Why sugar is the last craving standing
Plus: the coverage whiplash keeps going, GLP-1 use hits a new high, and a word on that viral Ozempic essay.
Hi friends,
Happy Tuesday and welcome back to your weekly breakdown of all things GLP-1’s and how to cut through the chaos.
What’s inside: a quiet-but-real news week, my two cents on the essay everyone is arguing about, and the thing I find most interesting about these drugs and sugar, which starts with the fact that they were built for something else entirely.
📊 The news, fast
GLP-1 use hit a new high. One in nine U.S. adults now takes a GLP-1 for weight loss, up from one in 12 a year ago and one in 33 in 2024, according to new Gallup data out this week. Over the same stretch, the national obesity rate slipped from its 2022 peak of 39.9% to 36.4%. The curve is steep, and it is still climbing. (Gallup)
The generics countdown started. The FDA accepted Sandoz’s applications for a generic tirzepatide autoinjector covering all of Mounjaro’s uses. It is the first real step toward a cheaper version of one of the two big drugs (though realistically, Lilly’s U.S. patents run to 2036, so barring a court challenge or settlement, do not expect a generic on shelves before the mid-2030s). (Fierce Pharma)
Meanwhile, the coverage whiplash continues. A Boston Globe piece this week laid out how commercial and state plans are pulling back: Blue Cross Blue Shield of Massachusetts and Point32Health dropped weight-loss coverage in January, the state commission covering roughly half a million public employees dropped it July 1, and Medicaid there ended weight-loss-only coverage this month, all while the cost-effectiveness data says the drugs are worth it. So even as Medicare opens a door and CVS reopens one, a lot of under-65 plans are quietly closing them. (Boston Globe)
💬 A word on the essay everyone is arguing about
The New York Times ran a first-person essay this week by Caroline Calloway about taking Ozempic, and it is doing what it was built to do: getting a reaction. It is provocative, it is pretty polarizing, and I get why. (the essay)
Here is what I keep coming back to. For a long time this conversation has had two very different ends: silence on one side, spectacle on the other, with a lot of talk about overuse mixed in. This essay lives at the spectacle end. What almost never gets airtime is the middle, where most people really are, and the reason is simple: spectacle is what gets clicks and views and gets rewarded, and the quiet middle does not.
A while back I wrote about the woman who spoke to CNBC about being on Wegovy and would not give her last name. Set her next to an essay this loud, and you can see the whole spectrum at once: silence to spectacle, with an enormous, voiceless middle in between.
Most people are somewhere in the middle. Curious. Watching how it fits into their life, or noticing that it already has. Not sure yet whether they want to say so out loud, because for all the noise, this is still a quietly taboo thing for a lot of people, and the loudest voices in the conversation are the least representative of it.
That is the part worth holding onto. If you are in the quiet middle, intrigued and unsure and not ready to announce anything, that is not a failure to have a hot take. That is where most of us are. (For the longer version of how stigma shapes all of this, my earlier piece is here.)
🍬 Do GLP-1s change the way you crave sugar?
Start here, because it reframes everything: these were diabetes drugs first. GLP-1s were built to manage blood sugar, and the appetite and weight effects were the surprise that showed up after. (Stanford Medicine) So the relationship between these drugs and sugar is not a side plot. It is the origin story.
Which is why the myth I want to bust is a good one: that these drugs “change your taste buds.” Sort of, but not where you think. In a study of more than 400 people on semaglutide or tirzepatide, about one in five said food tasted sweeter or saltier than before, so taste perception really can shift for some. (Diabetes, Obesity and Metabolism, via Healio) But that is the smaller part of the story. The bigger, better-documented effect is in the brain, not on the tongue. A peer-reviewed trial found tirzepatide significantly cut people’s preference for foods high in fat and in simple sugar, and deep-brain recordings in one patient showed it quieting the nucleus accumbens, the brain’s reward hub, though that effect faded over months. (tirzepatide trial, deep-brain recordings) Semaglutide points the same direction in its own research. (review) So the honest version is this: they change what you crave more than what you taste.
Here is the wrinkle I did not expect, and it matches my own experience exactly. These drugs do not make you want more sugar. What they do is make sugar the last craving standing. They quiet the pull toward fatty, savory, heavy food first and hardest, so when almost everything else goes quiet, the small wish for something sweet is what is left. I have never been a candy-over-cookies person, but lately a couple of Swedish Fish sound weirdly appealing on a day when most other cravings barely register. It is the last guest at the party.
The science backs up the feeling. Reviews note that while semaglutide cuts intake of high-fat, energy-dense food, animal studies suggest it may not reduce, and might even nudge up, consumption of low-to-moderate sweetness. (review) And in that same taste study, the people who found sweetness more intense also reported more fullness and less appetite, which means a couple of bites of something sweet can register more strongly and satisfy faster than a whole serving used to. (Diabetes, Obesity and Metabolism, via Healio) So it is not more sugar. It is less of everything else, a sharper hit from a little, and a few bites here and there instead of the whole bowl.
Turns out I am not alone, and the food industry noticed. Better-for-you candy is having a real moment, with low-sugar, higher-fiber takes on the classics showing up everywhere, Swedish-fish styles included. The little treat is not going away. It is just getting reformulated.
One thing to hold onto: like most of what these drugs do, the craving-quieting can fade over time, which is part of why the habits you build while the noise is down end up mattering as much as the drug itself.
Until next week,
Helaine
P.S. If one line in here was useful, forward it to the person who would find this interesting!
Important reminder: I am not a doctor. This is one person’s reporting and experience, not medical advice. Talk to yours before you change anything.
Who am I? Helaine Knapp is the founder of CityRow, a fitness company she built and scaled for a decade before selling in 2024. She is also the author of Making Waves, host of the Step Into Next podcast, and an executive advisor and coach working with founders and leadership teams navigating growth and transition. She has been on her own GLP-1 journey for nearly two years and is building something for everyone navigating this one.
helaineknapp.com · Substack
Making sense of the chaos, together.