Why Ozempic Beats Free Will

The NBC theory of consciousness explains why people on Ozempic feel less hungry.

Reviewed by Tyler Woods

Key points

• People taking Ozempic and similar drugs often report increased feelings of not being hungry.
• Such feelings of satisfaction versus hunger result from brain activity in the hypothalamus.
• These feelings are explained by the NBC theory based on representation, binding, coherence, and competition.

Billions of people are overweight, according to the World Health Organization. Why don’t they just get rid of the extra weight by using their willpower to eat less and exercise more? If people have free will, why don’t they simply choose not to eat?

Weight loss is hard, but the past decade has brought a new and effective means of weight loss using Ozempic, Wegovy, and similar drugs. People taking them often report reduced feelings of hunger and increased feelings of being satisfied. These feelings are conscious experiences, so the question arises: How does Ozempic affect consciousness? My NBC theory of consciousness provides a strong answer to this question, which yields further support for its plausibility compared to many alternatives.

Here is a brief timeline of the relevant research:

1980s: Discovery of the hormone GLP-1 (glucagon-like peptide-1).

1990s: Discovery that GLP-1 could normalize blood sugar in diabetics by increasing production of insulin in the pancreas.

2010s: Development of drugs to mimic GLP-1, and clinical trials that show their effectiveness for diabetes, cardiovascular disease, and weight loss.

2020s: Widespread use of Ozempic and similar drugs for weight loss and diabetes.

Developing drugs to mimic the action of GLP-1 was tricky, because the molecule only lasts in the body for about 2 minutes. But clever molecular engineering by Danish researchers eventually led to semaglutide, the ingredient in Ozempic and Wegovy that only requires an injection once a week. Similar drugs include Rybelsus, Mounjaro, Trulicity, Zepbound, and Saxenda.

GLP-1 affects many organs, including the pancreas, heart, and brain. Pancreas stimulation increases insulin production, which contributes to reduced blood sugar in diabetics. But the effect of weight loss requires action in the brain, in numerous brain areas, including the hypothalamus, which is important for hunger, and the dopamine-rich areas that process rewards. The neurophysiology of GLP-1 is increasingly well understood (references below), but no explanation has been given of why the drugs that affect it have such striking effects on people’s conscious experiences of hunger.

One explanation of why Ozempic makes people feel differently about food requires intersecting the physiology of GLP-1 with a theory of consciousness. My NBC theory proposes that conscious experiences result from the interactions of four brain mechanisms:

• Neural representations are patterns of firing in groups of neurons that can stand for things in the world, our bodies, and abstract ideas. The great diversity of neural representations explains the diversity of our conscious experiences.
• Binding is the combination of neural representations into new ones that may be mundane blends, such as “red jacket,” or highly creative concepts, such as “indivisible particle” for atoms.
• Coherence is using neural representations to make sense of complex phenomena by satisfying conflicting constraints, for example, in visual perception and language comprehension.
• Competition between representations occurs when they vie for attention, for example when your thoughts shift suddenly from working on something to a song playing in the background.

The neural firings most relevant to feelings of hunger and satisfaction are found in a region of the hypothalamus called the arcuate nucleus. Two groups of neurons there represent hunger and satiety, one group becomes active when animals are deficient in calories, and the other group is activated by eating. Recent studies have found that GLP-1 processing in the arcuate nucleus is an important part of the suppression of appetite in rats. Semaglutide enhances the neural firings that represent satiety

We thus have reason to believe that consciousness is affected by Ozempic through this causal chain:

Semaglutide -> GLP-1 receptors -> neural firing in arcuate nucleus -> feelings of satisfaction rather than hunger.

Binding is also an important part of this story because hunger and satisfaction can be directed at specific things. You can be satisfied by a meal overall, but you want a piece of chocolate to finish it off. These inclinations require bindings between the neural representations of hunger or satisfaction with representations for chocolate. Hunger is more than a physiological signal because it is bound with emotional and cognitive processes to create a conscious desire to eat.

Coherence as constraint satisfaction requires fitting elements together, and feelings of satisfaction and hunger are influenced by other factors such as social context. Companions' eating and talking behaviors may influence your own, as people find a fit between their experiences and those of others.

Competition between representations is also important for conscious experiences such as hunger and satisfaction. If you are hungry, you can distract yourself by shifting your attention to something else appealing, like a video. Competition is affected by the strength of firing of neurons in a representation, which can be influenced by semaglutide. After I started Ozempic for blood sugar control, I was surprised to find myself eating a good meal but quickly starting to feel that I had had enough, as the satiety neural firings outcompeted the hunger ones.

In sum, the major impact of semaglutide is on neural representations in the hypothalamus, with subsequent effects on binding, coherence, and competition. Additional effects of GLP-1 on the reward centers and sense of stomach fullness may also contribute. NBC thus meshes well with the physiology of GLP-1 to explain why Ozempic has psychological effects on feelings of hunger and satisfaction.

In contrast, the doctrine of free will says that people should have the willpower to resist eating. The most traditional view says that will is possessed by a non-physical soul that should be able to control the body. The worldwide prevalence of obesity suggests that such control is non-existent. In contrast, the effects of Ozempic display the primacy of matter over mind. The best way to resist the temptation to eat is not to have it, when satisfaction conquers desire. The explanation of Ozempic-induced experiences by the NBC theory of consciousness provides further reason to prefer NBC to philosophical and neuroscientific alternatives.