‘Give the diabetics their medicine’

Ozempic has been catapulted into the public eye in recent months as celebrities and wellness influencers began using it for weight loss. But Ozempic is a diabetes drug — and the craze has led to a shortage, leaving those who need it for type 2 diabetes at a loss.

Known generically as semaglutide, it was approved by the Food and Drug Administration in 2017 for the treatment of diabetes. But during clinical trials, researchers noticed a side effect: The drug led to weight loss by slowing stomach emptying and mimicking hormones naturally produced by the gut. that signal saturation.

That led manufacturer Novo Nordisk to rename semaglutide Wegovy – actually Ozempic in a higher dose, but intended solely for weight loss. Wegovy was approved by the FDA in 2021.

Semaglutide’s increasing spotlight has sparked conversations about correlations between health and weight, and whether another weight loss drug is the best approach.

Proponents call Ozempic and Wegovy part of a “revolutionary” new class of drugs to treat obesity, while opponents push for fair treatment of fat people, arguing that the end goal of shrinking waists and manipulating bodies is harmful regardless of the outcome.

At the center of it all are patients who can’t get the medicines they need.

Monique Judge, a Los Angeles storyteller, writer, and journalist, was diagnosed with type 2 diabetes in 2019. The following year, her doctor Ozempic suggested that she manage her A1C levels, which indicate average blood sugar levels over a 3-month period.

“I was hesitant, but I said yes because the only other alternative was weight loss surgery,” Judge said of the weekly injectable.

She’s lost weight since starting Ozempic, but Judge doesn’t just give credit to the drug. “I have completely changed my eating habits. I now eat more fiber and a lot of salads. I walk for an hour a day and do yoga.”

One challenge she faced was that Ozempic almost erased her hunger signals, until it was too late and she would reach dangerous “hangry” levels. So she made an eating schedule to follow.

She sees weight loss as a by-product of Ozempic’s real benefits: controlling her blood sugar and reducing chronic anemia. “My main focus has been getting healthier and getting my numbers down. And I feel like the weight loss is just a good side effect of everything I’ve been doing,” said Judge. “I don’t necessarily want to be skinny.”

After a test last month, Judge said her A1C levels have halved.

“I definitely noticed a difference using Ozempic,” she said.

Not long after starting the drug at a starting dose of 0.25mg once a week, Judge didn’t have access to the injectable pens – similar to an EpiPen – needed to administer it. After two weeks of back and forth with the pharmacist, her doctor had to increase her dose to 1mg to get around the Ozempic scarcity.

Some doctors believe that, when used correctly, these drugs could hold the key to a lock they’ve been breaking for decades.

“This new class of drugs has become a very powerful tool,” said Jaideep Behari, a transplant hepatologist and director of the UPMC Fatty Liver, Obesity and Wellness Clinic. Behari is also director of translational research for hepatology in the division of gastroenterology, hepatology and nutrition, and an associate professor of medicine at Pitt’s School of Medicine.

“We finally have a way to treat diabetes, obesity and NASH together,” he said. NASH stands for non-alcoholic steatohepatitis, a type of non-alcoholic fatty liver disease, which leads to excess fat being stored in the liver, cirrhosis, and sometimes liver failure. Ozempic changes how the body handles glucose, Behari said, which may help the liver.

“There is a desperate need for these drugs,” he said.

Public figures such as Elon Musk, who is among the high profile people touting it – in his case Wegovy – as a weight loss aid, contribute to the drug’s popularity.

Because there was more demand for semaglutide, Judge said it sometimes took three weeks to fill her Ozempic prescription.

“I was worried that my blood sugar wouldn’t be as well controlled. I finally got good labs back. I was paranoid,” she said.

Increasing an Ozempic dosage is not without its own pitfalls. In a clinical trial conducted by Novo Nordisk, approximately 83% of participants reported gastrointestinal side effects such as nausea and vomiting. Participants in that trial took 2.4 mg, much higher than Judge’s. Judge said she felt nauseated and constipated when she first started taking Ozempic, but those symptoms cleared up after a few weeks.

These side effects are a sticking point for opponents, but Behari said nausea and vomiting point to the drug’s intended effect.

“Our patients will learn very quickly that they need to change their eating habits,” he said.

A clinical trial by Ozempic found that participants lost an average of 15.2% of their weight on the drug after 104 weeks, but opponents revealed that many people regain weight after stopping the drug.

Behari said this result supports the idea that obesity is a chronic disease. “It is no longer accepted that it is explained by lifestyle alone,” he said. “The physiology of obesity is very complex,” involving genetics, environment and hormone levels.

“This isn’t about poor willpower,” says George Eid, president of the Allegheny Health Network’s Bariatric and Metabolic Institute and a bariatric surgeon. “There are so many factors that play a role in people being obese.”

“The medication has to be taken chronically to work,” Behari said. “It doesn’t cure obesity, it manages it.” As with blood pressure medications, such as propranolol, if you have high blood pressure and you stop taking it, your blood pressure may rise again.

However, not everyone believes obesity is a disease – and some don’t want to use the word at all anymore.

“Fat people have been around since the dawn of time,” says Vinny Welsby, a consultant and author who has spent years working to dismantle prejudices around fatness. “Fatness is not a harmful deviation from normal. Fatness is normal and what harms fat people are rampant anti-fat attitudes and ‘treatments’.”

Diet fads certainly have a long history — the grapefruit diet, Atkins, paleo — many of which were associated with profit models, including books and meal plans.

For Welsby, the perspectives are and should be shifting away from dieting and weight loss as health management tools.

“Manipulating your body size doesn’t work in the long run,” Welsby said. “This is the exact same pattern we’ve seen over and over again. It doesn’t prove that obesity is a disease. It proves that human bodies don’t like to be starved and that their weight is artificially manipulated.”

And marginalized groups are hurt the most by anti-fat bias: research shows that black women in particular are being fired by doctors, and that this leads in part to worse health outcomes, such as higher blood pressure.

Judge said she fought to see a black woman because she had not been recognized by medical providers in the past. “I feel like we’re not being listened to,” she said.

The Ozempic study acknowledged the limitation that many of the 304 participants were white, and so there is less data on whether this drug will affect people of color differently.

Conflicts of interest have also been addressed by the study authors of the Ozempic trial, arguing that they undermine the credibility of the drug. Several authors of the study were Novo Nordisk employees or reported receiving financial compensation or serving on the company’s advisory boards.

“Conflicts of interest in medical and biomedical research are ubiquitous … It’s a very common phenomenon,” said Jennifer Miller, an associate professor of medicine at Yale University School of Medicine who specializes in bioethics, and director of the Good Pharma Scorecard.

“Traditionally, Novo Nordisk has outperformed its peers on transparency…Disclosures were voluntary in the study. We want to applaud the transparency there.” This allows the reported conflicts of interest to be studied and questions to be asked.

And even if people don’t choose to change their eating habits or exercise routines, that doesn’t mean they don’t deserve respect, Welsby argued.

What Welsby is pointing out is a question of a language shift in how society thinks, talks about, and treats fat people.

“In the last five years there has been a very dramatic change in medical attitudes. The return of the condition means it’s not a choice. This will help change perceptions further,” said Behari. “Instead of blaming the individual, we recognize that they have a condition that is highly treatable.”

Behari said the Ozempic deficit is still a problem, but is declining. “I don’t think anyone expected how popular the [drug] would be,” he said. “I’m optimistic that things will ease later this year.”

Eid agreed that the shortage has improved, but noted, “Demand could be huge and the shortage could come back at any time.”

Judge called the shortfall “annoying” and acknowledged that her tenacity has helped her navigate the healthcare system. “I can’t imagine anyone who doesn’t have the resources I have” going through this, she said. “Give the diabetics their medicine.”

However, doctors interviewed stressed that Ozempic is “not a panacea” or a “miracle drug” and it may not work for everyone.

“The way people see it, it’s this miracle drug, and you don’t have to do anything else. You do,” Judge said, adding, “I hope people will consider that there really are people who need this drug to live .”

2023 PG Publishing Co.

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