Bryan Mercadente has already made his opinion known on semaglutide. His article Needles and the NHS: A Slim Chance of Salvation is one of his classic rants against the fat and smelly boys in his class at school. His main contribution to the debate is to agree that these weight management drugs have side effects, and then to hope that most of his classmates will take them and die of thyroid cancer—sooner than later, is his view. Our last conversation on the matter ended with the classic line: “Let them be thin, or let them die vomiting.”

That’s a style Bryan has perfected: deliberately harsh, morally clear, designed to humiliate the people who have been broken by a corrupt system, and who are themselves corrupt. But in this case, cruelty risks obscuring something important. Because he’s not wrong. Semaglutide really is being offered as a shortcut past personal responsibility. The NHS really is spending millions to suppress people’s appetites because it doesn’t know how to rebuild the conditions for healthy living. And politicians from all parties—but especially the Conservative Party—really have made this situation worse.

My aim here is to explore what The Great Ozempic Hustle, by “A Midwestern Doctor,” helps us understand about the long-term dangers of this new class of drugs, and why their adoption in Britain reveals a lot about what medicine has become. Ozempic is not just a new treatment. It’s a cultural experiment. And its biggest backers have interests that are more financial than medical.

Ozempic (semaglutide) is a synthetic GLP-1 analogue. It mimics a hormone that slows gastric emptying, reduces appetite, and boosts insulin secretion. It was developed for type 2 diabetes but was quickly found to suppress hunger so strongly that users began to lose dramatic amounts of weight—often without trying to.

In clinical trials, patients lost between 10 and 15 percent of their body weight in about a year. This was enough to get semaglutide fast-tracked for obesity treatment, under the brand name Wegovy. It is now widely prescribed in the UK, through NHS pilot schemes and private weight-loss clinics.

There’s just one problem: it only works while you’re on it.

These drugs cause profound metabolic disruption… They do not ‘reset’ the appetite. They override it. And when the drug is withdrawn, the body reasserts itself—often with a vengeance.
— A Midwestern Doctor, The Great Ozempic Hustle

A 2022 study in Diabetes, Obesity and Metabolism showed that participants regained most of their lost weight within a year of stopping semaglutide. Hunger returned, fat came back, and many patients ended up heavier than when they started. Which means that if the drug is to “work,” it must be taken forever.

The British press has started to report on what users are experiencing: facial gauntness (“Ozempic face”), tooth decay (“Ozempic mouth”), nausea so intense it mimics illness. Dentists in Glasgow and Manchester have warned of unexpected enamel erosion and gum recession, likely caused by chronic vomiting and nutrient deficiencies.

The MHRA has logged over 1,200 adverse reactions involving GLP-1 drugs. These include gallstones, pancreatitis, kidney injury, and in rare cases, death. A 2024 BMJ article reported 82 deaths linked to the class, 29 involving semaglutide specifically. While correlation isn’t causation, the number isn’t small enough to ignore.

There’s also the risk of thyroid tumours. In animal studies, semaglutide caused C-cell carcinomas. Human risk is disputed, but the company itself—Novo Nordisk—lists it as a potential hazard, and contraindicates the drug for people with a family history of medullary thyroid cancer.

Then there’s the psychological effect. “A Midwestern Doctor” writes about patients reporting dissociation, suicidal ideation, and emotional flattening. The cause may be extreme calorie restriction or drug-induced hormonal imbalance. Either way, it’s part of the real cost.

This is not appetite correction. This is chemical anorexia maintained by weekly injection.
— The Great Ozempic Hustle

According to NICE, Wegovy is prescribed for those with a BMI over 35 (or over 30 with a comorbidity), and the NHS price per dose is around £76. That’s roughly £3,800 per patient, per year. While the patient pays only £9.90 per prescription, the NHS carries the rest. The numbers scale quickly. If 100,000 people take it for two years, the NHS spends three-quarters of a billion pounds. If, as expected, people stay on it for life, the cost multiplies. And this is for a drug that stops working the moment you stop using it.

It’s not a medicine. It’s a metabolic leash.

Wegovy and Ozempic are manufactured by Novo Nordisk, a Danish company now worth over $500 billion. Its recent market growth has been driven almost entirely by demand for GLP-1 drugs. The more weight loss becomes a “medical condition” requiring lifelong drug management, the more they win.

In Britain, politicians have helped them along. The present Government believes that Ozempic will reduce the dole queues by helping the fat unemployed to lose weight and become more employable. Meanwhile, several Conservative MPs, before they lost their seats, accepted speaking engagements, consultancy roles, or indirect donations from pharmaceutical interests. According to The Guardian, “Drug companies are giving groups of MPs and peers that campaign on health issues hundreds of thousands of pounds a year in “hidden” funding that could hand them ‘undue influence.’” Supposedly free market policy institutes—often quoted in support of obesity medication—receive pharmaceutical company funding. Many refuse to disclose sources.

There is little scrutiny because the newspapers aren’t asking questions. Much of what appears in mainstream outlets now is press release journalism: news stories “based on” new research or “announcing” new rollouts, lightly topped and tailed by a “health correspondent.” We don’t get challenge, only packaging. PR dressed up as public service.

The public is not being treated. It is being trained to submit.
— A Midwestern Doctor

That sounds extreme. But it feels true. We are told this is health. We are not told who is being paid.

Obesity is not a random disease. It’s a symptom of cultural decay—of bad food, broken schedules, stress, absence of family life, and a complete collapse of self-restraint. You cannot fix this with injections. You can only suppress it. And even then, only temporarily.

Semaglutide is attractive because it promises results without change. It says: live how you like, and let the drug do the rest. That’s the logic behind the NHS rollout. It’s not about healing. It’s about management. Bryan, for all his aggression, is right on this. He is wrong, I think, to write off the patients. Some are desperate. Some have been misled. Others are simply trying the only option offered to them. But the system? That deserves contempt. Politicians pretend it’s science. Economists call it a growth sector. The media act like it’s a lifestyle story. No one talks about the bodies it damages, the minds it numbs, or the lie at the heart of it all: that you can fix appetite without fixing anything else.

If there is a conservative answer to obesity, it isn’t Ozempic. It’s clean food, quiet meals, daily movement, stronger families, and time to live properly. None of that requires drugs. All of it requires will. But the government doesn’t believe it can deliver any of those things. So it offers injections instead. Weekly needles for chemical hunger. Subscription plans for not eating. Medical dependency as policy.

This is where we are. And if it sounds dystopian, it is.