Credit: aarp.org
Over 40% of Americans struggle with obesity. It’s the leading cause of diabetes and heart disease, costing our health care system nearly $173 billion annually. Notoriously difficult to treat, only one in five diagnosed with obesity have successfully kept weight off for more than five years with diet and exercise alone.
The search for an effective anti-obesity medication has been ongoing for more than a century. Many Americans desperate to lose weight have risked their health — and sometimes their lives — by trying the latest “diet pill,” from high dose thyroid tablets in the 1890s to amphetamines in the 1930s to central nervous system stimulants in the 1990s. So when a new diabetes treatment created by Novo Nordisk, semaglutide (Ozempic), was also found to cause significant weight loss — an average of 35 pounds in 15 months — its popularity took off like a rocket.
Approved for use by the Food and Drug Administration in 2017 to control hyperglycemia (abnormally high blood sugar), semaglutide works by mimicking a gut hormone called glucagon-like peptide-1 (GLP-1). The medication lowers blood glucose by stimulating the pancreas to secrete insulin and acts on the brain to suppress appetite.
In 2021, the FDA authorized Ozempic as treatment for chronic weight management; this year, it was approved for prevention of heart attacks and strokes in obese or overweight patients.
Nearly 2.5 million prescriptions were written for semaglutide last year alone, making it the most widely used medication in the U.S.— just ahead of Humira for diabetes and Eliquis for blood clot prevention. About 90% of Novo Nordisk’s 2023 profits were from Ozempic and Wegovy (a high-dose semaglutide), amounting to $31.2 billion in sales. Subsequent anti-obesity medications called tirzepatides (Mounjaro and Zepbound) now compete for a share of the market.
Ozempic has a number of drawbacks. Since digestion significantly weakens the drug in pill form, it must be injected subcutaneously like insulin, once a week. Specialists caution patients not to stop the drug if it’s working for them. About 20% of patients who discontinue the drug regain all the weight they lost, and more after the first year of discontinuance.
Credit: health.ny.gov
About 20% of users experience side effects such as constipation, diarrhea, nausea or abdominal pain. Blood sugar can drop, causing blurred vision, headache and sweats — even seizures and coma. No deaths have been reported. Rarely, inflammation of the pancreas (pancreatitis), slow stomach emptying (gastroparesis), bowel obstruction and gallstones occur. Those with a family history of thyroid cancer cannot use semaglutide.
For the uninsured, out-of-pocket costs can be prohibitive for this chronic medication: a 30-day supply of Ozempic (four doses) averages $1,300—that’s $15,600 annually. For those who have coverage, copays for a month of semaglutide run from $25 to $50. Medicare and Medicaid do not cover the product for weight loss, but anticipate reimbursement in 2025 if prescribed for prevention of cardiovascular disease in obese or overweight seniors. Coupons, assistance programs and a current list of out-of-pocket prices are available online.
Semaglutide is in short supply in the U.S. due to the overwhelming demand, prompting desperate users to purchase online knockoffs. Sold as “compounded semaglutide,” these non-prescriptive products are dangerous. Studies have shown the drug strength may substantially exceed the labeled amount, making it easy to overdose. U.S. Poison Control has had a 1,500% increase in calls since 2019 due to compounded semaglutide-induced hypoglycemia (a minority involved self-dosing errors with the prescription drug). In January, the FDA issued a public warning: “Patients should only obtain drugs containing semaglutide with a prescription from a licensed health care provider, and only obtain medicines from state-licensed pharmacies…”
Research thus far suggests the benefit of treating obesity outweighs the risks of semaglutide, but the drug’s long-term impact is unclear. Healthy eating, exercise and behavior modification remain an essential part of successful weight loss, with or without semaglutide.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.