1) I'm having trouble finding a good citation, but I remember it being a minor scandal at some point that statistically, the real-world weight loss from semaglutide was found to be roughly half what it was in the trials, probably because the trial populations were unrepresentative (younger and fewer comorbidities than the real-world population, IIRC).

2) In the face of shortages of the standard branded Ozempic/Wegovy products, a lot of people are turning to compounding pharmacies. But according to Novo Nordisk, there is no legitimate supply chain of semaglutide for them to use, so these pharmacies are apparently selling people a semaglutide salt that is manufactured as a research chemical rather than a licensed drug [1]. The FDA has also warned of outright counterfeit Ozempic getting into the supply chain, complete with fake serial and lot numbers [2].

[1] https://www.nbcnews.com/health/health-news/ozempic-wegovy-we...

[2] https://www.fda.gov/drugs/drug-safety-and-availability/fda-w...

I agree there appear to be non-trivial side effects to these drugs, and I certainly won't be first in line to try them out. But I expect that they will be refined substantially, and that elimination of side effects will be a key goal. For example, if the drug can be administered via pill instead of injection, it would be easier to do a lower, steadier dose, which presumably would mellow out some of the side effects. Pharma companies undoubtedly see the huge pot of gold at the end of the rainbow and will do whatever it takes to get there. The best drugs will likely always be more expensive than the earlier generations, which will be used by larger portions of the population.

But to the extent that tastemakers are the elite, I think we'll see a cultural change regarding desirable traits even if mere mortals like me aren't on the medications. The change will accelerate as the drugs become cheaper and more available to the masses.