‘Let the diabetics take their medicine’

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

Generically known as semaglutide, it was approved to treat diabetes by the Food and Drug Administration in 2017. But during clinical trials, researchers noticed a side effect: The drug led to weight loss by slowing stomach emptying and mimicking naturally produced hormones through the intestines. that signal satiety.

This prompted manufacturer Novo Nordisk to rebrand semaglutide as Wegovy – basically Ozempic in a higher dose, but intended strictly for weight loss. Wegovy was approved by the FDA in 2021.

Semaglutide’s growing prominence has spurred conversations about the correlations between health and weight and whether another weight-loss drug is the better approach.

Advocates call Ozempic and Wegovy part of a “revolutionary” new class of drugs to treat obesity, while opponents call for fair treatment of fat people and argue that the ultimate goal of a smaller waistline and manipulation of bodies is harmful, regardless of the result. .

At the heart of it all are patients who cannot get the medication they need.

Monique Judge, a storyteller, writer and journalist from Los Angeles, was diagnosed with Type 2 diabetes in 2019. The following year, her doctor suggested Ozempic to manage her A1C levels, which indicate average blood sugar levels during a period of 3 months.

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

She’s lost weight since starting Ozempic, but the judge doesn’t give the drug sole credit. “I’ve completely changed my eating habits. I’m eating more fiber now and lots of salads. I walk an hour a day and do yoga.”

One challenge she found was that Ozempic nearly erased her hunger signals, until it was too late and she would reach dangerous levels of “hungry”. So she created an eating schedule to follow.

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

After a test last month, the judge said his A1C levels were cut in half.

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

Not long after starting the drug with a starting dose of 0.25mg once a week, Judge was unable to access 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 1 mg to work around the Ozempic shortage.

Some doctors feel that, if used correctly, these drugs could be the key to a lock they’ve been picking for decades.

“This new class of drugs has become a very powerful tool,” said Jaideep Behari, 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 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, leading to excess fat 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.

Helping the drug’s popularity are public figures like Elon Musk, who is among the high-profile people touting it – in his case, Wegovy – as a weight-loss aid.

With semaglutide in high demand, the judge said it sometimes took three weeks to fill his prescription for Ozempic.

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

Increasing an Ozempic dosage has its own pitfalls. In a clinical trial conducted by Novo Nordisk, around 83% of participants reported gastrointestinal side effects such as nausea and vomiting. Participants in that study took 2.4 mg, much more than Judge’s. The judge said that she felt nauseated and constipated when she started taking Ozempic, but these symptoms disappeared 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.

An Ozempic clinical trial found that participants lost an average of 15.2% of their weight on the drug over 104 weeks, but opponents point out that many people gain weight back after stopping the drug.

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

“It’s not about a lack of willpower,” said 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 who have obesity.”

“The medication must be taken chronically to work,” Behari said. “It’s not curing obesity, it’s managing it.” Similar to blood pressure medication such as propranolol, if you have high blood pressure and stop taking it, your blood pressure may rise again.

Not everyone believes that obesity is a disease – and some want to stop using the word entirely.

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

Certainly, fad diets have a long history—the grapefruit diet, Atkins, paleo—many of them linked to money-making models, including books and meal plans.

For Welsby, prospects are, and should be, moving away from diet and weight loss as tools for health management.

“Manipulating body size doesn’t work in the long run,” Welsby said. “This is exactly the same pattern we’ve seen over and over again. It doesn’t prove that fat is a disease. It proves that the human body doesn’t like to starve and have its weight artificially manipulated.”

And marginalized groups are hurt the most by anti-fat bias: Research shows that black women are especially shunned by doctors and that this partially leads to worse health outcomes like higher blood pressure.

The judge said she struggled to see a black doctor because in the past she had not been recognized by doctors. “I feel like we’re not being heard,” she said.

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

There has also been scrutiny surrounding conflicts of interest from the authors of the Ozempic trial study, arguing that they undermine the drug’s credibility. Several study authors were employees of Novo Nordisk 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 common phenomenon,” said Jennifer Miller, an associate professor of medicine at Yale University School of Medicine specializing in bioethics and director of the Good Pharma Scorecard.

“Traditionally, Novo Nordisk tends to outperform on transparency compared to its peers… Disclosures were voluntary in the study. We want to applaud the transparency there.” This allows reported conflicts of interest to be studied and issues raised.

And even if people don’t decide to change their eating habits or exercise routines, that doesn’t mean they aren’t worthy of respect, Welsby suggested.

What Welsby points to is a demand for a language change in the way society thinks, speaks and treats fat people.

“Over the past five years there has been a very dramatic change in medical attitudes. The return of the condition means it is not a choice. This will further help change perceptions,” Behari said. “Rather than blaming the individual, we recognize that he has a highly treatable condition.”

Behari said that the Ozempic shortage is still an issue, but it is decreasing. “I don’t think anyone predicted how popular the [drug] would become,” he said. “I’m optimistic that things will improve later this year.”

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

The judge called the shortage “annoying” and acknowledged that her tenacity helped her navigate the health care system. “I can’t imagine someone who doesn’t have the resources that I have” going through this, she said. “Let the diabetics take their medication.”

Clinicians interviewed, however, emphasized that Ozempic is “not a magic bullet” or a “panacea” and that it may not work for everyone.

“The way people see it is this miracle drug and you don’t have to do anything else. You do,” the 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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