Ozempic and Wegovy: the Good, the Bad, and the Ugly- Part 2
Welcome back! If you haven’t already, I highly recommend starting with Part 1- reviewing the basics of semaglutide. Now let’s dive into things that should be considered when prescribing or taking these medications.
The Research-
Wegovy was approved by the FDA in 2021 but wasn’t on the market until December 2022. The adult trial that led to the drug's approval lasted just 68 weeks. A year after participants in this study had stopped taking the medication, on average they were found to have gained back 66% of the weight. Remember, this is a medication that a person is intended to stay on for life to keep the weight off. It is not as if a person who takes this medication will continue to lose weight, but it is needed to maintain the initial weight loss that occurs in the first year of use. Novo Nordisk repeatedly uses the phrasing that “ob*sity is a chronic lifelong health condition” as justification for the need to take this drug for life, which is approved for children as young as 12. The weight regain after stopping this medication appears to be quite similar to the data of weight cycling, that for the majority of people who intentionally lose weight, it will be regained in the long term (2-5 years).
Novo Nordisk’s “long-term” study included 152 people taking semaglutide and 128 taking a placebo, and only lasted 104 weeks (AKA 2 years, but 104 sounds more substantial). Interestingly, the 68-week mark shows the most weight loss and the start to a slow trend of weight regain; besides the 100 to 104-week mark, where there is a clear upward trend in weight, and that is where data stopped being collected. The study does not mention the trend of weight regain but claims the results show “sustained weight loss.” Two years of data on less than 200 people taking a medication that is intended to be used for life does not feel like it should be regarded as “long-term” data. Not to mention, a drug company testing its own medication has a vested interest in showing that it works.
https://www.nature.com/articles/s41591-022-02026-4
A weight loss drug is considered effective if it results in an average loss of at least 5% of body weight. The “long-term” study by Novo Nordisk reports after 68-weeks 83% of adults taking Wegovy lost 5% or more of their weight compared to 31% of people taking a placebo. 47.9% of adults taking Wegovy lost 15% of their body weight (an average of 35 pounds) compared to 4.8% of the placebo group. Unsurprisingly, the data used was taken from the point of the most weight loss instead of the end of the two-year mark, where weight appears to be steadily increasing.
To put this into perspective Regan Chastain and Deb Burgard point out:
“In order to make these numbers more meaningful, I took the participant average weight of 231# and the average BMI of 38.6, and then calculated 5% (11.5#), 10% (23#) and what appears to be the amount of loss at two years (about 16%, 37#) for 50% of the sample. Imagine this average participant, whose BMI started at 38.6, whose resulting BMI is now 32.3. If they are being denied surgery due to "ob*sity," this amount of weight loss would not even remove them from the "ob*se" BMI category (which starts at 30).” Later, they point out: “Those outcomes need to be assessed for whether they actually reduce harms from stigma and discrimination, especially against the backdrop of harms of the drug itself, its financial expense, and the weight cycling it causes.” This is not to say that more weight loss is necessary for the drug to be effective, but to consider, even when working from the weight-normative paradigm, is this worth it?
“It was making me think I wasn’t hungry for so long I lost some weight. I didn’t want to be obsessed with being on it long-term. I was like, ‘I bet the second I got off I’m going to get starving again.’ I did, and my bingeing got so much worse. So then I kind of blamed Ozempic.” -Remi Bader
The Marketing-
From Novo Nordisk’s website with my additions in parentheses: “But with the right care (our very expensive lifelong drug), people with obesity can achieve sustained (is a 2-year study really showing “sustained” results?) weight loss that really makes a difference to their health (I believe they are vague here on purpose)…As leaders within the science of obesity, we are working to make obesity a healthcare priority (this makes us more money), defeat stigma (by trying to eradicate larger bodies?) and support better access to evidence-based care (we already have evidence-based care, it is called weight-neutral approaches).”
This use of weight-inclusive language is no accident. The marketing of these medications as being a way to reduce weight stigma makes my eyes cross. Making someone smaller to avoid weight stigma vs. dealing with the actual issue- those perpetuating weight stigma.
Both Noom and Weight Watchers (or now WW) are now offering GLP-1 medications as part of their programs. This follows their business model of having life-long repeat customers, making their customers believe that weight-cycling is due to a lack of willpower instead of biology. Selling a weight loss drug that requires you to stay on it for life to keep the weight off will help them keep customers coming back. A headline from WW: “How GLP-1’s for weight loss really work,” is this their way of finally admitting that their diet-point system doesn’t work? About time!
The Money-
Novo Nordisk is making a lot of money from semaglutide. From Forbes: “Ozempic and Wegovy account for 52% of Novo Nordisk’s $23.6 billion of total revenue through 2023’s first nine months, up from a 36% share during the same period last year.” Not only are these drugs being prescribed to millions of people, but they are also extremely expensive. According to novocare.com, a month’s worth of Ozempic costs on average $935.77 and Wegovy $1,349.02. That is $11,229.24/year for Ozempic and $16,188.24/ year for Wegovy for people paying out of pocket in the United States. Insurance coverage for these medications varies by plan, and even when they are covered, they tend to be used as justification for the rising cost of insurance premiums.
The Shortages-
Wegovy has been on the FDA’s drug shortage list since March 2022. Unsurprisingly, this leads prescribers to recommend Ozempic for off-label use (weight loss), making it difficult for folks with diabetes to access the medication. Part of this surge in Ozempic being prescribed for weight loss, was thanks to social media. The #ozempic currently 1.3 billion hits on TikTok. There have been social media challenges of trying to lose the most weight in 30 days, essentially marketing the drug as a quick fix to weight loss. Most users leave out reports of the debilitating side effects and only highlight the pounds lost. Folks who had been using this medication for years to manage blood glucose levels suddenly were unable to fill their prescriptions due to the sensationalized headlines of a “miracle weight loss drug.”
The Unknown-
There have been “miracle weight loss drugs” in the past. Amphetamine in the 40’s turned out to be incredibly addictive, “Fen-phen” caused heart valve problems, and “Hydroxycut” supplements caused liver damage, just to name a few. Will Wegovy eventually be added to the list of once-considered miracle drugs found to be incredibly harmful to health?
A lot remains yet to be discovered. What is the effect of taking a drug that impacts insulin release in someone that does not have diabetes? Could that be overworking the pancreas and making someone more susceptible to diabetes later in life? Not to mention, when taking the drug for the purpose of weight loss, people are essentially getting a double dose of what is used to treat diabetes. To me, that logistically doesn’t sound right.
What is the impact of starting this medication at the approved age of 12 years old? Following the current life expectancy, that would be 65 years of use. Besides the biological effects, what could that do to a person’s relationship with food? These drugs run a huge risk of encouraging disordered eating.
"I started on Ozempic last December and I’ve been off it for a while now, but my warning is don’t give it to teenagers, it’s just too easy. You can lose so much weight and it’s easy to become addicted to that, which is very dangerous.” -Sharon Osbourne
Why is the demand so high for weight loss medications?
Short version: Because our society treats people in larger bodies worse than those in smaller bodies.
Here at Feed & Flourish, we believe wholeheartedly in body autonomy. That people should do what they think is right for their own body. It is completely understandable that people living in our diet-culture-ridden, fatphobic society desire weight loss. There is no judgment towards the folks who choose to use these medications for the purpose of weight loss. Perhaps their reasoning is to fit in a plane seat, to meet the BMI cutoff for a surgery they need, or to try reduce the amount of weight stigma they face in the world. It may feel like the world is telling you your body size is a problem, but the lack of inclusivity for body size is the real issue here. One that is taking way too long to be corrected. We understand your frustration. It is justified.
We think Marquisele Mercedes says it best, “because weight stigma in science meshes incredibly well with the profit-seeking behaviors of companies like Novo Nordisk and other major stakeholders in the “war on obesity”. Many scientists are often encouraged by corporate sources of general and research funding to promote stigmatizing ideas about fatness, but, ultimately, corporate influence usually just reaffirms the biases that already shape science. Unless researchers face their deep seated biases against fat people, then corporations will continue to influence the bedrock of public health—its evidence base—and the wellbeing of people everywhere.” Mic drop.
If you are taking this type of medication for blood sugar management and are experiencing side effects that are difficult to manage, please know there are alternatives that may be a better fit for you. If you are taking or considering taking these types of medication for the “health benefits of weight loss” please know that there are no conditions that are unique to folks in larger bodies. When studies rave about the supposed health benefits of weight loss, they fail to mention that weight and weight loss are not a good proxy for health. When health benefits are noted, they also fail to recognize whether the weight loss itself or is it the behavior modifications- like having access to healthcare, food, and movement. Plus, we know with many different weight loss interventions, the weight comes back and can cause harm in the form of weight cycling and impacting one’s relationship with food and body. Weight loss and body weight are not accurate markers for health status.
We’d love to hear from you! Leave us a comment or question below.