For Some People, These Drugs Will Be Great
There are clearly people who will benefit from taking a GLP-1, like Wygovy or Ozempic, long-term. Some will see real improvements in their health and their life. Maybe their metabolic health will improve, or they’ll find the boost from these drugs helps them stay motivated to move and eat well without many side effects. People with a family history of metabolic syndrome may see a meaningful reduction in risk.
But that best-case scenario comes with a lot of conditions. It requires finding a dose that still allows you to nourish yourself consistently, to stay active, to manage your mental health, and to afford the medication month after month. It requires not experiencing the side effects that are very common on GLP-1s and for a significant number of people make the whole situation unsustainable.
From my perspective as a dietitian, I know that people who stay on these medications long-term will have to learn to eat three meals a day even when they’re not hungry if they want them to meaningfully improve their life long-term. They’ll have to resist the pull of losing weight as fast as possible and stay committed to eating enough and strength training to preserve muscle mass. They have to be honest with themselves about whether their relationship with the scale is okay. They have to play a long game in a culture that very much does not like long games.
This is hard work.
Are Side Effects Preventing People From Staying On GLP-1s?
According to a RAND survey of nearly 9,000 people, roughly 1 in 8 Americans has tried a GLP-1. One in eight! It is projected that 25 million Americans will be on them by 2030. Those are giant numbers for a medication that has only been widely available for a few years. And yet a large study tracking over 77,000 people on semaglutide in Denmark found that roughly one in two had stopped within a year, mostly due to cost and GI side effects. Most people have GI side effects on Wygovy or Ozempic that are bad enough to warrant them stopping. And the long-term data we’d need to truly understand what decades on these medications looks like doesn’t exist yet – because, well, they’re brand new.
What Happens When You Stop Taking Them
Just like when you starve yourself and lose weight by sheer will, the body doesn’t return to a neutral baseline when people stop taking GLP-1s. Instead, hunger signals get more intense, satiety signals become more difficult to hear and respond to, and metabolism stays suppressed as the body works hard to return to where it was before.
This is just how the body works to keep us alive.
Studies consistently show that most people regain a significant portion of the weight they lost, often quickly. This is not a personal failure. It never has been. This is the body doing exactly what bodies do when they’ve been in a state of significant caloric restriction (aka starvation): defend itself. It’s the same biology that makes yo-yo dieting so harmful, just with a drug instead of a meal plan more appropriate for a toddler.
The Money Behind the Message
I’m still surprised sometimes that it’s legal to market medications in the U.S. when so many other countries do not allow ANY medication marketing.
It’s worth noting that a medication taken indefinitely is a different business model than one taken for a year. Lifelong use is what most people will need if they want to “keep the weight off”, but from a revenue perspective – that’s ideal. I’m not suggesting that’s why these medications are being prescribed, but I do think it’s worth including in our collective dialogue about aggressive marketing.
Let’s explore the wild amount of money that has been going into marketing these drugs. Novo Nordisk spent $471 million marketing Ozempic and Wegovy in a single year, and that number has only grown since. By September of 2025, it was nearly $500 million. By the end of 2024, GLP-1 drugs had generated $71 billion in cumulative U.S. revenue, with projections adding another $470 billion through 2030.
The company spent a record $3.2 million on lobbying in just the first half of 2024, and more than $8 million on lobbying in the past year alone. They are the context in which every conversation about these medications is happening, including the ones in your doctor’s office.
And then the wellness industry arrived, as it always does, ready to monetize both the problem and the solution. Overnight there were GLP-1 coaches with no clinical training, supplements marketed as “natural alternatives,” none of which are regulated or are useful.
The Lawsuits Your Doctor Is Probably Not Telling You About
As of early 2026, there are more than 3,000 pending federal lawsuits against GLP-1 drug manufacturers, consolidated into something called “separate multidistrict litigations”, or MDLs. The first MDL covers GI injuries — gastroparesis, bowel obstruction, intestinal paralysis. The second covers vision loss — specifically a condition called NAION (non-arteritic anterior ischemic optic neuropathy), a sudden and painless loss of vision caused by damage to the optic nerve. Legal experts expect the number of cases to reach tens of thousands.
These aren’t fringe concerns. In August 2025, the presiding judge largely denied the drugmakers’ motion to dismiss, allowing key claims to proceed. The central allegation across all cases: Novo Nordisk aggressively marketed these drugs while failing to adequately warn patients about the risks. Yep, that tracks. If you tell patients about all the side effects, they might say no thanks.
Those side effects are real and well-documented. Between40 and 70 percent of patients on GLP-1 medications report gastrointestinal adverse effects. Studies show patients face anearly fourfold increased risk of gastroparesis and a ninefold increased risk of pancreatitis compared to people on other weight-loss medications — and the FDA’s own prescribing label already states that semaglutide is not recommended for patients with severe gastroparesis, which means the agency itself acknowledges the risk.
The FDA’s adverse event reporting system has received reports of hundreds of deaths linked to semaglutide — a voluntary database that is known to significantly undercount real-world adverse events, and one that records associations rather than confirmed causes. Novo Nordisk denies wrongdoing, of course.
They Borrowed Our Language
For years, the intuitive eating and HAES communities have been saying something radical, but true: your body is not the problem. The relentless pursuit of thinness is the problem. The belief that you can willpower your way to a smaller body, and that failing to do so reflects some moral deficiency, is the problem. We’ve been saying “it’s not your fault, it’s your biology” for a long time, because it’s true, and because it was a genuinely countercultural thing to say in a world that blamed fat people for their bodies constantly.
Novo Nordisk heard that language and used it to sell a drug.
Their website reads: “Where some may see character flaw, we see a chronic disease influenced by genetic, behavioral, and environmental factors.” Gee, that sounds like something an anti-diet dietitian would say.
It is also the homepage of a company that generated $71 billion in revenue selling a medication for that disease. The conclusion of the anti-diet and body positive movement has always been: your body is not the problem, and you don’t need to fix it. The conclusion of their marketing is: your body is a problem, but it is not your fault so don’t worry that taking a drug will seem like cheating. Here’s a $1,000 a month medication to fix that.
They Needed a Disease to Sell a Drug
“Obesity” as a chronic disease is not a neutral scientific classification. The American Medical Association voted to classify obesity as a chronic disease in 2013, a decision that was significant because it shifted larger bodies from a lifestyle issue to a medical one, opening the door to insurance coverage for pharmaceutical treatment.
It should surprise no one that Novo Nordisk provided funding for this. They advocated aggressively for insurance coverage for obesity treatment. The primary financial beneficiary of the reclassification was the company funding much of the advocacy for it. This is often how it works.
As an anti-diet dietitian, I want to be direct about where I stand on this: I don’t accept the premise that body size is a disease. The entire classification rests on BMI, which is not a medical tool. It was a population statistics tool that got co-opted by insurance companies, then by medicine.Even the AMA itself has acknowledged that BMI has significant limitations and racist origins, and has warned clinicians to exercise caution in using it.
Yes, there are correlations between body size and certain health conditions. But correlation is not causation, and those correlations cannot be honestly discussed without accounting for the profound health consequences of weight stigma itself, and of the weight cycling that results from decades of dieting. And we should not have this conversation without also looking at how behavior affects health without changing body size. Equating body size with character, discipline, or moral worth is not medicine. It is a very old and very profitable prejudice parading as clinical language.
How Much Harm Is Acceptable?
One question I keep coming back to, although I’m nervous to ask since I know some good is also being done, and I know it can sound alarmist. But when I look at the amount of people who stop taking them, the awful side effects, the lawsuits, the lack of screening, and the metabolic and emotional consequences of regaining the weight (again) I have to ask: how much harm are we collectively willing to accept in pursuit of smaller bodies?
Because based on the evidence, the answer seems to be quite a lot. And I think that answer has everything to do with how deeply we fear and loathe fatness in this country and just cannot accept that it’s just not as big of a problem as we’ve been led to believe.
But I suppose this shouldn’t surprise me. I work with eating disorders and anti-fatness is the leading reason our society is riddled with them. We are afraid to look under the hood. Eating disorders are a harm it seems we’re willing to accept.
Ragen Chastain has written about this with far more depth and clarity than I could. I’d recommend her Weight and Healthcare Substack and her conversation with Dana Sturtevant, Hillary Kinavey, and Sirius Bonner on The Body Trust Podcast.
How To Navigate GLP-1’s Thoughtfully
If you’re already on one of these medications and you’re trying to navigate it thoughtfully, I see you, and I didn’t write this to make you feel like you made the wrong choice. There are two other pieces in this series, one about considering disordered eating and GLP-1s, and the next about how to stay nourished on a GLP-1 like Wygovy or other types. I hope you find them helpful.
If you want to think through any of this with someone who will be honest with you, I made a free 25-minute workshop called Feeling Skeptical About GLP-1s?. It’s my honest clinical take on what the data actually shows, who these medications tend to help, and what I think works better for most people long-term. I’d love to have you there.
And if you’re ready to dig deep and work on your relationship with food, check out my program, Love Food Again.
About Emily
Emily Van Eck, MS, RDN specializes in Intuitive Eating, eating disorders, body image, women’s reproductive health, and healing from years of weight-bias and disordered eating. She helps people find balance, consistency, and peace with their eating habits so they can feel confident to get outta their heads and into their bodies. Emily is a registered dietitian and certified Intuitive Eating counselor with a master’s degree in nutrition science. Read more about her practice, values, and experience here.
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