “emotional distress.”   

Osborn, who self-identifies as fat, recommended a way to relieve fat-bodied people of weight bias, stigma, and discrimination in health care—which can cause physical, mental, and emotional harm: to find a weight-neutral provider or train their current practitioners to view them as a person in a smaller body to properly investigate their health concerns.

“I’ve had the same general practitioner for five years. She knows my stance: Give me the same treatment you would give somebody in a smaller body, who had the same thing going on. It took years to cultivate with the doctor and others in the office. They already know we’re walking past the scale,” Osborn said, laughing. 

Osborn is a well-recognized voice in fat advocacy and told Prism that she realizes not everyone has access to health care, or feels comfortable or has the skills needed to advocate for themselves. However, she is confident that doing so leads to better mental and physical health outcomes. Osborn also noted that it can feel like a never-ending process. For example, if her insurance changes, she has to “start over with new doctors.”

Osborn described a situation related to the hysterectomy she had a few years ago. A gynecologist, subbing for her original doctor, tried to push her into weight-loss surgery. It was the first conversation she had with the health care provider, and she was only there to prepare for her hysterectomy.

A lot of doctors who would have been either gently hinting or blatantly recommending weight-loss surgery, for someone of my size, are now recommending GLP-1s instead.

Tigress Osborn, National Association to Advance Fat Acceptance Executive Director

“We hadn’t even made it through the surgery I was here for, and you’re trying to talk to me about having weight-loss surgery when I recover from this,” Osborn said. “It happens to patients all the time. I’ve kind of replaced that conversation. A lot of doctors who would have been either gently hinting or blatantly recommending weight-loss surgery, for someone of my size, are now recommending GLP-1s instead.”

Fat activists like Osborn believe that GLP-1 drugs used only for weight loss reinforce weight stigma and the idea that body size must change to be healthy, rather than addressing systemic bias and honoring bodily autonomy. Osborn recalled a discussion she had with her endocrinologist, who mentioned taking a GLP-1 at a “diabetes dose,” which is almost like taking a different drug than taking it at the obesity treatment dose. “I’m not willing to take those risks,” she said.

The RAND Corporation, a nonprofit, nonpartisan research organization, surveyed a nationally representative sample of nearly 9,000 Americans last summer. It found that nearly 12%, or close to 41 million people, have used GLP-1 drugs. Forty percent of those users, or more than 16 million Americans, have taken them specifically for weight loss. Researchers reported more than 47 million said they were interested in using the drugs.

Peffley does not have Type 2 diabetes, but said her justification for taking a GLP-1 is based on the “what if.” What if she didn’t do anything about her health, increasing the likelihood she may struggle in the future with problems related to larger bodies?

“Regardless of whether GLP-1s are used for weight loss, the societal expectations around bodies, health, and personal responsibility are already prevalent,” she said. “Fat discrimination is about the only discrimination that society seems to justify.”

In addition to advocating for body justice and body positivity, Tovar is an author and lecturer who identifies as plus-size. She said she’s hopeful for the movement and has recently noticed a cultural shift when it comes to fatphobia and weight-based discrimination in the health care industry.

“One of the things that really boggles my mind—and it really speaks to the complexity of this issue—[is] I actually think the future is weight neutrality,” Tovar said. “I’ve never historically worked with medical schools or public health professionals, and that’s all the contracts I’m getting now. I think it speaks to a shift definitely.”

“Paradoxically, I think we’re [going to] be moving away from outright weight discrimination as a culture. But, the weight-loss industry isn’t going anywhere,” she added. “I think, fundamentally, people are attached to weight loss, and it’s emotional and it’s spiritual, and they’re more than happy to stop being mean to other people. But they’re not letting go of it for themselves.”

Editorial Team:
Tina Vasquez, Lead Editor
Lara Witt, Top Editor
Stephanie Harris, Copy Editor