In just four years, the cultural conversation around weight loss medications has shifted sharply. Dr. Mike Israetel, a leading expert in human performance and physiology, recently discussed this change on the Jack Neel podcast, pointing to how GLP-1 medications moved from being treated as taboo to becoming casual topics of conversation.
“If in 2021 you were taking Ozempic, people are like, ‘Oh, that poison pill,’”
Dr. Israetel explained.
“Now, if you’re taking Ozempic, people are like, ‘Oh my god, yeah, my aunt lost like 80 pounds on it.’ And that’s the end of the conversation.”
This change reflects a broader shift in attitudes toward pharmaceutical enhancement. Dr. Israetel traced his own understanding of this dynamic back to his time as a personal trainer in New York City around 2008 to 2009. While working with wealthy and educated clients, he began noticing a pattern that challenged how fitness culture presents itself.
Clients would initially say they wanted better health and more strength. After weeks of evidence-based training focused on conditioning and performance, many would circle back to the same request: more work on arms, shoulders and abs.
“At first we were kind of autistic about it,”
he recalled.
“We were like, ‘But you said you wanted strength and health.’”
Over time, the pattern became impossible to ignore. Roughly 95 percent of people who pursue structured dieting or training do so primarily for appearance, not health. By the time Dr. Israetel was teaching personal training courses at Temple University, this was no longer speculation but a consistent observation he built into his curriculum.
He noted that cultural discomfort around admitting vanity creates a strange double standard.
“If you were portioning out your meals at dinner”
and someone asked why, answers like training for wrestling or powerlifting tend to be accepted, he said.
“But if you were like, ‘I’m just trying to get ripped so I can look cool,’ you’ll probably get some kind of like, ‘Huh? Really? You just say that? Isn’t that vain?’”
That stigma extends beyond the gym. Dr. Israetel pointed to research showing that attractive people are often perceived as more competent, while those who fall outside conventional standards face obstacles in dating and professional life, despite widespread messaging about not judging appearances.
Modern GLP-1 medications such as semaglutide, tirzepatide and retatrutide offer a direct response to these pressures. When paired with resistance training and high-protein diets, Dr. Israetel says they can produce substantial fat loss with relatively limited muscle loss.
“Within about a year and a half that people take these modern (), they typically lose an amount of muscle just because they’re losing so much weight, some muscle, some fat,”
he explained.
“That is a little bit less muscle lost than the average person gains with about two to three days of 30 or 40 minutes at a time of resistance training for the same amount of time.”
Looking forward, he expects further advances. Oral medications may soon reduce appetite, increase metabolic rate and preserve or even build muscle, effectively creating a non androgenic anabolic option without the downsides of performance enhancing compounds.
This trend challenges the assumption that natural automatically means better. Dr. Israetel argued that this belief comes from earlier eras when artificial interventions were genuinely dangerous.
“Natural things are also really bad,”
he said.
“Cystic fibrosis in children is completely natural but devastating. So is getting poisoned by eating berries.”
Weight loss aids are only part of a broader shift. Cosmetic procedures that once carried stigma are now common, from Botox among women in their twenties to increasingly accessible facial surgery.
“If you’re like the last person in 2032 to get some kind of enhancement or take some kind of () or pharmaceutical or whatever, everyone’s just going to be a lot better looking than you and fitter and healthier and happier,”
Dr. Israetel predicted.
His upcoming book, The Aesthetic Revolution, frames this change as part of several overlapping developments, including longevity and disease resistance, cognitive enhancement, advanced psychiatric treatment and aligning human psychology with modern life.
The normalization of Ozempic and similar medications signals a wider acceptance of enhancement as a tool rather than a shortcut. What was once dismissed as cheating is increasingly treated as a practical option. As Dr. Israetel emphasized, the issue is not whether enhancement should exist, but whether people understand the trade-offs and make informed decisions about how they want to look and function.
The shift reflects a move away from passive acceptance of biology toward actively shaping the body through medicine and technology.