Ozempic Face

“Ozempic Face” has become part of the popular lexicon to describe the facial changes people experience after losing significant weight on GLP-1 medications. It generally refers to the sagging skin and hollowed-out appearance of the face associated with rapid weight loss.

What no one talks about is what these patients looked like before the weight loss.

I see this every day in the ER, where the vast majority of my patients need to lose weight. Statistically, a very large portion of the population is overweight or obese.

I recently saw a discussion on social media involving Mark Sisson (of Mark’s Daily Apple and The Primal Blueprint fame), who has been producing excellent information in the health and wellness space for decades. He made the point that, in general, men should not weigh more than 200 pounds. Obviously there are variations depending on height and frame, but I think he’s largely correct.

Using BMI (while acknowledging its many limitations), a man would need to be roughly 6'3" tall to stay out of the overweight category at 200 pounds. That’s a problem when the average American male is only 5'9". At that height, 200 pounds equates to a BMI of 29.5 — just under the official cutoff for obesity (30).

For women, the average height is about 5'4" and the average weight is roughly 170 pounds, which also puts them just under a BMI of 30. If Sisson’s general guideline holds, most women should ideally weigh no more than about 145 pounds.

No one wants to call the “pre-Ozempic face” fat, and I’m certainly not trying to fat-shame anyone. It actually makes me sad to see these patients in the ER, because there is a solution — and it doesn’t involve Ozempic.

Beyond excess adipose tissue, these patients are generally inflamed. “Inflammation” is a broad, non-specific term, but inflamed skin has a distinct look that most people intuitively recognize even if they can’t always name it. Patients often don’t realize how inflamed they were until they lose weight and notice the dramatic difference.

Almost all the adults I see with chronic medical problems look sad and doughy: double and triple chins, large jowls, very out of shape, and so physically weak that they can barely move their bodies. Their skin is the opposite of the healthy glow you see in people who maintain good health. They eat poor-quality food and don’t exercise. (“I’m on my feet a lot at work” — a common response when asked about exercise — doesn’t count. That’s just being a human being.)

Nurses have recognized this phenomenon for decades and often make excuses for difficult IV starts and blood draws: “I must have hit a valve.” It’s usually assumed to be a problem with the vein itself, but I believe it’s more often due to advanced glycation end products (AGEs). The skin and vascular tissue become tougher, thicker, and far less forgiving.

And when we start discussing their medical problems, the majority of patients immediately default to the same excuse: “It’s genetic.” They begin listing all the relatives who have the same issues, with an attitude of complete surrender — as if they’ve already given up and there’s nothing they can do. This isn’t limited to patients in their 70s and 80s. These conversations happen routinely with people in their 40s and even their 30s.

The older they are, the less chance I have — in our brief interaction — of convincing them that their body isn’t “broken” because of some specific genetic defect. Their health issues stem from the crappy food they eat and the bad habits they’ve adopted (the same ones their relatives had). There is no single gene that makes a person unhealthy.

Unfortunately, this genetic excuse has become so commonplace that it’s nearly impossible to convince most people otherwise.