“Stop breastfeeding!” Serena Williams’s coach barks at her before telling her she is “too heavy” and watching her burst into tears.
Footage of Patrick Mouratoglou confronting tennis’s 23-time grand slam singles champion for putting on weight in motherhood is as hard to watch now as it would have been when it first aired in the 2018 documentary Being Serena.
Patrick Mouratoglou tells Serena Williams to stop breastfeeding if she wants to compete at the top again in tennis – Being Serena
So when Williams brought up this showdown back in August while explaining why she had recently begun using appetite-suppressing drugs similar to Ozempic and Mounjaro, it raised some disturbing questions. That Mouratoglou responded to the American losing more than 2st this year by claiming a slimmer Williams would have retired with more wins under her belt merely compounded the controversy.
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Of course, Williams is hardly alone in turning to so-called a GLP-1 (glucagon-like peptide-1 receptor agonist) as a weight-loss drug, with the Telegraph last week revealing up to one in 20 adult Britons had done the same.
But the story behind her own use of such drugs will inevitably fuel a debate about medication designed to treat type-2 diabetics and the chronically overweight, one that has permeated the world of sport where she made her name.
Suspicions that elite athletes could use GLP-1s to cheat their way to glory pushed the likes of Ozempic and Mounjaro on to the World Anti-Doping Agency’s monitoring programme at the start of last year. That programme is designed to detect patterns of misuse to help determine whether a drug should be banned from sport, and GLP-1s will remain on it until at least the end of this year.
Last month, it emerged that, during the first year of monitoring, 8,402 urine samples provided by athletes during out-of-competition drugs tests had been checked for metabolites common to Ozempic and Mounjaro. There were just two positive findings, one from the sport of cycling and another from rugby league. Telegraph Sport has been told that, during the first half of this year, similarly low numbers were found, albeit with more than one positive coming from women’s cycling. Wada’s senior director of science and medicine, Dr Olivier Rabin, has now confirmed that unless “any sign of particular abuse in sport” was detected during the remainder of the monitoring period, GLP-1 medication would not be added to the banned list.
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If few athletes have been found to have used such drugs by Wada’s monitoring programme, even fewer have gone public about taking them. Former snooker world champion Stuart Bingham is almost alone in doing so after revealing earlier this year that he had lost 3st on Mounjaro.
Shortly before last year’s Olympics, Simone Biles became the face of the same drug along with her mother, a type-2 diabetic, despite neither taking a substance they were marketing to those with that very condition. Williams’s August announcement, meanwhile, coincided with the launch of the “Serena’s on Ro” advert for a telehealth brand in which her Reddit co-founder husband, Alexis Ohanian, is both an investor and director.
Athlete ignorance
It would be no surprise if athletes were concealing their use of GLP-1s given the stigma that exists around weight in sport (Pep Guardiola apologised last year for accusing Kalvin Phillips of returning from the 2022 World Cup “overweight”). One doctor who has worked in team sport in the UK told Telegraph Sport: “I’ve seen players who have taken Mounjaro and players who have taken Ozempic and they only confess when they’re ill.”
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The medic, speaking on condition of anonymity, added: “I’ve had one player who announced it when he got drug-tested. He was like: ‘I’ve been taking Ozempic. Is that illegal?’ It’s somebody who’s struggled with his weight.” One team the doctor has worked with was even said to have “actively discussed” putting a player who had a history of piling on the pounds during the off-season on Mounjaro.
The potential performance-enhancing benefits of such drugs are obvious given weight is a decisive factor in many sports. Whether that be in the likes of boxing and racing, where measuring it helps ensure fair competition, or in gymnastics and synchronised swimming, where a certain look is rightly or wrongly deemed to influence judging. Some weight-loss drugs are already banned if they act as diuretics because those can be used to mask the presence of other prohibited substances. Kolo Touré and Shane Warne were both suspended after testing positive for diuretics during their playing careers.
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Appetite-suppression can have similar effects to starvation
But the situation is less clear-cut for GLP-1 medication amid evidence that, when it comes to sport, they may do more harm than good. Unlike eating the optimal diet, appetite-suppression can have similar effects to starvation, depriving the body of the nutrients needed to maximise athletic performance. Eating less is also a relatively slow way to lose weight compared to some of the fast-acting methods adopted by the likes of boxers and jockeys, who often dehydrate before hitting the scales.
Dr Ian Beasley is one of British sport’s most experienced medics, having worked with the England men’s football team and at Arsenal, Chelsea, West Ham United, Fulham and until recently Bournemouth. He was also part of the Great Britain set-up at the 2012 Olympics. He was dismissive of the performance-enhancing potential of GLP-1 medication, telling Telegraph Sport: “It’s anti-performance, rather than pro-performance.”
Those views were echoed by Greg Whyte, a professor of applied sport and exercise at Liverpool John Moores University and former Team GB Olympian best known for helping train celebrities for extreme sporting challenges for Comic Relief and Sport Relief. “It’s quite a complex piece but I think, generally, GLP-1 agonists are wholly negative,” he said. “Weight-reduction is non-selective. So, it’s not just fat mass that you lose. You actually lose muscle mass. Muscle is locomotion. It’s fundamental to sport.”
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Back in the United States, a preventive neurologist, Dr Richard Isaacson, said earlier this year that he had recommended microdosing GLP-1 medication to patients who included a former Olympic champion. He said the unnamed gold medallist, who had previously switched to a new diet, had gained muscle, improved his aerobic capacity, and lowered his risk for neurodegenerative disease. Dr Isaacson also said he himself had begun microdosing and had gone on to run a half-marathon 10 minutes quicker than beforehand. Manufacturers of GLP-1 drugs, which are prescription-only medicines in the UK, have warned against users taking anything other than the recommended dosages.
Dr Rabin told Telegraph Sport it was unclear whether the likes of Ozempic and Mounjaro could have potential performance-enhancing benefits beyond weight loss. “We do not completely understand the mechanism of action,” he said. Feedback from amateur athletes who have used GLP-1s has been mixed amid potential side effects that go far beyond appetite suppression. Nausea, vomiting, constipation and diarrhoea are some of the more milder ailments linked with such drugs, along with vision problems, pancreatitis and thyroid cancer. In February, it emerged that data submitted to the UK drugs regulator, the Medicines and Healthcare Regulatory Agency (MHRA), showed a total of 82 deaths related to GLP-1s.
Four months later, the MHRA announced a study had been launched into possible serious side effects of weight-loss jabs after hundreds of people reported problems with their pancreas.
A substance does not need to be potentially performance-enhancing to be banned from sport. Instead it must meet two of three criteria, which also include that it represents a potential health risk and that it violates the “spirit of sport”. Wada’s Dr Rabin told Telegraph Sport he had worked on GLP-1 agonists for a pharmaceutical company, saying: “They are usually considered from a pharmacological point of view rather safe.” He added: “Even water can be toxic. I give you, fully acutely, four litres of water, you’re going to die.”
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Calls to ban
Yet, it is concern over athlete welfare – exacerbated by Williams and Mouratoglou’s recent remarks – that lies behind a new call for such drugs to be added to the prohibited list. Kate Seary is co-founder and director of Kyniska Advocacy, a UK-based safe sport organisation which has partnerships with both football’s Women’s Super League and UK Athletics. Seary said she feared coaches could put athletes under pressure to use the likes of Ozempic or Mounjaro, pointing out how runners working under Alberto Salazar at the Nike Oregon Project said they had felt coerced into taking thyroid drugs in order to lose weight. “The thing which we’re most worried about as a safe-sport organisation is the potential to use this drug as a way to control, used as a tool, essentially, for the physical and psychological abuse of athletes,” she said.
Alberto Salazar was banned for four years in 2019 for doping violations – AFP via Getty Images/Adrian Dennis
Seary also cited the spectre of Relative Energy Deficiency in Sport, a condition that arises when athletes do not consume enough calories to meet the demands of their training. It has been linked with reproductive problems, as well as issues with bone health, metabolism and mental wellbeing. She added: “If an Olympic champion has the resources and money to do it with a doctor ‘safely’, that’s not the same for amateur athletes who might be using this drug, plus pushing their body to the physical limit. That sounds like the recipe for disaster, quite frankly.
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“Using this drug when you need it is a game-changer. For public health, it’s an incredibly powerful tool. It can give people their lives back when it’s used in the way it was intended. But, to be taking it for performance-enhancing is not what it was intended for. We don’t know the risks of doing that properly. To me, it’s a really worrying regression on a number of levels. Especially on body-positivity and body image in sport. We’re moving away from athlete wellbeing and enjoyment and safety to conversations about shrinking our bodies again and sacrificing health for win-at-all-costs.”
From the sport medicine side, Beasley said: “It’s definitely true that weight control and body image is a big thing in football, in sport. You’ll see a lot of players in the gym doing work, not necessarily that aids performance but gives them a good look. I think if you play at the Emirates and, every week, you run out in front of 60,000 people, plus the television audience, you get barracked by the crowd if you are overweight, as does the referee. It’s bad enough if you have a bad game. But if you have a bad game and you don’t look the part, people always post stuff on social media. So, it is an issue. But I don’t think the weight-loss injections come into it, just because they suppress appetite, and you’re trying to get food, the right food, into players, stop them going to McDonald’s on the way home.”
Professor Whyte said: “Where there is fame and money, there are always those individuals who are prepared to cheat to get it. There will be coaches out there who are poorly informed, who don’t understand the drug, but have heard rumours that it might improve performance. And, of course, there is a tiny percentage of those who would be prepared to push the envelope.”
Denouncing what he branded the “misinformation and mismarketing of the drug” to the public at large, he added: “They’re told that it does something different to what it actually does. And I think that social media has fed that. It’s fed this craze and this craving for Harry Potter’s magic wand. I would say I have a conversation daily about GLP-1s because it’s such in the public consciousness.
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“And, yet, the misinformation and the poorly understood nature of the drug is absolutely rife. We’ve got an industry that is pushing a particular message to increase sales, as it always is in the pharma industry. And then that is supported by incredibly poor information and, I would say, erroneous information on social media.”
We will never know whether Williams would really have won more had she used the likes of Ozempic and Mounjaro back in 2018. Even if she joins older sister Venus in coming out of retirement, it is hard to imagine a 44-year-old Williams going on to surpass Margaret Court and Novak Djokovic’s record of 24 grand slam singles titles.
Until a current athlete confesses to taking similar drugs or someone carries out a study into how they affect performance and health, their true impact on elite sport will remain shrouded in mystery.