Over 40% of Americans are obese and despite the fact that weight loss clinics and diet fads abound, these statistics continue to rise. The experts have been helpless to stop these burgeoning numbers so it is no wonder that the pharmaceuticals Ozempic, Wegovy, and other semaglutide medications seem like the miracle drugs Americans have been praying for.
“With just the first dose [of Ozempic?], your body starts burning body fat all on its own without annoying diet or exercise! Speed up your metabolism, increase energy levels, and improve the quality of your sleep all while being actually approved by the FDA – and we can get you this prescription by connecting you to a doctor online in seconds!”
But is this miracle drug all that it’s cracked up to be?
The answer is both yes, and an emphatic NO. For a medical perspective, I consulted my friend, Dr. E.
Dr. E: Initially, I was extremely skeptical. Endocrinologists had been using these drugs for years to get sugar levels down, but they were very expensive and did not reduce sugar levels that much, so I didn’t prescribe them. When reports of weight loss first came out, I was still unconvinced because it was coming from the pharmaceutical companies. However, when reports of “clinically significant” weight loss came out about one to two years ago I began to prescribe it.
What does not get as much press are the side effects – maybe 75% of people get at least some nausea when they start the drug, and some experience a lot of nausea. And, every time patients increase the dose there’s more nausea. This makes it difficult to increase the dose to the target dose or even keep patients on the medication. I needed to educate patients to tough it out until the nausea improved, usually after a few weeks.
In my own experience many people do not get up to the so-called “target dose,” but many of these people can lose weight by taking less than the target dose. I keep patients on whatever dose they can tolerate and that also makes them lose weight. Most people do lose weight, but it varies; some lose 5 –10 pounds and others lose 30 pounds and more.
A big unanswered question is the long term. Any long-term drug use has side effects and people are going to have to stay on the drug for the rest of their lives. However, a morbidly obese person who loses 60 pounds has so many benefits, from heart health to decreased joint pain, that people are willing to tolerate some side effects. “A well-regarded magazine” did report that Ozempic caused permanent stomach dysfunction/nausea in some people (known as gastroparesis) even after it was stopped, so I have my ears up, but most people say they are happy.
Obesity is so prevalent, and the bad health effects of obesity are so severe and well-established, that anything that can cause a significant weight loss — if it works —, is worth the risk. It doesn’t really have to be 100% safe or easy to take because the potential benefits are so big. Before these drugs became available, people were resorting to bariatric surgery to lose weight – so taking a self administered shot once a week approaches being a no brainer.
For some reason, the insurance companies themselves are promoting these drugs, even though they cost about $15,000 a year to take and, at the current time, the drug is only approved for people with obesity and diabetes. If patients are obese and without diabetes, insurance companies won’t cover it, so it’s too expensive for most people. But if people meet the qualifications the insurance coverage is there.
The medical evidence is pretty clear that the lighter you are, the fewer health issues you have. Until these drugs came out, pretty much nothing else worked, so you can understand why they are getting all this attention and use. Bariatric surgery is almost not a thought any more.
New drugs will be coming out, but at the moment the drug companies are having a hard time manufacturing enough to meet the demand, and short-term shortages and unavailability are not uncommon in RI and the rest of the US.
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And there you have the rational side of Ozempic, Wegovy, and other semaglutide weight loss drugs.
Unfortunately, the distribution of these new drugs is not proceeding according to medical wisdom. Right now you can go online and find at least 20 different sites that will hook you up with an online physician and get you a prescription without going through either your insurance or the medical network.
America leads the world in obesity. I don’t blame the doctors. Doctors advise their patients all the time to lose weight. But people just can’t do it. The result is that they are willing to pay $15,000 a year for medication that will at best probably make them lose 30 pounds that they’re going to regain as soon as they stop taking the medication.
Losing weight is not a simple problem and keeping it off is even harder. But this move to pharmaceuticals as the ultimate solution seems to say that we’ve just given up; and I would hate to think that is true.
