Semaglutide, sold in the form of Ozempic and Wegovy, shot into the public consciousness last year as an effective weight-loss drug, thanks to spiel from social media influencers and the likes of Elon Musk.
The unexpected surge in demand for the weight loss drug has created a global shortage.
The production of the drug – which is administered as a weekly self-administered injection – requires a unique production setup, so it will take some time to reestablish a global supply. It is expected back in Australia at the end of March.
Semaglutide (in the form of Ozempic) is an effective drug in the management of type 2 diabetes – and its shortage means that some people with diabetes have difficulty finding pharmacies with their treatment in stock.
For many people with diabetes, Ozempic has better controlled their blood sugar (and often helped them lose weight) than other medications.
Due to the shortage of Ozempic, Australian GPs have been advised not to prescribe it for the treatment of obesity.
However, Semaglutide in the form of Wegovy is designed specifically for weight loss. Regulators in the United States and Australia recently approved Wegovy for that purpose, although it has not been available for use in Australia until now.
When the shortage is resolved and semaglutide becomes available again in Australia for people with diabetes, it’s unclear who will have access to it for weight loss.
Patients and doctors are also asking how much they will pay and what role it will play in controlling obesity.
How does it work?
Semaglutide works in several ways, including increasing the feeling of fullness by acting on the appetite centers in the brain and slowing stomach emptying.
It affects the secretion of insulin and glucagon, which is why it is so effective in diabetes.
It also reduces the risk of heart attacks and strokes.
Previous weight loss drugs have reduced weight but increased the risk of dying from a heart attack, making them generally too dangerous.
Studies show that semaglutide helps 66 to 84 percent of people taking the drug lose weight, making it more effective than other drugs on the market.
After two years, patients who take it still benefit by not regaining their lost weight – but only if they are still taking the drug.
Unfortunately, once stopped, patients notice a gradual recovery of up to two-thirds of the weight they lost. So essentially semaglutide only works while it’s taken – it “manages” but doesn’t “cure”.
Semaglutide is intended as an adjunct, not a substitute, for exercise and a healthy diet.
Research on the medication has always been done in conjunction with a healthy diet and exercise, as that is considered best practice.
So we don’t know what happens if you just take the medicines without starting or maintaining a healthy lifestyle. We do know that exercise is key to maintaining weight over time.
What are the side effects?
Semaglutide can cause nausea, bloating, constipation and diarrhea.
Questions have been raised about the risk of pancreatitis and thyroid and pancreatic cancer. So far, the research is reassuring, but these are all rare, so it’s unlikely we’ll know if there will be a significant increase in the years to come.
How much is it?
One of the biggest barriers to semaglutide for weight loss is cost.
While patients spend less on food as they take it, by 2022 (when it was more readily available in Australia) it would cost around $130 a month.
It could be more expensive once supply issues are resolved as manufacturer Novo Nordisk spends millions of dollars building new facilities to meet increased demand.
In the United States, prices are already over $1000 a month unless covered by insurance.
Australians with diabetes will continue to have access to the drug on the Pharmaceutical Benefits Scheme (PBS) for the usual cost of a script. However, if used for obesity, it would be on a private prescription, so the cost is still unknown.
Obesity is more common in people with lower incomes. So from a public health standpoint, those who benefit the most can afford it the least.
This lack of fairness needs to be addressed if this drug is to be widely used to treat obesity. Subsidizing on the PBS for weight loss is one option.
What are the disadvantages?
A serious concern is the possibility of semaglutide being used by people who are not obese, particularly those with eating disorders. Because it suppresses appetite, it can enable people to starve themselves in an unhealthy way.
Obesity is defined as a body mass index (BMI) over 30, and overweight is a BMI of 25 to 30. Still, there are reports of people with a BMI under 25 using it to “lose just a little weight” “.
The psychological and social pressure to be thin is a powerful motivator, especially in a society that often stigmatizes obesity. People may view semaglutide as a way to “treat” their body image issues.
Another concern is the impact on the enjoyment of food. Patients feel full after just a few bites, making meals with friends uncomfortable and sometimes limiting their social lives.
Why do doctors prescribe it for weight loss?
First-line obesity management should always consist of lifestyle interventions: improving your diet and getting more exercise, with the help of a multidisciplinary team.
But when this is insufficient, patients’ options are limited.
The most effective is bariatric surgery. Although surgery is generally well tolerated, it is an irreversible, lifelong change.
Once the semaglutide access issues are resolved, Australian regulators should seek input from the community and physicians, and think carefully about the role the drug should play in controlling obesity and weight loss in Australia.
In addition to fair access and protection for people with body image issues, we need clear, evidence-based guidelines that take into account the psychological and social impact of the drug.
Natasha Yates is an assistant professor of family medicine at Bond University.
This article is republished from The Conversation under a Creative Commons license.