Wegovy and Ozempic are being touted as weight-loss “miracles” — and that may be true, as long as you can afford the medications. Studies show patients lose more weight than on other medications used for weight loss.
The two medications are approved for different people — they use different doses of the lab-created hormone semaglutide, delivered by costly weekly injections. Wegovy is approved by the U.S. Food and Drug Administration for chronic weight management in those who are considerably overweight who have related medical conditions like high blood pressure or high cholesterol. Ozempic is prescribed to manage type 2 diabetes — the weight loss side effect a happy-accident discovery. The shots run about $1,400 a month.
Science Alert said that in clinical trials Wegovy patients lost an average of 15% of their weight over 68 weeks, compared to other weight-loss drugs where patients lost 5%-10%.
The weight loss derives from the fact the hormone is a glucagon-like peptide-1 that mimics a satiety hormone, telling people they feel full and don’t need to keep eating. The drugs are produced by Novo Nordisk, a Danish pharmaceutical company.
The high monthly cost is not a barrier to many of the celebrities who tout the drugs, creating considerable hype. As the Deseret News reported in January, Ozempic has been embraced joyfully by Hollywood celebrities and other well-heeled patients, “with hashtag #ozempic having over 450 million views on TikTok. Elon Musk credited significant weight loss to the medication on Twitter, and Mindy Kaling has been rumored to be hosting ‘Ozempic parties.’”
But for those who must pay for the drug themselves, the so-called miracle is likely very temporary, if it’s in reach at all. Experts say the drugs are meant to be taken long term and weight rebounds if a patient stops using them.
Dr. R. Richard Rasmussen, a gastric and general surgeon at Intermountain Utah Valley Hospital who’s an expert in medically supervised weight loss, told the Deseret News the drugs are new enough that the impact of long-term use isn’t known yet, either.
Meanwhile, some believe low-income individuals may not have access to the medications, even though they disproportionately face many of the potentially dire health ramifications of America’s overweight pandemic.
Semaglutide-based medicine is “not a silver bullet,” Dr. Marcus Shabacker, CEO of the independent nonprofit ECRI, which looks at the safety, quality and cost-effectiveness of health care, told the Deseret News. “But they need to be part of a well-thought-out therapy plan which includes dietary changes, lifestyle changes, exercise, access to healthy food, as well as drugs. They’re certainly part of a therapeutic regimen proven to be effective — aside from a cost many cannot afford.”
For those who can afford them, there’s another challenge at the moment — Ozempic is in short supply and many prescribed the drug to manage their diabetes cannot find any at their local pharmacy.
America’s weight problem
More than 4 in 10 American adults are obese — not overweight, but obese — increasing the risk of medical conditions like heart disease, stroke, type 2 diabetes and certain cancers, according to the Centers for Disease Control and Prevention, which said those are among leading reasons for “preventable, premature death.”
More weight than is healthy can also increase musculoskeletal problems and joint wear.
Nearly three-fourths of Americans 20 and older are overweight, the CDC says. Obesity rates are higher in rural parts of the country than in urban and suburban areas. The CDC says the estimated annual U.S. medical cost of obesity is around $173 billion a year. Medical costs are nearly $2,000 higher for adults with obesity each year than for those at a healthy weight.
And Americans spend as much as $70 billion a year on weight-loss efforts, as ECRI reported.
As NPR reported, “Of course, exercise and diet modification are still the first strategies to try. But given that about 70% of Americans are overweight or obese, nearly half of adults in the U.S. have hypertension and more than 1 in 3 have pre-diabetes, doctors’ groups cite an urgent need to layer on more interventions that can be helpful.”
Rasmussen said he doesn’t prescribe the weight-loss drugs, “but as I talk to patients who’ve been put on these medications, and as I talk to people who are prescribing them, they’re pretty optimistic. It’s had more weight loss than any of the medications that have been available for a long time.”
Some suggest the semaglutide-based drugs could become the equivalent of a chemical gastric bypass, replacing the surgery, he said. “I think it’s a little early to know that for sure. But hey, how great would that be if you could get significant weight off and control type 2 diabetes and heart disease without surgical risks?”
Shabacker noted neither Wegovy nor Ozempic are intended for casual users who want to lose a few pounds or to “style your body.” They are for people who are significantly overweight.
The side effects can be troublesome. Those are often but not always gastric, including nausea, diarrhea, constipation and heartburn. Some patients also complain of pain related to pancreatitis. NPR reported patients with a family history of thyroid cancer need to pay attention and discuss whether they have a particular risk with their doctor. “The drug does carry a black box warning because in rodent studies it caused thyroid tumors.”
Rebound weight
One concern with Wegovy as weight-loss medicine is that the weight could come back if the medicine is stopped.
Because the medications that use semaglutide are new, Rasmussen said, “I don’t think we know” if they need to be taken lifelong. “Definitely there are patients who stopped taking them who seem to regain the weight. … But how much have they changed their habits?”
Weight can be regained with different treatments, including surgical interventions, for different reasons, Rasmussen said. “What we find often in patients is they fall back into kind of some old habits and eat foods that the body can’t tolerate,” he said, noting one way to think about obesity is as an intolerance to carbohydrates. “And our modern food supply is just packed with carbohydrates in a variety of forms, so the deck is kind of stacked against anybody who has any genetic predisposition.”
Not everyone who regains weight didn’t stick with the plan, he added, noting obesity is a chronic disease. “If somebody has high blood pressure and you treat them with one medication and that’s not cutting it, then you need to add a second medication and sometimes a third medication. Similarly with obesity, if they’ve had surgery and they’re having some weight regain, well, maybe they do need the addition of a medication or meal replacements or other tools that are useful for the treatment of obesity.”
For those who regain weight, another factor could be involved, he said. “If you are obese and you’ve lost a significant amount of weight, the data shows that you’re going to forever need to consume fewer calories than somebody else who weighs that same weight.”
Rasmussen said a lot of subsidized foods that can be made — and thus sold — more cheaply “have ingredients that just don’t work as well for our body.” For people of a lower socioeconomic status, food can eat up more of their budgets.
The convenience aspect plays in, too. People who are exhausted at the end of the day eat out more and also eat more prepared, processed foods. “Our society just pushes us toward that,” he said.
And while insurance may cover obesity-related diseases like heart disease and high blood pressure, many don’t cover the cost to treat obesity itself, Rasmussen said.
“It’s interesting. If you look at bariatric surgery, for instance, there’s actually a return on investment. You can show after two, three years, that insurance company is actually going to save money, but they live in a world where they only look at it a year at a time,” he said.
Rasmussen said when the Affordable Care Act passed, 22 states had weight-loss surgery as one of the benefits and 28 states didn’t. Colorado is the only state that has converted from one that didn’t to one that did.
“That creates a barrier, because for that cheapest insurance plan, nobody wants to add it. And that’s where you’re getting back to the socioeconomic discussion,” he said. “That’s where a lot of those patients are coming into the market — in those types of plans.”
Overcoming cost
ECRI believes effective weight-loss drugs should be treated like other medications and “destigmatized,” Shabacker said. When someone has hypertension, they may be encouraged to exercise and watch their diet, but they’re also given beta blockers. He said exercise and diet are vital to address obesity, but so are effective medications.
In a position paper released in December 2022, ECRI said that “a large body of evidence shows that these drugs are beneficial as an adjunct to diet, exercise and counseling and should be considered for first-line treatment in many patients.”
Of weight-loss drugs in general, ECRI added, “Widespread skepticism among patients and physicians, unrealistic expectations of rapid weight loss, and the drugs’ side effects all limit drug uptake; however, the most important barrier is financial. … Most Americans can access weight-loss medication only through health insurance, but coverage for these drugs is limited. Weight-loss drugs are excluded from Medicare Part D plan requirements, and most Medicaid state plans and private plans qualifying for Affordable Care Act subsidies do not cover weight-loss drugs.”
Shabacker believes that patients and physicians alike should be putting pressure to bring the cost down and boost coverage, including by Medicare and Medicaid. And insurers should be talking to the manufacturer to request reasonable prices in exchange for more insurance coverage of the medications.
“It takes a village,” he said, “and the folks who work on Capitol Hill and make policy — they get visited more often than I care for by lobbyists, and they just need to take a stand.”
A societal problem like obesity, he said, creates societal responsibility.
He emphasized that ECRI is proud of its independence. “We have no reason to speak up about this other than we are interested in the well-being of the population and the patients out there. So we have no secondary motives — we’re not getting paid by Novo Nordisk or anybody.”