Ozempic’s weight loss promotion remains a slippery slope where different schools of thought collide. Moreover, more and more experts are sounding the alarm about its use not for its intended purpose.
#Ozempic, social media wave
Ozempic injection devices on Instagram and Facebook are a new accessory for weight loss enthusiasts. Communities are created to share strategies to get a prescription-only drug. Questions about the management of side effects also monopolize the debate.
The drug is taken on an increasing basis, when the doses are increased and adjusted in accordance with the metabolic response of people. This period for many means the widespread presence of symptoms such as nausea, diarrhea, vomiting and constipation. Some people also describe an aversion to certain food categories.
” These are pretty strong side effects, to the point that some people stop taking the medication. »
— Quote from Anis Uyakhia, pharmacist
Studies also show that discontinuing the drug causes weight gain to be regained, he says. The numbers are clear: we have a curve that drops sharply and an equally significant rise when Ozempic stops.
Influencers on TikTok are praising its weight loss effectiveness as they try to figure out if Hollywood stars’ sudden thinness is due to Ozempic. Elon Musk on Twitter(New window) attributed his recent weight loss to taking Wegovy (from the same class of drugs).
Faced with this phenomenon, doctors are trying to deal with this wave of popularity by trying to debunk the misinformation about this drug and target people who meet the criteria needed to use it.
Because people who really need it for their health sometimes get punished. Ozempic challenge(New window) (Ozempic challenge, in French) on TikTok will be held responsible for a drug shortage in Australia that will take people with diabetes by surprise for months, according to the country’s Therapeutics Goods Agency.
The use of this class of drugs, GLP-1 receptor antagonists, which include Ozempic, is not new. However, the new generation offers unprecedented results. Pharmacist Anis Ouyakhia says this is just the tip of the iceberg. Social networks are just a few months on fire from the mention of this drug.
” For me, Ozempic is the theme of 2023. »
— Quote from Anis Uyakhia, pharmacist
It’s an old story to offer miracle weight loss methods that make people believe that by pursuing the goal of losing weight, they will become happier, says psychiatrist Sylvain Iseta. They will exacerbate the risk of an eating disorder. Our celebrities like Elon Musk are not helping the cause.
The Science Behind Ozempic
Approved by Health Canada in 2018, the drug, developed by the Danish pharmaceutical company Novo Nordisk, is designed to treat type 2 diabetes and can lead to weight loss when combined with exercise and an adequate diet.
In Quebec, the Régie de l’assurance maladie (RAMQ) only reimburses prescriptions for Ozempic for type 2 diabetes. Radio-Canada’s RAMQ data mentions that the number of people with a prescription for Ozempic has decreased in the government’s plan. from 74 in 2019 to 34,373 in November 2022.
In the therapeutic arsenal for type 2 diabetes, Ozempic was the first injectable drug, far ahead of insulin, explains Dr. Remy Rabasa-Loret, endocrinologist. It lowers sugar levels with the accompanying benefit that in people with heart disease, the drug reduces the risk of a heart attack.
The active ingredient included in Ozempic, semaglutide, mimics a gut hormone already present in the body that triggers insulin secretion, regulating satiety signals. The brain sends a signal to the digestive system that hunger is satisfied. This latter property makes it a primary therapeutic tool for the medical profession, but also detracts from its primary function, which is the treatment of type 2 diabetes.
That’s why Novo Nordisk released Wegovy, which contains a higher dose of semaglutide than Ozempic and is only for weight loss. The drug was approved by Health Canada in 2021. However, the timing of its commercialization in the country remains uncertain due to high demand in the United States.
this medicine [sémaglutide] very effective,” says pharmacist Anis Uyakhia. We have this signal from the brain that tells the gastrointestinal system to stop eating. With the help of a diet, it is easy to return to cravings for food, and the weight returns. While here semaglutide manages to control it. But, in my opinion, this is the equivalent of a diet if a person does not take drugs all his life.
According to a published study(New window) in 2021, the New England Journal of Medicine observed a 14.9% weight loss after 68 weeks of weekly use of Ozempic in people who are overweight or obese when taking the drug in combination with lifestyle coaching.
When doctors prescribe off-label
The delay in marketing Wegovy in Canada is prompting doctors to prescribe Ozempic, which is meant to treat type 2 diabetes, off label. Anis Ouyahia questions the drug’s effects when administered to a population class that was not included in scientific studies.
The pharmacist knows patients who had access to semaglutide but were not diabetic and did not meet the criteria for a body mass index greater than 30 as outlined in the weight loss and Ozempic studies. Health Canada’s approval of an indication changes little, except that it formalizes the arrival of its regular prescription in the country.
Canadian Journal of Health Technology(New window) showed that the increased use of Ozempic is due in part to claims of other conditions or conditions other than type 2 diabetes.. For example, in some provinces, between 36 and 74% of people who claim reimbursement from federal government plans or private insurance companies do so when they do not have diabetes.
The threat of a shortage of Ozempic, as in the US or Australia, does not bother Dr. Rabas-Lauret, president of the Quebec Professional Council on Diabetes. However, I understand that some pharmacies have supply issues,” he notes. They are low on drug supplies and are almost restocked by the unit.
The British Columbia Department of Health estimates that nearly 10% of the population receiving a prescription for Ozempic in the province are US citizens. The government attributes these numbers to supply difficulties in the United States, prompting some people to cross the border to get it.
Blind spots and dietary culture
The use of drugs in the fight against obesity divides doctors. Benoît Arceneau, a researcher at the University Institute of Cardiology and Pneumology of Quebec, is concerned about the massive interest in semaglutide for weight loss.
This drug will improve the lives and health of many people, he notes. This is the consensus. Where white spots persist is that they reinforce stereotypes in diet culture that thinness equals health.
The researcher refuses to link obesity to the disease. The very fact of having a lot of weight does not justify this, he believes. You can’t tell two million people in Quebec overnight that they have a disease because of a number on the scale.
BMI remains an indicator used to explain the use of semaglutide for weight loss. However, this tool has been contested for several years, in part because it is only one of many indicators for measuring health status and because it has limitations.
More research is needed to find out which patients would benefit from this drug in terms of disability, says Benoit Arceneau. We have no data on the effects on quality of life, self-esteem, or people with eating disorders.
Stephanie Leonard, a psychologist who specializes in the treatment of eating disorders and eating behavior, visited several people for a consultation who discussed with their doctor the possibility of using semaglutide for weight control. Discussing with me, they all decided not to go down that path because it went against the work they were doing on their relationship with food.
A drug like one that reduces appetite, makes you crave certain foods, or makes you feel full quickly can make eating disorders worse once you stop taking it, says Stephanie Leonard. Have we really worked on our relationship with food? It doesn’t fix anything.
Should Quebec’s government plan reimburse Ozempic’s purchase?
Obesity drugs have been excluded from the general drug insurance plan, RAMQ, since 1997, and there are no exceptions even for people awaiting transplants.(New window).
In the eyes of the authorities, obesity is associated with an aesthetic problem, laments Dr. Rabasa-Loret. I have never had anyone compensated by a public plan for this. If I wrote, “Madame needs semaglutide to gain normal weight for a life-changing transplant” or “Madame needs semaglutide to lose 10 pounds for her wedding,” RAMQ’s answer would be the same. It’s unfortunate.
Eyes on the National Institute of Excellence in Health and Human Services (INESSS), which advises the government on medical conditions for which an exceptional drug is reimbursed. What would INESSS recommend for the use of semaglutide for weight loss? Doctors are eagerly awaiting the organization’s findings.
According to pharmacist Anis Uyakhia, only part of the population should enjoy benefits. The first criterion will be an obese adult patient with a BMI greater than 30, or the second criterion will be an overweight adult patient with a BMI greater than 27 who has a risk factor for cardiovascular disease, high cholesterol, hypertension, sleep apnea. or other cardiovascular diseases.
The pharmacist also wonders about the ability of the state to pay in the long run, since stopping the drug leads to weight gain. In his opinion, the question that the Ministry of Health should ask INESSS should be about the duration of the recommended coverage.
For endocrinologist Remy Rabas-Lauret, obesity is a chronic disease that the government and medical professionals should treat. He notes that in Quebec, the state does not provide reimbursement unless there is follow-up in hospitals for lifestyle-related care such as nutrition, psychology, or kinesiology. The drug must be administered through the 2nd or 3rd line, accompanied by specialized support. The priority in the current public system will be to cover these services, followed by reimbursement, in certain well-defined cases, for the cost of the drug.