My Wife is on a Maintenace dose. She's lost about 50 pounds on it. She cut drinking wine way back when she first got started. Ozempic helps curb her appetite and slows down how quickly her body metabolizes food. She has slowly ramped back up her wine consumption, but does still eat a lot less. She is more active and has more energy since the weight loss. While she was never pre-diabetic, her fasting blood sugar was high normal and now is comfortably in the normal range.
Her grandfather is a diabetic, and her father was pre-diabetic and got on ozempic, lost 40 or 50 pounds, and now his fasting blood sugar is in the normal range, the insurance will not pay for his meds anymore, so he pays out of pocket.
Both her and her father has GI issues initially, but learned diet influenced that side effect (fried and greasy food + Ozempic) and as long as they moderate/remove those foods don't have the GI side effects.
I do agree that being skinny does not mean you are healthy, but obesity really is a killer, so skinny people with bad lifestyle habits are less unhealthy than heavier people with bad lifestyle habits.
I really feel like the ozempic and alcohol consumption are separate issues though. However, I totally agree there are a lot of people with moderate alcohol dependence.
I would speculate that you don't see as many [middle-aged] men on ozempic, because they are on Testosterone, which helps increase their metabolism and lose weight/maintain current weight.