When Karen Vasquez turned 50 in December of 2021, she wanted to throw herself a party. The covid vaccine was widely available and people were starting to gather again. But one worry kept giving her pause: She’d put on weight during the pandemic and was self-conscious about being in photos. In fact, she always had been. “I realized that every significant milestone in my life had always been clouded by the subtext of do I look fat?” says the Arlington resident and marketing consultant.
Tired of hiding from mirrors and cameras, Vasquez joined a fitness studio, took up Pilates, cut out alcohol and drastically reduced her caloric intake. A month later, she stepped on the scale and was crestfallen. “I’d worked so hard, and I lost three pounds. Three—out of a goal of 60,” she recalls. “I was heavier than I’d ever been.”
She decided to ask her doctor about GLP-1s. “My insurance wouldn’t cover a prescription, so I bit the bullet and paid out of pocket,” she says. “It was life changing.”
Almost immediately, the “food noise” in her head quieted and she was able to cut calories with less effort. Her desire to drink subsided. She began sleeping better and feeling more energetic. As the pounds melted away, her joints were less stressed, making it easier to be active. Losing weight was no longer a Sisyphean struggle; it was a new way of living that felt tenable. Within 18 months, she’d hit her goal weight.
Slimming down wasn’t the only upside. Vasquez believes that by being more active, she may have sidestepped some of the health problems that accompany excess weight in middle age. Studies suggest GLP-1s may lower risks associated with heart disease, sleep apnea, Type-2 diabetes and other chronic conditions.
But the biggest relief for Vasquez was a quieter mind. “I used to start each morning thinking about exactly what I was going to eat and when I was going to work out,” she says. “I ended every day berating myself for every little thing I could have done differently. When I restricted calories, the food noise would get louder and I’d feel deprived. That led to a boomerang effect on my eating that would take up even more space in my brain.”
The conversation was like a scrolling tickertape in her head. “Engaging the conscious part of my brain to tell myself no required constant vigilance,” she says. “And when you’re tired or feeling sad—or you’ve had a day, or you’re stressed, or your hormones are out of whack? The food noise wins.” With GLP-1s, it stopped.
Medications containing glucagon-like peptide-1 agonists—known as GLP-1s—have been available for two decades. Exenatide was the first GLP-1, prescribed under the brand name Byetta, in 2005, to treat Type-2 diabetes. Now the handful of FDA-approved formulations on the market includes semaglutides (sold under the brand names Ozempic and Wegovy) and the slightly newer tirzepatides (Mounjaro, Zepbound) which, in addition to a GLP-1, contain a glucose-dependent insulinotropic peptide hormone, or GIP, to support weight loss.
GLP-1s work by mimicking naturally occurring hormones that slow digestion, increase satiety, reduce blood sugar and decrease insulin resistance (and therefore inflammation). Evidence of their meteoric rise is everywhere—in friends, family members, neighbors and co-workers who are literally shrinking before our eyes.
“I’ve been prescribing these drugs for seven years,” says Arshad Ali, director of obesity medicine at VHC Health’s bariatric and metabolic health center. “All of a sudden, it went from me trying to convince patients that [a GLP-1] would be beneficial for them to patients coming in asking for this treatment.”
In 2022, 40% of American adults met the definition of obese, with a body mass index of 30 or higher, according to Gallup research. By 2025, that number had fallen to 37%.
One in five American adults has tried a GLP-1 drug, according to a November 2025 Kaiser Family Foundation health tracking poll. GLP-1s are reshaping not just our bodies, but how many of us eat, spend, play and socialize.
“It’s not just a weight loss medication,” says Meetal Mehta, a bariatric medicine specialist at Inova Health. “It’s a tool [for healthier living]. Other conditions can be improved, too. Lower blood pressure and cholesterol, less pressure on joints, even reduced risk of heart attack.”
Add to that list addictive tendencies. Many patients report that their desire for alcohol and other substances diminishes or disappears on GLP-1s.
That’s what happened to Michael Barrett when he started taking a semaglutide for weight loss. It allowed him to finally quit smoking.
“For years, I’d tried to quit. Gum, patches, vaping, the step-down method, being hypnotized—nothing worked,” says Barrett, 46, a senior stylist at Arlington’s Smitten salon. “Now, I don’t even want one cigarette.”
Currently on a tirzepatide, he’s shed 50 pounds from his 6-foot-2 frame.
His sweet tooth went away, too. “Before, I was constantly thinking about what I could find that was sweet within arm’s reach. If there was a tray of cookies in the back of the salon, I’d have one in each hand and another in my mouth,” he laughs.
Once he decided to get serious about losing weight, however, willpower wasn’t the problem. “For five months [before I started GLP-1s] I’d been consistently hitting the gym, food journaling, meeting my calorie goals, and the needle wasn’t moving,” he says.
Barrett speaks candidly about his experience and isn’t embarrassed to tell people he’s taking GLP-1s. He wants to dispel the notion that people who use them are too lazy to exercise, that they lack self-control, that taking the drug is somehow a form of “cheating.”
He’s exasperated by folks who hide their GLP-1 use, attributing their weight loss to clean eating and portion control alone. He says it perpetuates a false narrative. But at the same time, he gets it.
“It’s almost like the new fat-shaming,” he says. “First, society judged people for being heavy. Now we have to worry about shaming people who are taking a GLP-1?”
For Nicole, who asked not to use her real name, the stigma felt overwhelming. “Three years ago, I went on Ozempic and lost 30 or 40 pounds over a period of nine months,” says the Arlington resident, now 58. “But then I freaked out about safety concerns and buckled to pressure from people who were judging me for not trying harder to lose the weight on my own—as if there’s some virtuousness of doing it without medication. So I went off of it. And guess what? I gained all the weight back.”
Nicole returned to GLP-1s, this time Zepbound, and slowly lost the weight she’d put back on. She still gets negative feedback from a sister who thinks she should be able to manage her health without medication.
“She’s been very judgy,” Nicole says. “She’s trying to lose weight and has been doing it with [an app that helps her track her diet]. I feel like she thinks I’m cheating—like I’m not doing it the right way.”
Losing weight is seldom as simple as just eating less, says Seba Ramhmdani, an internist with Privia Health in Falls Church. “Being overweight is a multifactorial disease. It’s not just from overeating. It’s hormonal. It’s ingrained in the way you were raised to look at food, whether as a way to manage stress or [with the expectation to] to finish what’s on your plate.”
As one Zepbound user put it, “Telling someone not to eat the food they’re craving is like telling a person who has depression not to be depressed.”
Even the most vigilant dieters won’t accurately track the calories they consume in a day, says Ali of VHC Health. He points to a study conducted on dietitians who self-monitored their eating habits for a week: “On average, they underestimated their caloric intake by about 30%.”
Genetics, epigenetics and age are factors as well. “If I’d been doing all the same things 10 years ago, I would have lost 15 to 20 pounds [without medication],” Barrett says of the diet and exercise regimen that somehow failed him once he entered his 40s.
For Vasquez, perimenopause made the weight harder to shed. That realization assuaged some of the guilt she’d be feeling. “Maybe it wasn’t all my fault,” she says. “Maybe I wasn’t just a lazy overeater.”
Metabolically, we have built-in survival mechanisms that kick in when we cut back. “Our bodies were designed to gain weight, not to lose it,” explains Rohit Suri, an obesity medicine specialist at Nova Physician Wellness Center. “Evolutionarily, we were designed to eat as much and as fast as we can, because there was no way to preserve food.”
Extra calories are stored as fat, “but as soon as you start losing weight, your body starts thinking something’s wrong,” Suri explains, “which, hormonally, makes it harder to lose weight.” The body responds by increasing appetite and slowing metabolism, and the hormones that regulate feelings of hunger kick into high gear, “to drive your body weight back to the set-point range.”
GLP-1s and GIPs help override those hunger signals while improving the insulin receptivity that allows your body to burn fat. But it takes time to achieve a new normal. “Research and my clinical experience has shown that you need to be at your goal weight for about two to three years for your body to recalibrate its set point,” Suri says.
GLP-1s also rewire the brain’s pleasure response to certain foods, says Sarah McCarthy, a dual-certified family and psychiatric mental health nurse practitioner with the McLean Counseling Center. “GLP-1s work on the hypothalamus to reduce the dopamine reward you get from eating certain foods. So the sugary, fatty foods patients once craved no longer produce as strong of a dopamine hit, which encourages them to find healthier coping mechanisms.”
And yet the prescription is only one piece of the puzzle. Nicole goes to a comprehensive weight loss clinic, where she’s working with coaches to establish sustainable eating and exercise habits. Barrett, the Arlington stylist, is working with a nutritionist.
“When you start the medication, you really need to focus on protein and fiber intake, and doing weight training,” says Ramhmdani of Privia Health. “When you do, your metabolism is likely to pick up. You can’t skip meals.”
Strength training is especially critical for women, who are more likely to lose bone mass.
“GLP-1s aren’t the magic answer,” McCarthy stresses. “They’re a supportive resource that allows people to notice the benefits of their efforts earlier and helps reinforce motivation for healthy habits.”
“Miracle drug” is an oft-used term, with new studies suggesting GLP-1s may even slow the progression of cancer and Alzheimer’s disease. But the cost can be prohibitive. Most insurance companies provide only partial coverage, if they cover the drugs at all.
“The biggest limitation is access, particularly through insurance, even if patients fit the criteria through FDA guidelines,” says Mehta of Inova Health.
Employers burdened by rising costs may be reluctant to shoulder higher premiums. Philadelphia’s nonprofit Jefferson Health system, which employs 65,000 healthcare workers, is a telling case study. Prescription drugs made up 14% of the company’s insurance costs a decade ago, but by 2025, they accounted for 40%, according to an NBC News story. Semaglutides and tirzepatides were significant drivers.
Last year, the net price for a 30-day supply of GLP-1s ranged from $617 to $766, according to a study by the Employee Benefits Research Institute for Blue Cross Blue Shield, and the number of people taking them is very likely to increase. The report states that more than 40% of privately insured adults—more than 57 million people—are clinically eligible for GLP-1 drugs. That includes individuals diagnosed with diabetes, obesity or being overweight with additional risk factors.
While the financial burden is significant, companies that offer GLP-1 drug benefits have reported greater overall employee satisfaction, which can contribute to greater productivity, according to a recent Petersen-KFF Health System Tracker report. Employers could see financial paybacks down the road if their newly fit employees avoid costly medical issues stemming from being overweight.
Many GLP-1 users say the money they spend on medication is offset by savings on food, alcohol and insurance co-pays for more serious health problems. But the initial price tag can be daunting, prompting some patients to turn to online pharmacies that offer compounded versions of the drugs at a fraction of the price. These formulations are called “compounded” because they purportedly contain the same chemical compounds as the FDA-approved medications, but with an additional ingredient—often a vitamin—that allows the seller to tweak the recipe just enough that it can be sold under a different label.
Barrett initially ordered GLP-1s through a compounding pharmacy, but later switched to an on-label medication (Zepbound) and reported fewer side effects and more consistent success. Vasquez started out on Ozempic and later shifted to a compounded version.
Direct-to-consumer discounts offered by pharmaceutical companies have made brand-name drugs more affordable for patients who are paying out of pocket. In July, the federal government will roll out a Medicare pilot program covering GLP-1s for $50 per month. And for those who fear needles, the drugs, which have traditionally been administered as injections, are becoming available in pill form.
Medical professionals unilaterally caution against using any medication that is not FDA-approved. “I do not prescribe [compounded medications],” says Inova Health’s Mehta. “The compounding pharmacies aren’t making the medications in the exact same way, which makes them hard to study. Some people have success and some say they don’t work.” If you’re taking meds that are FDA-approved, she says, you know exactly what you’re putting in your body.
Ali of VHC Health is similarly wary of compound formulations. “If you have a bad reaction, is it because of the medicine, or is it because they’ve tweaked the formula—like adding high doses of vitamins? If it doesn’t work, I don’t know if it’s because of the composition or because you’re not responding to the active ingredients.”
Easy access to off-brand GLP-1s sold on the internet has also raised alarm bells among doctors and psychologists who treat people with restrictive eating disorders such as anorexia.
Not everyone Loses weight on GLP-1s. Mehta cites two recent clinical trials that found 15% and 17.8% of participants taking FDA-approved GLP-1s were unable to lose at least 5% of their body weight. Side effects such as nausea and gastrointestinal distress make the drugs unbearable for a subset of patients. Some have reported reduced libido, hair loss or general feelings of malaise.
GLP-1 usage carries a risk of pancreatitis, as well as kidney, gallbladder and stomach issues, and therefore should be administered under a physician’s care. Research has raised suspicions that the drugs may also be linked to a rare vision issue called non-arteritic anterior ischemic optic neuropathy (NAION), an “eye stroke” caused by a sudden lack of blood flow to the optic nerve.
But proponents would argue there’s risk in not embracing GLP-1s—particularly when the inability to lose weight increases a person’s chances of developing heart disease, Type-2 diabetes and other killers.
“Most of my life I was an average weight, and then covid hit,” says Arlington resident Chris Collins. “I was in menopause. I lost energy and started [over]eating when the lockdown happened. I tried Weight Watchers, Jenny Craig—all things that worked temporarily, but I always gained the weight back.”
Collins, who is 5-foot-6, had been contemplating GLP-1s for almost two years when she finally ordered through a compounding pharmacy in 2024. She’d talked to her doctor about getting a prescription, but the cost of buying it through her insurance was prohibitive. After battling some initial nausea and switching from a semaglutide to a tirzepatide, she lost 100 pounds in the span of a year.
With her shrinking waistline came some unexpected surprises. Her blood pressure, once dangerously high, has “gotten under control to the point that I’ve been able to stop taking two blood pressure medications,” she says.
Her interpersonal interactions have changed, too. “People treat you differently when you’re thin,” says Collins, 56, an office manager at an architecture firm in Old Town, Alexandria. “They’re nicer, they’re more interested, they want to talk to you. It’s in the tone of their voice and the look on their faces. I wonder if they even know they’re doing it.”
Collins says she’s stopped avoiding social events for fear of being judged—or worse, feeling invisible. “There would be times at a party where people wouldn’t even make eye contact. People used to look past me, like I wasn’t there,” she says. “It’s different now.”
Given the growing list of purported health benefits, should everyone be on GLP-1 meds?
No, says Nova Physician Wellness Center’s Suri. “The guidelines are very clear. These drugs have only been studied on people with a BMI of 30, or of 27 with a comorbidity.” (Comorbidity meaning complicating health risks like hypertension or high cholesterol.)
Patients who don’t meet the standard criteria may still be candidates, he says, but those determinations are case by case. “We look at the patient on the whole, not just their BMI. If you just want to lose 10 to 15 pounds, we start with diet and lifestyle and behavior modifications. If you’re insulin-resistant or prediabetic, you might benefit from a GLP-1, but that’s a clinical judgment for the prescriber.”
GLP-1 drugs were never intended as a first line of defense, says Ali at VHC Health. “Usually, by the time patients are referred to us, they’ve already struggled with weight loss for a long time.” Medication becomes an option when lifestyle modifications have not worked.
He says the majority of people taking GLP-1s are in it for the long term. “There’s no clinical data to support going off of it. No matter how long you’re on it, when you stop it, we see weight gain.”
Maria Jordan has no plans to ever stop taking GLP-1s.
“I wasn’t always overweight,” says the 51-year-old Arlington resident. “I used to be a size six. Then I had my child. I felt stuck and I just sort of spiraled. I’d get depressed about my weight, then eat or drink to self-medicate.”
A medical appointment in 2023 revealed that she was prediabetic. Her doctor prescribed Ozempic, which was covered by her insurance. “When I look back now, I didn’t realize I was that big,” she says.
As the weight came off, Jordan started playing pickleball and doing Pilates. “Instead of eating a sleeve of Girl Scout Cookies, I would eat just a few,” she says.
She stopped avoiding social events because she had nothing to wear. And she changed careers—pivoting from her at-home graphic design business to a more public-facing role as a mahjong instructor.
The victories feel bittersweet. “I think about all the things I missed out on with my kid, all the events I didn’t go to because I would have had to put on a f*cking tent,” she says.
After losing 60 pounds, Jordan elected to have surgery to remove excess skin. When her weight loss plateaued, she switched from Ozempic to Zepbound, which she now takes at the highest dose.
Today she is 90 pounds lighter, and her blood pressure and cholesterol have both improved.
“It’s taboo to talk about [GLP-1s], but I think that’s bullshit,” Jordan says. “You’re just using something to help you get better. I’m so excited that this is working, that this can help people live better lives. We don’t have to suffer in silence.”
Adrienne Wichard-Edds is a writer whose work has appeared in The New York Times, The Washington Post, The Hollywood Reporter and Billboard. She lives in Arlington with her family.
