'Real Housewives' star Margaret Josephs is unapologetic about using a 'game-changing' weight-loss drug most of Hollywood refuses to talk about

• Margaret Josephs of "RHONJ" fame gets weekly injections of a GLP-1 agonist. She's lost 22 pounds.
• GLP-1s are in the same class of drugs as the buzzy, new weight-loss treatments Ozempic and Wegovy.

Margaret Josephs is many things: a fashion designer, an entrepreneur, and a reality-TV star, to name a few. One thing she most certainly is not? Apologetic.

After she infamously pushed her "Real Housewives of New Jersey" costar Danielle Staub's husband, Marty Caffrey, into a pool, Josephs stood tall, saying in an after-show clip: "Why would I regret it? He asked for it."

Josephs is equally unapologetic when it comes to her use of a GLP-1 agonist, the class of drugs to which Hollywood's hottest weight-loss treatments — Ozempic and Wegovy — belong.

"I take them as a shot once a week, and that helps you lose weight and improves your metabolism," Josephs told Insider.

She and her prescriber, the NYC physician assistant Jamie Gabel, would not specify the name of the GLP-1 agonist she's taking, but they were clear that it's not Ozempic, specifically.

Nonetheless, while some celebrities are recoiling from rumors that they're using one of these game-changing drugs, Josephs is one of the rare public figures to acknowledge that the visible change to her figure is not exclusively the product of healthy eating and a fitness regime.

"Everyone is like, 'Marge, you look great,' although some of my costars think some of my weight loss is not a great idea," Josephs said. "But I think it's ridiculous. I think it's whatever works for me."

Josephs says weight loss isn't her primary motivator for taking a GLP-1 agonist

Josephs acknowledges that celebrity and exacting beauty standards go hand in hand. But she said her use of a weight-loss drug wasn't simply about looks.

She first went to Gabel's office at Advitam, the "metabolic aesthetics" arm of the Shafer Clinic in Manhattan, New York, because she was concerned about feeling sluggish. After reading a Town & Country article that sang the clinic's praises for increasing energy, she went in for a consultation.

Gabel put Josephs through a battery of tests to measure her hormone levels, as well as her metabolic and overall health. He discovered that her A1C — a test for blood-sugar levels that's often used to detect diabetes or prediabetes — was elevated.

GLP-1 agonists like Ozempic and Wegovy mimic natural hormones that stimulate the pancreas to produce more insulin after eating, lowering blood sugar. That makes them useful in treating type 2 diabetes, for which the Food and Drug Administration originally approved Ozempic in 2017.

"I wasn't familiar with GLP-1s when I started taking them," Josephs said. "But as far as I was concerned, it's a peptide that's already in your body, and it evens out your blood sugar."

Josephs is correct: Lab-made peptides that mimic those naturally occurring in the body are nothing new — though they are becoming more popular. Insulin and human-growth hormone are peptides. So is semaglutide, the active ingredient in Ozempic and Wegovy.

Advitam was an early adopter of peptide therapeutics; Gabel estimated that he started using them about four years ago to improve his patients' recovery times, skin, and metabolism.

"It's hard to give a percentage" of how many Advitam patients are taking a GLP-1 agonist for weight loss, "but, of late, there's quite a lot of interest in this," Gabel said. "Even patients who feel that they need to lose 10 pounds are bringing this up, whereas you would think you would have these conversations more with the patients who are 30, 40, 50 pounds overweight."

That's not to say that Gabel will prescribe GLP-1 agonists to anyone who asks — and he warns against providers who will. Like Josephs, any patient to whom he prescribes the drugs must undergo blood work to assess metrics like cholesterol and A1C, as well as a physical exam, to determine eligibility.

Medications like GLP-1 agonists "need to be used longer term," said Dr. Disha Narang, an endocrinology, diabetes, and metabolism specialist at Northwestern Medicine, Lake Forest. "In our-day-to-day, we need to think about, 'Are we active? What do we eat? What are we doing to address that?'"

Josephs, who's been taking a GLP-1 agonist for about a year, said she lost 22 pounds in her initial months on Gabel's peptide regimen. She hasn't made other major changes to her diet and exercise — and joked that she should probably take up yoga for her mental health — but said she's now just taking the drug to "maintain."

"My blood work is better than it used to be — my cholesterol is down. All my blood work is better," Josephs, who undergoes regular exams at Advitam, said. "I want to stay around for the people I love, so I'm about maintaining myself. Because if you don't have your health, you have nothing."

As for the more outward results, she acknowledged them with a shrug: "Healthy people look good."

Celebrities have taken heat for buying Ozempic amid shortages, but Josephs said she's 'not taking from anybody who needs treatment'

Josephs' weight loss hasn't gone unnoticed. Twitter users and gossip sites have speculated on whether she's taking Ozempic. And while she didn't call out Josephs, specifically, Josephs' fellow "RHONJ" cast member Jackie Goldschneider said that witnessing her reality-TV peers' use of the drug had harmed her recovery from anorexia and disordered eating.

"A lot of people in the 'Housewives' world are on Ozempic," Goldschneider said in a February episode of Page Six's "Virtual Reali-tea" podcast. "It was tough for me to come back and suddenly no one's eating when we go out to dinner."

Then there's the shortage issue: Ozempic and Wegovy's explosive popularity has made it hard for many people who need the drugs — especially those with diabetes, for whom Ozempic can be essential to keep blood sugar in check — to get them. While shortages are finally starting to abate, the idea of wealthy people buying up the pricey drugs to lose weight has drawn ire from people with diabetes.

Josephs and Gabel declined to say how much her treatment cost. But brand-name Wegovy and Ozempic can pack a monthly sticker price of $1,000 to $1,400 when it's not covered by insurance. Semaglutide from a compounding pharmacy can be found online for less, but doctors say it could have additives that make it dangerous.

"That's their right, to purchase this out of pocket," Narang, who uses both Wegovy and Ozempic to treat patients with diabetes, said. "But in the setting of a shortage, I have to determine who the sickest patient is. I would love to have my patients with elevated weight who are at risk for diabetes be on this medication, trust me, but what do you do for sicker patients who need this for their sugars?"

Josephs said she hadn't heard of Ozempic when she started on a GLP-1 and that the drugs she used were not intended for diabetic patients.

"What I'm taking, I'm not taking from anybody who needs treatment. It doesn't come from the same company," she said — meaning the drugmaker Novo Nordisk, which has a patent on the specific molecule that's used in Ozempic and Wegovy.

While Josephs said she's remaining on a GLP-1 agonist for her health, she's frank about the importance of appearance in her job.

"I've never had an issue with my physicality," she said. "But I was getting older. I've had a facelift. Was I morbidly obese? No. I was a voluptuous sex kitten; now, I'm a thin, middle-aged white woman."

Some critics have expressed dismay that the popularity of drugs like Ozempic and Wegovy may represent an undoing of the body-positivity movement. Josephs has no patience for it.

"Be it they're heavy, be it they're thin — as long as everybody feels good about themselves, I think that's good. People can assume whatever they want. I am on TV, so if I look good, that's great," Josephs said. "My packaging has always been important, but all that counts is that you feel good about yourself."