In early 2022 — while most of us were finally putting away our pandemic sourdough recipes and relearning airplane etiquette — GLP-1s became a household name. Well, not GLP-1 specifically, which is short for glucagon-like peptide 1. Not even semaglutide, a GLP-1 receptor agonist that helps lower blood sugar levels by mimicking hormones that regulate appetite.

But suddenly everyone was hearing about Ozempic and Wegovy, two brands of semaglutide used for Type 2 diabetes. Wegovy was approved for weight loss by the Food and Drug Administration in the summer of 2021, which caused a shortage and thus made headlines. Ozempic still has not been approved for weight loss, but it is a common off-label use. (Other brand-name drugs Mounjaro and Zepbound, which contain tirzepatide instead of semaglutide, work similarly.)

Almost immediately came the shame — “Ozempic face” entered our vocabulary, referring to how someone lost weight — and blame for the shortage that adversely affected people who needed the drug for their Type 2 diabetes.

But shame around body size is nothing new — especially with women’s bodies. Yes, the conversations about body positivity are blooming. But the social motivators continue for those seeking a GLP-1 to lose weight, particularly among women.

So, nearly five years in, where are we on the success and stigma of GLP-1s?

The Success

The U.S. obesity rate is decreasing, according to a recent Gallup National Health and Well-Being Index: In 2025, the obesity rate was 37%, compared to the all-time high of 39.9% in 2022. (That’s approximately 7.6 million fewer obese adults.) The same research shows 12.4% of adults in the United States are taking a GLP-1 compared to 5.8% in February 2024 — more than double — with 15.2% usage among women and 9.7% among men.

Bernadette Asias-Dinh, a clinical associate professor at the University of Houston College of Pharmacy, sees the enthusiasm around GLP-1 to be a combination of health outcomes and the value society places on being thin. Asias-Dinh specializes in diabetes and chronic disease state management and serves on the editorial advisory board of the Journal of the American Pharmacists Association.

“If your goal has been to lose weight for a long time and you haven’t been able to, these meds are really effective,” she says. “[People] are seeing results they just haven’t seen despite trying. A lot of patients say, ‘I feel really good’ and ‘I feel much better now.’ There’s a decrease in their weight, less food intake, their sugars have gotten better. I sit with them and look at their labs, their cholesterol, kidney protein levels. Those are big positives people get excited about.”

There are known health benefits that come with weight loss — reduced risk of heart disease and Type 2 diabetes among them. GLP-1s also bring with them the opportunity to streamline medications. Sometimes people can discontinue several medications as their weight decreases and their health stats improve with a GLP-1.

GLP-1-type medications continue to improve with fewer side effects when combined with a glucose-dependent insulinotropic polypeptide (or GIP), like in tirzepatide, and more blood sugar control. In the future, we’re likely to see more long-acting GLP-1s, oral doses replacing injections and studies that show these medications can serve other therapeutic purposes.

“Sometimes people ask for my thoughts on using them for weight loss,” Asias-Dinh says. “If it prevents a heart attack or a stroke, maybe it’s worth it to stay on them long-term. Prevention isn’t always an easy sell, but we could prevent all these other complications.”

The catch? Although nearly 50% of patients stop taking a GLP-1 within a year — the rate is even higher among those who do not have Type 2 diabetes — research shows the benefits last only as long as the medications are taken.

That makes sense to Asias-Dinh.

“Overall, the thing we see with weight loss interventions in general is the weight will come back, especially if you just stop abruptly,” she says.

Samantha Kwan, an associate professor of sociology at UH, points to a 2020 study of popular diets, including Jenny Craig, Atkins and paleo, that found such diets result in “modest weight loss” in the beginning and the benefits largely stop after a year.

GLP-1s are no different. Recent research at the University of Oxford estimates that those who stop the medication return to their baseline weight after 1.7 years.

“Folks who take these drugs aren’t necessarily altering their habits and putting in place the tools to sustain realistic long-term weight loss without them,” Kwan says. “Weight loss isn’t just about nutritional changes and changes in physical activity. It’s influenced by many things, including sleep patterns and hydration, genetics, medications, stress, one’s support system, and a healthy mindset toward food and exercise.”

And that, she says, highlights what’s missing from the mainstream public health discussion on the topic right now: “the need for more comprehensive approaches to weight management that include tools and resources to sustain long-term lifestyle changes that prioritize both physical and mental well-being.”

The Stigma

When GLP-1s came on the scene, many health experts hoped they were seeing the beginning of the end of weight stigma, that eventually people would see weight loss drugs more like cholesterol or blood pressure medications — just something some people need and may stay on for the rest of their lives.

As a society, we aren’t there yet, it seems.

Asias-Dinh has many patients who have worked hard and consistently with exercise and diet and aren’t getting the results they want. She points out the physiology behind body size and food cravings, likening it to smoking.

“A lot of food can be addictive,” she says. “It’s made to be addictive. That’s why I feel for those who have tried and are having a hard time. It’s in our food supply.”

Still, she hears healthcare providers continue to offer the “just-exercise-and-diet” advice.

“A lot of people are really helped [by GLP-1s]. Then they can exercise more because they’ve lost the weight,” Asias-Dinh says. “GLP-1s have opened people’s eyes about being overweight, that it’s not about people just being lazy.”

Kwan agrees but says the societal stigma of being overweight persists, despite the lessons offered by weight loss drugs. She says it comes down to a deeply ingrained societal belief that managing weight is a matter of willpower.

Kwan covers this topic in her latest book, “Under the Knife: Cosmetic Surgery, Boundary Work, and the Pursuit of the Natural Fake.” “The assumption is that you’re too lazy and lacking in restraint to adopt better lifestyle habits. This is why cosmetic surgery patients who undergo procedures including fat removal often insist that they’re ‘good patients’ who did everything they could first before going under the knife. They exercised and dieted extensively but still couldn’t get the results they wanted.

“It’s [considered] a sign of laziness, lack of moral fortitude, lack of discipline, lack of self-care. For this reason, some people think the negative treatment of overweight people is justifiable — from judgmental looks to overt words and actions.”

Since the introduction of GLP-1s as a weight loss tool, in addition to judgment about being overweight, there’s now judgment about taking the medications and judgment for not taking them. If weight is considered controllable, then blame can be assigned for not controlling it.

In other words, while there is a stigma attached to being overweight and to taking weight loss drugs, there is a stigma around not taking them now that they’re available. GLP-1s and other weight loss drugs, as well as cosmetic surgeries, can be viewed as cheating, yet they’re also viewed as an option overweight people should take advantage of.

So many factors affect weight management, including access to exercise, access to healthy foods, knowledge about losing weight and maintaining a healthy lifestyle. And that list now includes expensive GLP-1 drugs.

“All of these things impact a person’s ability to embody health and beauty ideals,” Kwan says. “The conversation needs to include tools and resources for sustaining realistic, long-term lifestyle changes. That [conversation] should prioritize a more comprehensive understanding of weight gain that considers not only personal agency but also how biology, social structures and cultural forces shape our agency.”

The Stigma Amplified for Women

Kwan specializes in how cultural meanings of bodies and health are socially constructed — including how society equates body size with morality, identity and worth.

She shares two key reasons the pressure to lose weight is often still specific to gender. First, the idea of female beauty is “pervasive and narrow,” she says.

“While there are subcultural ideals and diverse images circulating, it’s mostly a thin, toned and youthful look. There’s not a lot of wiggle room. In contrast, although the masculine ideal is also toned and athletic, there’s some flexibility. Even overweight, older men can be framed positively as ‘big’ and ‘strong.’”

Second, a woman’s looks are closely tied to how society values her.

“Women are sometimes judged more on how they look than, say, their credentials, competence and intelligence. And women know this. They are culturally savvy. Women not only want to avoid the accusations of lacking discipline and self-care. They know the way they look can be tied to their successes — on dating markets or in the workplace — as well as their self-esteem and confidence.”

So, society has something to say about (mostly) women’s bodies. And society has something to say about (mostly) women trying to make those bodies smaller. One more: Society has something to say about how long they take these meds.

Just like being overweight indicates, in society’s mind, a lack of willpower, so does the discussion around GLP-1s as a long-term solution, Kwan says.

“Again, society says there’s a right and wrong way to lose weight. As a nation, we’re generally not very forgiving of addiction and dependence — whether it’s fentanyl, alcohol or weight loss medication. We’re supposed to have willpower.

“Despite the body positivity, body neutrality and related movements, there’s still pressure for people — especially women — to conform to hegemonic beauty ideals,” Kwan says. “There’s moral judgment that comes with being overweight. This stems from public sentiment that people can control weight — unlike, say, race or age. While we generally agree that judging someone on race or age is discriminatory, weight-based judgement is different. Because weight is assumed to be controllable, a person is supposedly blameworthy for being overweight.”