Weight Loss Wonder Drugs: Are We Now Seeing Their Wider Impact?
The global market for Ozempic, Wegovy and similar drugs is projected to explode during the next five years. Fashion – which has made hard won gains in size inclusivity – is already seeing the impact
Welcome to the Ozempic era. It’s hard to believe it has been only two years since Elon Musk made headlines attributing his startling weight loss to “fasting and Wegovy”, referring to the injectable medication semaglutide.
Other boldfaces now also on the record about using Ozempic and similar drugs include Chelsea Handler, Kathy Bates, Tori Spelling, Rebel Wilson, Amy Schumer, Oprah Winfrey and Boy George. But such has been the uptake of the drugs beyond Hollywood and Silicon Valley, economists have coined the term the “Ozempic Economy”.
In 2023, global sales of branded obesity drugs amounted to US$6 billion. Earlier this year, however, the investment bank Morgan Stanley projected that, by 2030, the market will blow out to at least US$105 billion and as much as US$144 billion – dramatically revising its earlier forecast of US$77 billion.
In many countries, regulatory challenges and supply shortages have limited people’s access to these drugs. But with Ozempic counterparts Wegovy and Saxenda now available as weight-loss treatments for non-diabetic patients – and a 2022 Australian Institute of Health and Welfare report classifying 32 per cent of the adult population as obese – we’re about to feel their impact firsthand.
Ozempic, made by Danish pharmaceutical company Novo Nordisk, was first approved for diabetic patients in 2017 by the American Food and Drug Administration (FDA). Its sister drug Wegovy, containing the same active ingredient (semaglutide) but intended purely for weight loss, came onto the market in 2021. Both work by mimicking a naturally occurring hormone called glucagon-like peptide-1 (GLP-1), which slows down digestion and tells our brains we’re full. A landmark trial involving 1961 adults and published in The New England Journal of Medicine in 2021 showed those using Ozempic lost an average of 14.9 per cent of their body mass over 68 weeks (compared to a mean loss of 2.4 per cent in the placebo group). For a 90kg woman, that’s the equivalent of shedding 13 kilograms – enough to change your clothing size and, more importantly, cut your risk of developing heart disease and some types of cancer.
Watching all this closely is the fashion world, which was notoriously slow to embrace larger sizes, particularly at the luxury end of the market. The late Karl Lagerfeld, for one, offended many with his occasional bursts of fat-shaming commentary. But much has changed since 2009, when Lagerfeld told Germany’s Focus magazine that “no one wants to see curvy women” on the runway. In recent years, not only has there been far greater plus-size representation in clothes available on the high street, we’ve seen the emergence of new players, such as the size-inclusive luxury e-tailer 11 Honoré, as well as a cadre of celebrity curve models including Precious Lee, Paloma Elsesser and Jill Kortleve, who now make regular, if tokenistic, appearances in luxury-brand runway shows.
Alas, there are early signs the Ozempic effect may be reversing some of these gains. Molly Rooyakkers, an Amsterdam-based data analyst, researcher and strategist, who also operates the popular Style Analytics Instagram account, says she’s seen evidence that consumers have been focusing on smaller sizing since 2022. “Retailers’ internal studies indicate an increase in sales of smaller-sized clothing in the US over the past year, a trend also reflected in search data,” says Rooyakkers, “For instance, searches for size 0 jeans at popular youth-focused retailers in the US have risen by eight per cent in the past year.”
According to Rooyakkers, we are also seeing a resurgence in the idolisation of ultra-thin bodies, with fashion aesthetics like “indie sleaze” and “heroin chic” trending on TikTok and Pinterest. Although there is no clear way to show causation, Rooyakkers’ theory is that these trends are linked to the rise in popularity of Ozempic. At the same time, she says, search volume for terms like “plus-size dress” and “plus-sized dress H&M or Zara” have decreased by between 15-43 per cent since 2022, while TikTok videos with the hashtags #bodypositive and #plussize have seen a 23 per cent and 11 per cent decrease, respectively.
According to the Fall 2022 Diversity Report published by web forum The Fashion Spot (TFS), that season featured a record-breaking 103 plus-sized models – or 2.34 per cent of total castings – up from 81 plus-sized models who walked earlier for the spring 2022 shows. TFS has yet to publish a fall 2024 season equivalent, but according to the Vogue Business fall 2024 size-inclusivity report published in March, just 0.8 per cent of the 8800 looks presented across 230 shows and presentations throughout fashion month were plus-size (18+), 3.7 per cent were mid-size (10-16), with the remaining 95.5 per cent “straight” size (4-8).
The retreat of size diversity on runways has become so pronounced that, in September, Belgian designers Ester Manas and Balthazar Delepierre, co-founders and co-creative directors of the size-inclusive Belgian label Ester Manas, named their Spring 2025 Ready-to-Wear collection ‘The Elephant in The Room’. As a show backdrop, they installed a giant elephant sculpture that featured in every runway photo of their size-inclusive cast.
“Everyone should do what they want to do, but when the norm becomes rigged by something quite defined and medical and conforming like Ozempic, for us it’s kind of an issue,” Delepierre told Women’s Wear Daily after the show.
But the shift isn’t limited to runways, says Michaela Wessels, CEO of Style Arcade, a fashion retail analytics software company that works with more than 120 brands and retailers globally, including The Iconic, White Fox and Aje. “What I saw early on within our luxury brands was buyers shifting into smaller sizes,” she explains, “and then you saw high-street brands catching up as well, and sports. But the luxury brands have typically never invested enough into being size inclusive or plus size, so really their market is just getting smaller.”
Michaela continues: “Across the board we’re seeing a 10 per cent shift downwards in every size, but some high-street and fast-fashion brands are seeing a more pronounced shift from average sizes M-XXL into XXS-M. And investment is moving accordingly.”
On top of that, Michaela says they’re seeing demand move out of some plus-sized brands entirely and into more mainstream labels. But why would brands so quickly backtrack after decades of pressure to cater to larger body sizes? Well, says Wessels, not only do brands stand to save money by making smaller garments, but many have struggled to cater their supply chain, marketing and patterns to fit more diverse bodies. For them, easy access to a magic pill that promises to drop people into mainstream sizing comes as a relief to their business model.
Despite well-publicised shortages, in the US, one in eight adults has already tried Ozempic or Wegovy, according to a survey by independent health-polling company KFF in May. And with more than 40 per cent of Americans now classified as obese – a number that’s remained steady over the past decade, according to the latest US National Center for Health Statistics data – there’s still a much larger potential market for semaglutide. Young people, particularly, seem keen to try the drug: between 2020-23, the number of American women aged 18-25 using it increased by 659 per cent, according to a study published in JAMA, with men in the same age bracket not too far behind. Morgan Stanley’s April 2024 Obesity Medication: Ripple Effects report estimates that, by 2035, nine per cent of the US population will be taking weight-loss medication.
Ozempic is now surging in popularity in the Middle East too, as obesity rates are among the highest in the world – with reliance on cars rather than public transport for commutes, and high temperatures that keep people indoors, and a growing appetite for home-delivery fast food. According to the Global Nutrition Report 31 per cent of men and 44 per cent of women in the United Arab Emirates live with obesity, while in Qatar, the figures are about 36 per cent for men and 46 per cent for women. There was a shortage of the drug in 2022, but the introduction of Mounjaro, helped offset demand.
For every person who raves about Ozempic or Wegovy, someone else is bemoaning its side effects. The UAE’s federal system means that rules vary from emirate to emirate. So while in Dubai and Abu Dhabi a prescription is needed to buy, elsewhere it can be purchased over-the-counter, which means there is a lack of doctor supervision. “In some of the large trials out of the US, nearly half the people are experiencing nausea, vomiting, diarrhoea, constipation or tiredness” says Lauren Ball, a professor in community health and wellbeing at the University of Queensland. “The severity of that is not the same for everyone, but that’s a large percentage.”
In September, British model Lottie Moss (half-sister of Kate), used an episode of her Dream On podcast to recount her “horrible” experience with Ozempic, which she acquired from a friend. Calling using the drug the “worst decision” of her life, Lottie said it caused vomiting, seizures and “the scariest [situation she’s] ever had to deal with”. “Do not take it,” she warned. “This should not be a trend right now. Where did body positivity go?”
While the more severe side effects include pancreatitis and bowel obstruction, reports indicate that a lot of people simply can’t get used to injecting themselves weekly or daily – depending on the drug – and the loss of desire for food is a form of misery.
According to an analysis led by US-based Prime Therapeutics and published in the Journal of Managed Care & Specialty Pharmacy in August, on average only one-third of people continue taking GLP-1 drugs one year after starting them. This followed trial-extension research published in Diabetes, Obesity and Metabolism in 2022 that found that, one year after ceasing semaglutide injections, participants regained, on average, two-thirds of the weight they’d lost.
It seems we’re not even close to seeing maximum take-up of these drugs in this region. Furthermore, manufacturers are working on oral versions, which would further reduce the barrier to entry.” On one hand, we can celebrate the drug because we’ve all been crying out for it. Obesity has been a concern for so long for so many people,” says Lauren. “But it’s causing us to rethink our relationship with food and how we, as a society, accept different body types. And that poses a different kind of risk.” Morgan Stanley’s survey cited in Ripple Effect also shows that the number of people who worked out weekly doubled once they started taking GLP-1 drugs, and 26 per cent said they’d bought more athleisure apparel and footwear.
Last year, Wolfgang Puck’s Spago restaurant in Beverly Hills, California said it would shrink portion sizes on request for people taking Ozempic, while other high-profile LA and New York restaurants are reportedly increasing their offerings of smaller tapas plates. In May, Nestlé released a new frozenfood line, Vital Pursuit – high in protein and fibre, relatively low in calories – “intended to be a companion for GLP-1 weight-loss medication users”, the company said. And cosmetic clinics are seeing an uptick in clients requesting filler to combat a gaunt ‘Ozempic face’ caused by rapid weight loss.
Despite alarming stories like Lottie’s, semaglutide, used correctly, can undoubtedly help stave off serious illness. On top of the cardiovascular benefits, a study published in the Journal of the American College of Cardiology in August that tracked more than 17,000 people using semaglutide for an average of three years revealed a reduced risk of death from any cause, including infection and cancer. “[It] has far-reaching benefits beyond what we initially imagined,” journal editor Professor Harlan Krumholz, of the Yale School of Medicine, told The Guardian in September. “It wouldn’t surprise me that improving people’s health this way actually slows down the ageing process.”
If that proves to be the case, the implications for national health budgets are immense. “It really is the Ozempic economy – that’s not hype,” Jessica Couch, founder of North Carolina, US-based fashion and tech consultancy Luxor & Finch, told Bazaar Arabia. And though she’s concerned about how quickly fashion seems to be turning its back on plus-size women, she thinks the resultant backlash could be the shake-up the industry needs to address, finally, its sizing issues. “Women’s body types are still being misunderstood – a numerical size doesn’t actually correlate to a body shape,” says Jessica, who recently launched a peer-to-peer shopping platform – looks.fit – where women can buy clothes that they see on real women with a similar body type to their own. “When we’re requesting smaller sizes, we still want clothes that fit larger hips or shorter or longer torsos.”
Jessica continues: “A lot of people are happy with their bodies. We might all be watching Hollywood get super thin, but I think a lot of these brands may be in for a rude awakening if they think they can go back to ignoring other body types.” Professor Ball similarly doubts that everyone is going to revert to wanting to be a size eight. “I would hope weight-loss medication will become just another tool for us to pursue health and wellbeing in a way that’s meaningful to each of us individually,” she says. “There’s still a limit to what we know about how these drugs are affecting our bodies and our relationship with food. We’re absolutely just seeing the beginning of how this will change our society.”
Lead image credits : Pinterest / @ Bea N.ribeiro