The summer of 2022 marked a watershed in the life of 34-year-old "Sarah" who worked at a large firm in Michigan in the United States. That was when her career really took off. She was given more responsibility (taking charge of three departments ), was included in important meetings, and even got a 25 per cent pay rise.
To what did the young marketing executive owe her newfound success? What made her workplace superiors suddenly take notice of her and deem her a winner? Had she obtained additional qualifications, did she exhibit increased drive and determination, or demonstrate better decision-making?
It was none of those things. What had made her a gold-star player in the eyes of her managers and increased her value in the company was that she looked different. She had lost five stone because of taking Ozempic, the diabetes medication hailed as a "wonder drug" for its weight-loss benefits, for the previous six months. Her dramatic weight loss had changed the trajectory of her career and her status in the company. Interestingly, its positive effect extended to her personal life, too.
Men began to open doors for her, clients and competitors lingered to talk to her, and even her loving, but somewhat absent father, showed new interest in her.
She found this star treatment exciting but depressing. Dropping 70 pounds had lifted some kind of "invisible cloak" that had obscured her and her talents, says Galway woman, Aimee Donnellan, who interviewed Sarah for her newly published book Off the Scales - the Inside Story of Ozempic and the Race to Cure Obesity.
"She was being seen, she was being heard, and she could see that in the eyes of her colleagues, friends, and family. She was now worth their time," explains Aimee.
Sarah, a former yo-yo dieter, had been told about the weight loss injection by a nurse practitioner. There were "astounding" results from drug trials with users shedding an average of 15 per cent of their body weight. That was all Sarah needed to hear.
Opened new doors
Losing weight opened new doors for her. She no longer hid in plus-size clothing, she now went on shopping sprees, and took part in a marathon. Her health and life changed for the better.
However, Ms Donnellan, who writes with empathy and sensitivity about her interviewees' struggles and the often harsh criticism and cruelty overweight people are subjected to, says Sarah feels her sudden good fortune is an indictment of society's view on weight.
"Her two Master's degrees, her ideas and innovations that generated sales for her company and her relentless approach to her job seem to matter less than her size. She remembers her invisibility in a larger body. She often thought of herself as a painfully shy introvert who struggled to connect with people. But now she believes that the reason she couldn't connect with people is because they didn't want to connect with her."
Her story will resonate with many who are struggling with obesity, says the book's author. "The disease often begins in early childhood and this is typically when diet and exercise are introduced as a blanket treatment. They rarely work and these people spend their lives berating themselves for not making better choices, for being weak willed, and for wondering why their friends and family members are able to control their weight."
Sarah had been referred to a dietician when she was seven-years-old. She was told her portion sizes were too big and was advised to count her Cheerios! Aimee says the little girl realised two things that day - which unfortunately would remain with her for life - that she was "big, and that big was bad".
Ms Donnellan says while obesity tended, especially in the past, to be considered an American phenomenon, rates of the condition were increasing throughout Europe, Australia, South Korea, parts of North Africa, and Saudi Arabia, as well as South America, by the late 1980s and 1990s. "In these places, cheap, unhealthy food gained popularity, particularly in economically depressed areas."
Experts attributed rising obesity figures to many factors, she says, busy and sedentary lifestyles, a growing appetite for takeaways, and less home cooking. "In 1990, rates of obesity in most European countries were less than 10 per cent. By 2022, in countries like the UK and Ireland, over a quarter of their populations were living with the disease." More than one billion people worldwide are obese, according to an Irish Medical Times report in 2024.
Little public sympathy
Overweight people received little "public sympathy" in the 1990s and 2000s, according to Ms Donnellan, who is from Knocknacarra and is a columnist with Reuters. Television personalities sometimes demeaned celebrities by commenting on their weight. The condition was often treated as a spectacle, spawning reality weight loss television shows. "Having failed to reckon with obesity as a medical condition, society began to use it as a source of cheap amusement."
Meanwhile, people continued to struggle with their weight, often blaming lack of willpower and insufficient activity for their lack of success. Aimee says the "calories in, calories out" mantra from doctors and slimming clubs did not tell the whole story.
There are many genetic and environmental factors which make some people more prone to weight gain than others. "Scientists estimate there are hundreds of genes that predispose certain people to obesity. In 2019, British researchers studied people who were thin all their lives to understand the mechanisms controlling their weight. They identified a gene, MC4R, which, if activated, shuts off the desire for more food quickly. People with this genetic make-up are less likely to have to deal with weight issues."
Psychological factors and trauma can also make people more susceptible to weight problems, she says. Major life events, such as divorce or death, can set off weight gain. Swedish research estimates that severe childhood abuse can increase the chances of developing adult obesity by almost 50 per cent.
Despite greater awareness of obesity causes, there is limited knowledge of the specific struggles people with the condition experience, she says. Some say "food noise" dominates their lives. They constantly think about what they can eat and rarely feel full.
While obesity levels continued to climb over the years, especially in the US, the issue attracted less airtime or attention than conditions such as cancer or heart disease. "There was always something more urgent to tackle. Obesity was a stealthy, slow-burning disease. Its deadly offshoots like diabetes, heart disease, and stroke took decades to surface. Experts say obesity may not appear on a death certificate but it is responsible for hundreds of other deadly conditions."
Weight loss benefits
Ozempic, a once-weekly injection for adults with type 2 diabetes, emerged onto the US market in January 2018 and was sold in Asia and Europe later that year. But it was when news spread about its weight loss benefits that people really began to sit up and take notice. A catchy TV commercial released in the summer of 2018 by its makers, the Danish pharmaceutical company Novo Nordisk, which listed weight loss as a side effect among other health benefits, captured international attention. By 2020, it had been launched in 52 countries. Celebrity endorsements fed the social media frenzy about the jab, sending public demand soaring.
"It's little wonder that a magic drug that promised quick, dramatic, and long-lasting weight loss - even if it wasn't totally clear why exactly it was working so well - immediately became so enticing to some many," says Aimee Donnellan. "There is no doubt that Ozempic, and its followers like Wegovy and Mountjaro, were dramatically improving people's lives. But they were not cure-alls."
And not everyone can afford them. "You need at least €200 a month to pay for these drugs. And if you stop taking them, the weight can pile back on again. People think, I'll take them for a year and I'll take up healthy eating while I'm on them. But when you are off them, the cravings for junk food can go right back."
Some users report side effects such as nausea, vomiting, diarrhoea, constipation, and abdominal pain. However, they often persevere with the medication in the hope that their bodies will become accustomed to it and because the pay-off in terms of weight loss is so great.
"Doctors have come a long way since Ozempic was first launched. Many are now insisting that patients embark on weight training programmes and significantly increase their protein intake to counteract the loss of muscle mass. Others are keeping patients on the lowest dose of the drugs to help them adjust to the side effects which often ease within a month of the first injection. But they had to learn on the job as the launch of GLP-1 drugs [such as Ozempic] has been a rapid and unprecedented healthcare experiment."
But not everyone is singing the praises of these medications. She says that some critics and supporters of the body positivity movement view Ozempic and its generation of drugs as a "curse on society". But the Novo Nordisk scientist behind Ozempic, Lotte Knudsen, and indeed other scientists, say obesity medications will transform healthcare. "They say obesity medication will reset the world, which was eating itself to death."
Writing the book brought home to Aimee the real struggles that overweight people face - the hurt, the rejection, the lack of understanding. And the fear, too. "You get situations where people are battling their weight for ages but they are not able to tell people they are on it [Ozempic]. It is almost like they are doing something else wrong. Lots of people I spoke to for the book didn't want their mom or dad to know.
"I knew this topic was very sensitive but I didn't fully understand how sensitive people were. They feel they are being judged all the time, they are experiencing stigma. I hope that changes."
Aimee, a mother of two, a four and a six-year-old, began writing her book in 2023. She says the generosity of family and friends made it possible to get time to do it. She is delighted with its success and says sadly, her late father, Pat Donnellan, was not here to see its publication. He passed away in February 2018. "He had motor neurone disease but he would have gotten a great kick out of the book."
"Off The Scales - the Inside Story of Ozempic and the Race to Cure Obesity" by Aimee Donnellan is available from local bookshops.
