By Liz Colombini
Artwork by Eliyahu Greenwald
The rumors began in 2021. Celebrities were shedding pounds by using a magical elixir. By the 2022 awards season, the secret was out: stars were taking the diabetes medication Ozempic to lose weight quickly and successfully. Mainstream America took note, and the trend caught on so quickly that people with diabetes suddenly faced a shortage and were forced to switch to less effective and more expensive alternatives not always covered by insurance. But today, the market is flooded with GLP-1 (glucagon‑like peptide‑1) agonist medications, including Ozempic, Wegovy, Mounjaro and Zepbound, and it has become one of the most talked-about pharmaceutical developments in years.
Yet behind the headlines, the social media ads and the before-and-after photos, there is a more complicated story about how these drugs work, who they are meant for and what happens when they are used without proper medical oversight. For patients navigating this landscape, local endocrinologists agree on one thing: these medications are powerful tools that require serious and ongoing medical supervision to be used safely. So before you speak to your doctor or go the DIY route and order that GLP-1 patch or pill online, here’s what you need to know.
The science…and the question marks
GLP-1 medications were originally FDA approved in 2005 to help people with type 2 diabetes better manage their blood sugar, and today, they are commonly prescribed as a daily or weekly injection. They are what’s called receptor agonists, which, in this case, means they are medicines that bind themselves to our body’s naturally occurring GLP-1 hormone (which we produce in our intestines after eating). This action causes your pancreas to release more insulin (it’s how your body turns the food you eat into energy) while also lowering the amount of glucose (sugar) in your blood. Because these medications only stimulate insulin when your sugar is high, they don’t carry the same risk of causing dangerously low blood sugars like older diabetes medications do.
GLP-1 medications earned a reputation for weight loss because, as they prompt your body to release insulin, they also slow gastric emptying (a.k.a. digestion), helping you feel full longer. While these medications have the same effect in people who are not diabetic, experts caution that you shouldn’t rely on them alone to experience weight loss. “These drugs work best when people exercise and change their diet as well,” says Dr. Eric Rudin, an endocrinologist who has practiced in the area for more than two decades and is now with White Plains Hospital Physician Associates’ Scarsdale Medical Group. “Semaglutide (the synthetic peptide) is the generic name for both medications. When it is used for diabetes, it’s called Ozempic; when it is used for weight loss, it’s called Wegovy, but they are the same medication.”
In May 2022 and November 2023, Eli Lilly and Company earned FDA approval for two tirzepatide medicines very similar to GLP-1s called Mounjaro and Zepbound. Instead of only targeting the GLP-1 hormone (like Ozempic and Wegovy do), tirzepatides are dual-action drugs that activate both GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptors, which may contribute to their effectiveness in regulating appetite and metabolism. Mounjaro was designed to improve glycemic control in adults with type 2 diabetes mellitus (caused by high glucose), while Zepbound was designed for adults diagnosed with obesity or those who are overweight and have at least one additional weight-related condition.
“The differences between these medications always cause confusion with my patients,” notes Rudin, who has prescribed GLP-1 medications for nearly 20 years. Rudin notes that this dual‑hormone effect is likely why tirzepatide is, on average, more effective and, in some patients, may be slightly better tolerated. “I expect that future medications may have other hormones as well.”
Beyond that, researchers are still learning exactly how these medications impact and benefit the brain and the body. “The brain seems to be the key,” Rudin says. “There is a lot of research directed at the complicated relationship between GLP-1 medications and multiple areas of the brain.” That brain connection may also explain why these drugs appear to help with more than weight loss—for example, researchers are learning they can improve addiction-like behaviors as well as mood and cognition. Ongoing research has also pointed to the medications’ benefits for various organs, finding they can help treat cardiovascular disease, sleep apnea, kidney disease, fatty liver disease, and systemic inflammation.
In March 2024, Wegovy received FDA approval for reducing the risk of heart attack, stroke and cardiovascular death in adults with established heart disease who have obesity or are overweight—a significant milestone that has expanded insurance coverage to a broader group of patients. Since then, additional approvals for GLP-1 medications have followed for sleep apnea, kidney disease and fatty liver disease, and various trials are in the works to determine these medications’ ability to treat other conditions.
Are they right for you?
In addition to diabetics, medical guidelines generally support prescribing GLP-1 medications to patients with a BMI of 30 or higher, or 27 or higher or if they also have conditions like type 2 diabetes, heart disease or high cholesterol. Rudin says he follows those parameters closely. “I won’t treat anybody with a BMI under 25. I don’t feel good about that.” According to a 2025 report from the National Center for Health Statistics, 26.5 percent of adults with diagnosed type 2 diabetes used GLP-1 injectables in 2024, with usage highest among those with obesity (32.4 percent), compared with those at a healthy weight (16.7 percent).
Dr. Delia Stefan, director of endocrinology at Northwell’s Phelps Hospital, echoes the same caution about appropriate candidacy. “I will not use it for somebody who wants to lose four or five pounds,” she says. “It’s really for somebody who has to lose over 30 or 40 pounds. These medicines come with possible side effects, and a specialist needs to monitor patients carefully.”
Additionally, the doctors we interviewed say that certain people should not take these drugs at all. Specifically, people with a family history of medullary thyroid cancer or a personal history of pancreatitis should avoid GLP-1 medications, as they could cause significant harm leading to tumor growth and can trigger or aggravate pancreatic inflammation in susceptible patients.
There are also groups for whom caution is essential. GLP-1 medications are not currently used in pregnant or breastfeeding women. “There is not enough information about safety [for that population] yet,” Rudin explains. For patients with gastrointestinal conditions like colitis, the picture is more complicated. While some patients report improvement in inflammatory symptoms, the drugs can also cause GI side effects that may worsen pre-existing conditions. Rudin says a careful GI history is critical before prescribing so physicians can “understand how side effects may uniquely affect a population.”
As for whether there is a weight limit, “there is not a BMI ceiling for GLP-1s,” Rudin confirms. For non-diabetic patients, any licensed physician can prescribe GLP-1 medications, but Rudin stresses that doing so properly requires more than writing a prescription. Most patients under appropriate care should receive a basic exam and lab work, including diabetes screening in many cases, and their doctor should take a detailed history, inquiring about a personal history of pancreatitis, GI issues, and diet, as well as a family history of thyroid cancer, before starting treatment. “We are all obligated to prescribe this medication responsibly,” Rudin notes.
The fine print
A lot of the media coverage of GLP-1 side effects has focused on the scariest outcomes, including blindness, pancreatitis and thyroid tumors. But for most patients who take these medications responsibly, the day-to-day reality is far more mundane and manageable.
“The real side effects I’ve seen are gastrointestinal,” Rudin says. “Some are so bad that they make it hard for certain people to even be on the medications.”Nausea, vomiting, diarrhea, constipation and belly pain are the most frequently reported complaints, and they tend to worsen each time the dosage is increased.
The reason for these symptoms comes down to how the drugs work in the body. GLP-1 medications slow gastric emptying and alter gut motility (the automatic movement of muscles in the GI tract). While this process is central to the medication’s appetite-suppressing effect, it’s also what triggers the nausea, cramping and other digestive complaints so many patients experience.
Dr. Mitchell Roslin, chief of bariatric and metabolic surgery at Lenox Hill and Northern Westchester hospitals, notes that these side effects are largely manageable when dosing is handled carefully. “Gastrointestinal side effects are common but largely dose-dependent,” he says. “Therapy should focus on reducing ‘food noise’ rather than on maximizing weight loss. The standard approach to managing and preventing GI side effects is to start the medication at a low dose and titrate up slowly, increasing the dose every four weeks if the patient is tolerating it well. “There is no biologically mandated target dose,” Roslin says. “When you continue increasing the dose, which is being done a lot with these medications, it increases the odds that patients will become resistant or tolerant and experience side effects. The rush to achieve weight loss and overcome a weight loss plateau is increasing the risk of side effects. So increases must be done judiciously, and the lowest effective dose should be used.”
The vision concerns that circulate online are real but frequently misunderstood. Blindness has occurred primarily in diabetic patients who experienced very rapid blood sugar normalization. “It’s the variation in the sugar,” Stefan explains. “If it’s too fast, one of the side effects is blindness.” That risk is managed by avoiding aggressive dose escalation in patients with very high baseline blood sugar levels. Our experts say this side effect doesn’t occur in a nondiabetic person taking the drug for weight loss.
The kidney concerns require context. Dehydration from persistent vomiting or inadequate fluid intake can lead to renal problems, but Roslin pushes back on the idea that GLP-1 medications directly cause kidney failure. “These medications are not intrinsically nephrotoxic (causing rapid kidney deterioration),” he says. Roslin explains that when renal issues occur, they are typically driven by secondary effects, such as reduced oral intake, nausea, vomiting and eating less food. Roslin notes that many patients starting GLP-1 therapy already have years of poorly controlled diabetes or hypertension and that observed kidney decline could also represent natural disease progression.
When caught early, the damage is generally reversible. The condition, says Roslin, is called prerenal azotemia—an acute kidney injury typically caused by dehydration rather than structural damage. With proper rehydration, dose adjustment and monitoring, kidney function can usually recover without dialysis or a transplant. Clinical trial data also show that GLP-1 receptor agonists reduce symptoms and slow diabetic kidney disease, suggesting earlier use should prevent, not cause, renal failure.
Recently, Novo Nordisk came under scrutiny. In March 2026, the FDA issued a warning letter citing the company for repeatedly failing to investigate and promptly report serious adverse events tied to its GLP-1 drugs (Ozempic and Wegovy), including strokes, suicidal ideation and patient deaths. Federal inspectors found that Novo Nordisk’s internal policies allowed call-center operators to dismiss side effect reports and skip required follow-ups, prompting the FDA to raise concerns about systemic failures in the company’s safety surveillance. It was the third FDA warning letter Novo Nordisk received in six months. Meanwhile, more than 5,000 patients have filed lawsuits against Novo Nordisk and Eli Lilly, alleging that the companies failed to adequately warn of serious risks, including blindness, neurological disorders and intestinal blockages. As of deadline, these medicines remain FDA‑approved and on the U.S. market while the agency requires Novo to implement more robust safety monitoring and reporting systems. “This news is disappointing to hear,” says Rudin. “The timely reporting of adverse effects is essential so the FDA can promptly determine whether the effects were related to the medication and ensure patient safety.”
Yes, “Ozempic face” is a real thing, but you can prevent it
The phenomenon of “Ozempic face”—a gaunt, prematurely aged appearance that some users develop—receives significant attention, thanks to celebrities like Sharon Osbourne, Meghan Trainor and Rebel Wilson, who have spoken publicly about using GLP-1s and this side effect. Physicians attribute Ozempic face to rapid, muscle-wasting weight loss driven by patients who treat the medication as a passive solution rather than something that complements a lifestyle change. “They think they can take this magic shot, eat whatever they want, skip the gym and the weight will just come off,” Stefan explains. But in addition to losing fat, “they’re also losing muscle, and that’s when they start to look sick.”
The fix is straightforward and requires active effort. Patients who exercise regularly, eat adequate protein and take a daily multivitamin can lose significant amounts of fat while preserving muscle. Stefan says she has patients who have lost 70 pounds and “look amazing” because they went to the gym three times a week and paid attention to their nutrition. “It is preventable, but you need to do it properly,” she says.
When the body loses weight rapidly without resistance training, it breaks down muscle along with fat. In the face, that loss of volume creates the gaunt, hollow look commonly called Ozempic face. Strength training tells the body to hold on to lean mass, while adequate protein provides the building blocks for muscle repair. Without that combination, patients also risk weaker bones, as muscle loss and reduced caloric intake can accelerate declines in bone density.
Roslin stresses that the composition of weight loss matters just as much as the number on the scale. “Up to approximately 40 percent of weight loss associated with GLP-1 therapy may be lean mass, including muscle,” he explains. As previously mentioned, that loss can be mitigated with adequate protein intake, resistance exercise and monitoring your body composition through tools such as a bone density X-ray. “Being thinner is not synonymous with being healthier,” he adds.
Here’s the part that nobody tells you
Perhaps the most consequential issue with GLP-1 drugs isn’t being shared in ads: the data shows most of the weight loss reverses when patients stop taking them. In a 2022 study of almost 2,000 adults, which is one of the most cited studies on semaglutide (the synthetic peptide/generic name for GLP-1 medications), participants who stopped the drug regained two-thirds of the weight they had lost within a year. And a 2026 meta-analysis published in the British Medical Journal found that patients who stopped taking semaglutide or tirzepatide medications regained an average of 22 pounds in the first year and were projected to return to their starting weight within 18 months. For those who stopped, regaining the weight was not just a possibility; it was the norm. “Once you lose the weight, to maintain it, you have to take the medicines for the rest of your life,” Stefan says plainly. “It’s a chronic disease, and it needs chronic therapy.”
When speaking to his patients, Rudin says he frames GLP-1 use the same way he explains blood pressure medication: the drug is managing a condition, not curing it. When the medication stops, the condition and the weight tend to return. Obesity is now widely treated as a chronic disease in clinical settings, a shift our experts see as overdue. “Obesity is an epidemic,” says Rudin. “People, including physicians, are beginning to understand that we need to treat obesity as a chronic disease and not a failure of willpower.”
Oprah Winfrey’s experience illustrates that point. In December 2025, she told People magazine that she quit her weekly GLP-1 injections on her 70th birthday in January 2024, roughly six months after starting them, to prove she could maintain her weight on her own. Despite sticking to her diet and exercise routine, she gained 20 pounds over the following year. “It’s going to be a lifetime thing,” she was quoted saying. “I’m on high blood pressure medication, and if I go off the high blood pressure medication, my blood pressure is going to go up. The same thing is true now, I realize, with these medications. I’ve proven to myself I need it.”
The online & telehealth problem
These days, GLP-1s are everywhere, including online (without a prescription) and through telehealth services. Despite inadequate medical monitoring (or any in some cases), this segment of the market has grown rapidly. According to a February 2026 report from J.P. Morgan, it’s estimated that around 30 million Americans will be treated with a GLP-1 medication in 2030. That’s an increase, they say, from 10 million people taking branded GLP-1s right now. This trend concerns the doctors interviewed for this article.
Stefan is direct about the risks of unsupervised use. Patients who purchase these medications online often have no way of knowing whether they are getting the real thing. When branded versions like Ozempic and Wegovy were scarce, compounded semaglutides flooded the market. The FDA has issued multiple warnings about these compounded products, citing reports of severe adverse events including, nausea, vomiting, dehydration, acute pancreatitis and dosing errors that led to patients injecting up to 20 times the intended dose, sometimes requiring hospitalization. Novo Nordisk has filed more than 130 lawsuits across 40 states against compounding pharmacies, telehealth companies and weight-loss clinics, arguing that these entities are selling unauthorized, non-FDA-approved copies of its patented medications and putting patients at risk.
Without a specialist monitoring dose escalation, blood work, hydration and nutrition, patients can run into serious problems. “It’s a dangerous medicine if it’s not administered properly and if the patient is not monitored properly,” Stefan says. “Seeing your primary care physician is sometimes not enough.” And because these physicians are often overwhelmed, Stefan says they might not have the time to provide the close monitoring that GLP-1s require. So, she recommends patients on GLP-1s also see a weight loss specialist and a nutritionist.
Rudin is more optimistic about how the medical community has handled the rollout, noting that online pharmacies and primary care physicians are generally asking the right questions. But the doctors we interviewed for this article agree on one point: patients who are self-dosing or escalating aggressively without guidance are putting themselves at risk. If you’re in that position, Rudin’s advice is simple: don’t panic, but don’t continue without oversight either. “Make an appointment with your healthcare provider and discuss specifics,” he says. “Healthcare providers are understanding people. We are all here to help.”
The great unknown
Perhaps the most striking thing an expert said during interviews for this article was also the least reassuring: nobody knows what three or four decades of GLP-1 use looks like. “What I get nervous about is that we’re introducing this medication to healthy, not overweight people, and so many people are on these drugs,” Rudin explains. “What don’t we know? What’s going to come up in five or 10 years?” His concern isn’t limited to any one age group. It’s that there is no easy off-ramp with these medications, and the longer someone is on them, the more the unknowns can accumulate. “I think the benefits of these drugs seem to outweigh the long-term risks,” he says. “We just need to be vigilant in our commitment to continue to learn more about the good and the bad.”
He is careful to note that the risk-benefit calculation looks very different for patients managing serious obesity or diabetes than it does for someone who wants to lose 15 pounds before a vacation. The drugs have nearly 20 years of safety data in diabetic populations. But the data on long-term use in otherwise healthy patients who are overweight but not clinically obese (which is defined as a BMI under 30) is newer and still accumulating. “We’re calling this condition a chronic disease,” Rudin notes. “And that means we’re going to treat people forever with this medication.”
The research pipeline is ongoing. There are two oral versions of semaglutide available (one is only for adults with diabetes); they are less effective than the injection but a meaningful option for patients with needle anxiety. Researchers are studying new formulations and dosing strategies, including injections every two to four weeks to reduce side effects. The field is moving quickly. The shot alone is only part of the story.
If you believe GLP-1s are right for you, our experts’ advice is clear: find a physician who will do a thorough intake, evaluate whether you’re a candidate for long-term treatment, monitor your labs and your weight, adjust your dose carefully, and stay with you for the long haul. These drugs are powerful, but only when the patient’s work is, too.
Julie Schwietert Collazo edited and fact-checked this article. The artist used Blender to create and render his art.
This article was published in the May/June 2026 edition of Connect to Northern Westchester.
