Months into the weight-loss-drug bonanza, various medical, cultural, and political challenges have materialized. Doctors are reporting rampant use of these new weight-loss drugs among the rich. To make matters worse, as use expands, more people report unwanted side effects.

Every drug has side effects. Patients on semaglutide and similar drugs have reported nausea and vomiting, which can be partly managed by starting patients on a low dose. The drugs can also produce gallstones, shared among all patients undergoing rapid weight loss. Some people using Ozempic report accelerated “facial aging” when they lose fat in their cheeks.

These drugs could also scramble our relationship with the basic concept of willpower in ways that aren’t cleanly good or bad. How long should doctors recommend that their patients press forward with “diet and exercise” recommendations now that pills and injectables may safely and consistently keep off the weight? Is the U.S. healthcare system ready to treat obesity like any other disease? Obesity is not a failure of the will, Yanovski told me, again and again. “It is a complex chronic disease,” she said. “It affects almost every organ system. If you can successfully treat obesity instead of individual conditions, it could positively impact health.

The weight loss drug Ozempic rocketed into public consciousness last year, and a social media–fueled desire for the medication has led to shortages for patients with type 2 diabetes. People increasingly recognize the medication’s side effects, including loose skin, which has become known as “Ozempic face.”

In clinical trials, nausea occurred in 20% of people taking a 1 mg dose of Ozempic, 16% on a 0.5 mg dose, and 6% on a placebo. Vomiting and diarrhea were less common but still occurred in about 9% of people on the 1 mg dose compared with 2% taking a placebo.

There is no doubt that we will see more patients with side effects as usage expands but will people who aren’t at risk for Type 2 diabetes be shortchanged by people willing to pay cash to lose weight? It will if insurers require an A1C test and weight before approving the use. In any case, the media will excite and warn patients about these drugs. It’s up to the physician-patient relationship.