You do have to factor in the (probable) cost of not using Ozempic, aka keeping the pounds on. It may be imprecise, but as an example, if a person was likely to die within 10 years at their current weight, any bad effects beyond the 10 year mark have to be heavily discounted.
I'm sure there are plenty of people taking it as a shortcut to dropping 10 or 20lb or whatever, but I imagine most people taking it are in the "I need to lose 70+ lb of fat" range.