There’s no doubt that 2024 has been the year of semaglutide. In the space of just a few months, the drug – designed originally to treat type 2 diabetes and sold under a variety of brand names, chiefly Ozempic and Wegovy – has kick-started a cultural and diet revolution.
We talk of ‘Ozempic face’ (a gaunt look that users get, see also Sharon Osbourne); the internet is full of memes about the drug; plus it’s the topic of conversation around dinner tables and the subject of endless gossip and TV discussions (are they or aren’t they, would you, wouldn’t you?).
Semaglutide has almost single-handedly destroyed the hitherto mighty and highly lucrative diet industry (shares in WeightWatchers have fallen by 80 per cent over the past five years); Conservative leadership contender Robert Jenrick admitted using it ‘for a short period of time’; and it’s sparked concerns about the return of the waif in the fashion industry, which has, understandably, upset the body-positivity movement.
It’s also been the subject of several high-profile clinical trials claiming that, as well as ‘curing’ obesity, it can stave off other diseases such as cancer and dementia; while there have been dire shortages and horror stories of fake formulas being sold online causing nightmarish side-effects and even death. And it’s made its manufacturers very, very rich indeed.
It’s a game-changer and, like all game-changers, it’s attracted much controversy. The world seems to be divided into those who think it’s the work of the Devil, an easy way out for the morally weak, aka fat people; and those who believe it may resolve one of the biggest health problems facing the Western world.
It’s certainly brought the topic of obesity – nearly two-thirds of all adults in Britain are overweight – to the fore. And demand shows no sign of abating.
All of which has been fascinating for me to witness, since I’ve been on it longer than anyone I know and, very possibly, longer than most. July 2018, to be precise, was when I got started on the fat jabs – which by my reckoning makes it almost six and a half years.
So I thought I would share what I’ve learned for the benefit of anyone weighing up whether or not to take the plunge in the New Year.
Sarah Vine started using fat jabs in July 2018 – almost six-and-a-half years ago
1. It’s not cheap – But it’s worth every penny
People talk about the cost of semaglutide. But if I add up the money I’ve spent over the years on pursuing stupid fad diets and expensive detoxes, it’s cheap at the price.
When I first began ‘using’, it was about £175 a month – these days I’m on a much less frequent dose, so it probably costs less than £50 a month. Some people would say that’s still a lot – but then some people will happily spend £500 on a handbag or pair of shoes, whereas I will not.
I consider it a long-term investment in my health, every bit as worth it as a gym membership. I was first prescribed liraglutide, semaglutide’s daily precursor, in the form of the drug Saxenda. At the time I weighed 98.4kg or 15st 7lb (at 5ft 7in or 1.72m, that put me firmly in the obese category), and was at my wits’ end after years of struggling to keep my weight under control.
I was going through the menopause, I was depressed following a tumultuous few years, my marriage was falling apart, my self-esteem was on the floor. I was trying my best with exercise and diet, but it was a losing battle.
I’ve never been happy being overweight. I have huge amounts of respect – and perhaps envy – for people who can be comfortable in their skin no matter their size. I love their self-confidence and almost sensual self-appreciation. But that’s not me.
I don’t mind it in others, but as far as my own body goes, I really hate being overweight. I feel self-conscious and uncomfortable. It makes me tetchy and short-tempered, constantly irritated by my own failure. It aggravates my self-loathing. I get sad, which only makes me eat more.
It’s a vicious cycle – and the only way out of it is to lose weight.
For years I managed this with vigorous exercise, various diets and periodic bouts of starvation – but as I got older and hit the menopause, it just became incredibly hard to keep the weight off.
2. It will cure your addiction to junk food
I’ve not always had a difficult relationship with food. I was not a fat child and was not remotely self-conscious about my size. Until, that is, I hit puberty. That coincided, as these things often do, with a few other upheavals in my life, and I began to seek comfort in food.
Where once I had been a lithe, happy child, I was now a morose, pudgy teenager.
I also moved from a healthy food environment – Italy, where my parents had settled in the mid-1970s and where in those days there was virtually no processed food in the shops and fresh, delicious produce was the norm – to a very unhealthy one: Britain in the late 1980s.
Where before there had been no such thing as chips in my life, now they became a staple. There were sweets, crisps, takeaways. I went from almost exclusively living off fresh fruit and veg and simple proteins – in other words, the classic Mediterranean diet – to consuming, not to put too fine a point on it, junk.
Processed food is the enemy. It’s the root cause of our obesity epidemic, a product of corporate greed and the industrialisation of food production. It’s designed in laboratories, formulated to be irresistible to the human palate. It provides little by way of nutrition – vitamins, minerals – and yet is plentiful in calories.
Even when I was a teenager, processed food was on its way to supplanting ‘real’ food. Heavily promoted for its convenience, in reality it was of no benefit to anyone other than the food manufacturers.
They had discovered that if you combine enough fat with enough sugar in the right quantities, you can get entire generations of humans hooked on foods that have long shelf lives and huge profit margins.
That’s why, when I returned to the UK in the late 1980s to study, my weight woes started. I didn’t know any of this back then, I was just seduced by all these forbidden wonders. I began to adopt what I would call a ‘corner -shop diet’.
I went home after that first term noticeably heavier. But within a few days of eating a healthy, fresh Mediterranean diet, the weight fell off. After all, I was young. It wasn’t necessarily that I was eating any less – if anything, the opposite. It was what I was eating that was so different.
The other problem with junk food – apart from the fact that it makes you fat and has very little benefit – is that it’s addictive. Processed foods provide an instant high, followed by a crushing low – and leave you wanting more.
It can be a difficult cycle to break. I spent the next few decades as the junk food equivalent of a functioning alcoholic.
There were times when I was better able to control my cravings, others when I was not.
Exercise helped to an extent – but sometimes it made things worse, since I had a tendency to ‘reward’ myself for a tough workout with treats.
In 2024, Ozempic and Wegovy has kick-started a cultural and diet revolution
In my early 30s I was diagnosed with an underactive thyroid, which undoubtably didn’t help. Hypothyroidism is an auto-immune disease and can be caused by several factors, hereditary and external. My erratic and unhealthy eating probably didn’t improve matters.
Either way, it was another vicious cycle: the thyroid problem made me feel so utterly dog tired, so lethargic and exhausted, so fuggy in the head that I would find myself desperate for that sugar hit – and round and round it went.
All of which was why I found myself, aged 51, sitting in the office of Professor Marcus Reddy, a consultant general, laparoscopic and bariatric surgeon, determined to have a gastric sleeve fitted. I just wanted to knock the lifelong battle with my weight on the head, and was prepared to have surgery to do so.
In the event, it was not to be. An exciting new drug had just been licensed in the UK, Mr Reddy explained, which was able to chemically mimic the effects of a gastric band.
It worked, he told me, by suppressing hunger hormones in the stomach, enabling patients to feel fuller more quickly and to go longer between meals.
If I didn’t like it, he added, I could always reconsider surgery, but it was worth a try – and I agreed.
I began with the daily injection (liraglutide) and then switched to the weekly one (semaglutide) in the form of Ozempic once it became available about a year later. I’ve never looked back.
At the moment I take 1.75mg every two to three weeks, which seems to work very well as a maintenance dose. It has been utterly life-changing.
3. If I get them, side effects pass quickly
Having read various horror stories about side-effects, I must confess that has not been my experience. I do occasionally get a wave or two of mild nausea, usually a day or two after injecting – but this passes within a matter of seconds.
The main side-effect is that, like a physical gastric band, if you binge on very sugary or very fatty foods, or overindulge in alcohol, it’s very likely that you will be sick. But that’s really just the medication doing its job.
4. It lets you stay slim after losing weight
My weight has been stable now for several years at around the 80kg (12st 7lb) mark. Technically that still puts me slightly in the ‘overweight’ category of the dreaded BMI scale, but I’m perfectly happy where I am, which is a size 14.
For me this was never about being skinny anyway. It was just about being comfortable in my own skin, and I’ve achieved that.
I no longer shy away from changing rooms or go into meltdown at the prospect of having to wear a bathing costume.
5. You’ll be fitter and your joints will be less sore
In terms of my overall fitness, it’s helped me become more active. Being less heavy makes it a lot easier to exercise – and a lot more fun.
My joints are a lot less sore and stiff, and I no longer feel like a great big heffalump in any given exercise class situation. I cycle a lot, I walk, I take the stairs. It’s so much easier when you’re not carrying round the equivalent of several extra bags of sugar.
6. I’ve been able to cut back on other medication
I’ve also stopped taking my HRT, which I was prescribed in my late 40s after experiencing all the usual symptoms: I just found I didn’t need it any more.
I checked with my doctor and with the specialist and they both said that was fine if I felt I no longer needed it.
I have no idea if being a healthier weight and no
longer experiencing menopausal symptoms are linked – that’s just my own personal experience – but it’s nice not to have to take so much medication.
7. I can’t get drunk – and can only drink a little
There’s one more advantage: alcohol. Semaglutide really doesn’t like alcohol. In fact, I’ve found that if I drink more than two or three glasses of anything on it, I feel distinctly queasy. Which for someone my age is probably just as well.
8. It will boost your mental health, too
But while the physical effects are noticeable and very rewarding, what’s perhaps even more remarkable are the mental ones.
Put simply, six and a half years of fat jabs have cured my toxic relationship with food. The ‘food noise’ which used to haunt me – as in Alice In Wonderland’s ‘eat me, eat me’ – is no longer a constant voice in my head.
Food simply doesn’t offer the same rewards in terms of pleasure, and therefore I don’t think of it in those terms any more, merely as just a means to an end.
So whereas before if you offered me a box of chocolates I would want to scoff them all, now I’m fine with one or two.
I still enjoy food – but it doesn’t give me that same high. Some might say this is a big price to pay – indeed, some users find this very off-putting and, in some cases, depressing. But for me it’s a fair exchange.
Or to paraphrase Kate Moss, nothing tastes as good as being able to do up my trousers feels.
9. Once you start you may not want to stop
People think nothing of being on statins or other medications all their lives.
Will I always take semaglutide?
I don’t know. If my doctor is happy, probably yes. Although these days I find I take it infrequently – about every two to three weeks – as the length of time I’ve been on it has resulted in a fundamental change in my eating habits. I think it’s more of a crutch these days, but I’m not quite ready to let go.
10. Your overall health will get better
Being less heavy alters the body’s chemistry. I have regular broad-spectrum blood tests to monitor my thyroid and they show how, over time, my liver and kidney function have improved. My blood pressure is back within normal range, my cholesterol less alarming.
