The diabetic drug Ozempic recently vaulted into the public interest. Searches for #Ozempic have generated more than 350 million views on TikTok – not for the drug’s ability to moderate insulin in diabetics, but because of the once-weekly injection’s notable side effect: weight loss.
Ozempic is the brand name of semaglutide, just one of many in a drug class known as incretins. A higher dose of semaglutide, Wegovy, also started trending when Tesla founder Elon Musk said the once-weekly injectable was his secret weapon for looking “fit, ripped, and healthy.”
Multiple studies show clear evidence that regular exercise can help achieve overall fitness, better cardiovascular health and improved mental health. I also previously wrote in this column how getting your daily 7,000-10,000 steps in could also reduce your risk of dying. And another new study found that those who lift weights just 1-2 times per week had a 9% reduced risk of dying from all causes (except for cancer).
However, when it comes to weight loss, exercise alone is not that effective.
And over the last two decades, the prevalence of obesity in the United States has increased from 30.5% to 41.9%. Obesity is a chronic medical condition – not a lifestyle choice that people should be shamed for.
And an effective weight-loss treatment would be a game-changer for millions of Americans suffering from obesity. This is one instance where physicians are equally excited about a treatment that has gone viral.
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Ozempic, Mounjaro and weight loss
Tirzepatide, brand name Mounjaro, is another incretin that recently was approved by the FDA in May 2022 as a diabetes medication.
Incretins work by regulating the amount of insulin that is secreted in diabetics after eating.
But interestingly, during research trials, scientist noted that participants had two major side effects: early satiety and delayed gastric emptying. Satiety means that recipients of the medication felt fuller faster. And delayed gastric emptying means that digested food moved more slowly from the stomach through to the small and large intestines, which made recipients feel even more full.
The end result? Trial participants ate less and lost a large amount of weight very quickly.
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Ozempic side effects and results
Physicians are excited about this treatment because the best current option for their patients suffering from obesity is bariatric surgery. However only those with a BMI >40 qualify for the procedure and only 1% actually end up going through with it. On average, bariatric surgery patients lose approximately 25-30% of their body weight.
Incretins such as semaglutide measure up to the results of bariatric surgery. Large randomized control trials demonstrated that semaglutide study participants lost approximately 6% of their weight by week 12 and 12% of their weight by week 28.
Most patients would much rather avoid surgery if possible; and likely more would qualify for incretin treatment once officially sanctioned by the FDA. However, incretins need to be taken indefinitely – it’s not a “one and done” miracle cure. And incretins themselves are not without side effects, which can include bloating, constipation and diarrhea.
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Ozempic shortages and what it means for diabetics
The limiting factor is that Medicare pays for bariatric surgery but does not cover obesity treatment for weight loss. And private insurers tend to to follow Medicare’s lead as far as drug coverage. There is currently a bill before Congress called The Treat and Reduce Obesity Act to expand Medicare to cover evidence-based obesity treatment options. But the Act has made little progress despite being introduced in every Congressional session since 2012.
This has created an unfortunate dichotomy. The well-off can afford the $1,200 to $1,500 per month price tag of Ozempic and get it legally prescribed off-label from their doctor. They can then use it to treat their obesity or as a quick-fix slimming agent, as popularized by celebrities. But this practice is not without consequence.
Due to high demand – no doubt catalyzed by TikTok trends like #MyOzempicJourney – some pharmacies are reporting the injectable unit is on back-order through December, potentially threatening the supply for diabetics who depend on it for blood sugar control.
Is Ozempic the answer?
So what’s the bottom line?
Obesity is a public health emergency. Congress is long overdue to expand Medicare coverage for anti-obesity drugs. Only with a combination of options including diet, exercise, and either bariatric surgery or anti-obesity medication, can we fight this epidemic.
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Michael Daignault, MD, is a board-certified ER doctor in Los Angeles. He studied Global Health at Georgetown University and has a Medical Degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps Volunteer. Find him on Instagram @dr.daignault and Twitter @MichaelDaignau3