Ozempic, the Yellow Brick Road, and the New Fast-Food Economy

Dear Friend,

In our last letter, I left you with a question about fighting your body’s inflammation:

The fire is changing. Are we changing with it?

A tornado has swept through American medicine. It picked up 30 million patients, whirled them through a pharmaceutical revolution, and set them down somewhere unfamiliar: a landscape where their hunger has shifted, their portions have shrunk, and their relationship with food has been chemically altered. They have landed, blinking, in a new world.

Welcome to Emerald City.

I did not expect the food industry to answer so quickly or quite so literally. Fast-food restaurants, have moved with surprising urgency. Major chains are now curating menus explicitly designed around what GLP-1 drugs like Ozempic do to a patient’s appetite, palate, and relationship with food.

Something remarkable has happened beyond the clinic. On the surface, this looks like responsiveness. Look closer, and a more complicated picture emerges.

💡 Follow the Yellow Brick Road.
It now leads to a High Protein Bowl, a Good Fit menu, and a Protein Pocket.
The Wizard will see you shortly.

Meet the Cast

In this new “Land of Oz,” where GLP-1 drugs like Ozempic are reshaping the path to health, every story has its characters. The Oz of pharmaceutical weight loss is no different.

Let me introduce you to the cast.

The Obesity Epidemic

The obesity epidemic. One in two American adults projected overweight by 2030. A tornado that arrived all at once, sweeping patients into a medical landscape they were not prepared for. More than a tenth of American adults have now used a GLP-1 drug.

Dorothy

Swept up in the tornado, following the road she’s been told leads to the answer. Wearing ruby slippers: her body’s wisdom, her personal habits, her own inner terrain, that she doesn’t yet know she possesses. She is looking for the Wizard to fix what she already has the power to address.

Emerald City

Gleaming, green, and magnificent from a distance. Ozempic. Wegovy. Zepbound. The city everyone is marching toward. Real benefits, genuine utility but built, on closer inspection, from a particular shade of marketing and a curtain few pull back.

The Wizard

The man behind the curtain. Powerful, promise-filled, and good at projections. The weekly injection that suppresses appetite restructures eating, for as long as the prescription continues. Pay no attention to what happens when it stops.

The Yellow Brick Road

Shake Shack’s “Good Fit” menu. Chipotle’s High Protein Bowl. Subway’s Protein Pockets. The golden road the industry has paved: responsive, well-designed, and pointed, always, toward the Emerald City.

The Cowardly Lion

Knows the right question to ask. But is afraid of falling behind schedule. The appointment is twelve minutes long. And so, despite knowing better, the lion writes the prescription and sends the patient down the road.

The Tin Man

He has a heart the whole time. He just forgot how to use it.

Integrative medicine tries to restore what the system rusted over: the curiosity to ask how the patient is living: Food, sleep, movement, stress, meaning. The oil can is a remembering.

And when the Tin Man moves again, freely, with feeling, he is the most dangerous character in Oz. Because he treats the whole person, not the symptom the Wizard has a drug for.

Toto

Small. Persistent. Pulls back the curtain when no one else will. The ingredient list no one reads. Toto doesn’t care about marketing. Toto just pulls.

Glinda

The power Dorothy had all along. The patient’s own food history, daily habits, and inner terrain. The answers were always there waiting for the right question from the doctor who took the time to ask.

The Yellow Brick Road, Restaurant by Restaurant

The road is real, and it is paved with good intentions and considerable market research.

For the roughly one in eight American adults who have used a GLP-1 drug, there is a market. And markets, as they always do, get products designed for them.

The Yellow Brick Road is now a franchise.

Shake Shack — “Good Fit” Menu

High-protein, lower-carb options including lettuce-wrapped burgers, explicitly positioned for customers on GLP-1 drugs. The “Good Fit” label does the work a prescription pad used to do.

Chipotle — High Protein Bowl

Protein-dense, appetite-appropriate, and marketed as compatible with reduced hunger. Even fast-casual is reading the same prescription data. The road runs through Chipotle now.

Subway — Protein Pockets

Protein-dense, appetite-appropriate, and marketed as compatible with reduced hunger. Even fast-casual is reading the same prescription data. The road runs through Chipotle now.

💡 The question is not whether fast food should adapt to its customers.
The question is what it means when a pharmaceutical side effect of a diabetic drug becomes a menu category and the industry profits from the symptom rather than addressing the cause.

THE MAN BEHIND THE CURTAIN SPEAKS

“It’s stupid.”

British celebrity chef, Gordon Ramsay’s three-word verdict on Ozempic-branded menus.

Love him or not, the instinct is worth examining. There is something uncomfortable about a restaurant advertising not the pleasure of a meal, but its pharmaceutical compatibility. Even the Wizard, it turns out, had limits to what he was willing to sell.

There is a lesson here for the Fire Brigade.

The question is not whether to acknowledge the terrain. The question is how we engage with it.

Our patients deserve the conversation that goes deeper.

• What are they eating when the drug is not working?
• What happens when they stop?
• What did food mean to them before the prescription, and what does it mean now?

These are not dietary counseling questions. They are terrain questions. And terrain is what we are educated to uncover.

Wait…there’s more:

For some, they can come with side effects to one degree or another: increased risk of heart attack, bowel obstruction, thyroid cancer, vision loss, muscle loss and brittle bones especially for those in their 40’s, 50’s and 60’s.

Not to mention the possible permanent lowering of digestive ability once off GLP-1s, along with the return of the body fat lost, if the situation that originally brought about obesity has not been addressed.

(Please see John’s Hopkins advice: https://hub.jhu.edu/2024/01/11/ozempic-wegovy-weight-loss-drugs-pros-cons/)

This is the medical crutch I warned about from the stage in Chicago. GLP-1 receptor agonists have meaningful clinical utility, and I do not dismiss them. But the cultural scaffolding being built around them concerns me: the idea that appetite suppression is a destination rather than a detour, that the hard conversations about food and habit and terrain can be bypassed by a weekly injection and a high-protein bowl at the end of a road someone else built.

💡 We have not solved the obesity crisis.
We have given it a menu.

A GOOD WITCH EXISTS: TUCCI, NEW YORK CITY

Not every restaurant reached for a marketing label.

Max Tucci, chef and founder of Tucci in New York sister restaurant to Delmonico’s, America’s first fine dining establishment simply listened.

When customers quietly began asking for smaller portions, Tucci paid attention. Not because of a trend report, but because he was watching the tables.

“Now they are not ashamed to say it,” he observed of his Ozempic-using guests.

His response:

• One meatball instead of three
• One arancini instead of three
• Proportionally priced
• For those who ask

No branded menu. No Emerald City marketing. Just a host who saw what his guests needed and responded with grace.

Dorothy didn’t need the Wizard. She needed someone who actually knew her.

THE RUBY SLIPPERS MOMENT

Glinda the good witch’s great revelation to Dorothy was not a new pair of shoes. It was the recognition that Dorothy had always possessed the power to go home. She had it the whole time.

From the stage in Chicago, I said the same thing about our patients: they already hold the answers. Not in a prescription, not in a Shake Shack menu, not in a Protein Pocket. The answers live in their daily habits, their food history, their inner terrain waiting for a doctor who asks the right questions.

The power was always there. We just stopped asking.

A MOMENT OF REFLECTION

Are You Following Someone Else’s Yellow Brick Road?

• When you reach for the “healthy option” on a menu is it because you want it, or because a label told you it was the right choice?
• Has a drug, a menu, or a trend ever replaced a conversation you needed to have with yourself about your own health?
• If Oz is the destination the whole culture marches toward, what would it mean to click your heels and go home instead?
• What would it look like to reclaim your relationship with food from both the fast-food joints and the pharmaceutical industry at once?

The food industry has found a way to profit from a pharmaceutical trend.

The Brigade’s task is not to maintain the road. It is to ask whether the destination is real. And to sit with the patient long enough to help them realize they were wearing the ruby slippers the whole time.

There’s no place like home.

And home, in medicine, is the conversation we stopped having.

That conversation starts in Issue 3.

COMING IN ISSUE 03

If patients already hold the answers, what are the right questions?

This is the power of a good question.

Next issue, we go inside Dr. Manek’s consultation room.

Until next time click your heels, know your terrain, and remember:

The answers were always inside your patients.