Despite movements promoting body positivity and \”fat acceptance\”, new drugs that can result in people losing up to 20 per cent of their body weight have been met by overwhelming demand.
The diabetes drug Ozempic has experienced worldwide shortages this year as an off-label weight loss tool, highlighting the huge popularity of pharmaceutical weight loss treatments.
It\’s likely to be just the beginning of a new wave of much-hyped drugs, according to obesity expert Professor Michael Cowley of Monash University in Melbourne.
\”I think we\’re going to have a variety of choices of medicine very soon – next five years we\’ll have half a dozen drugs that cause really substantial weight loss,\” Professor Cowley said.
While other weight loss drugs are already available, including one Professor Cowley has developed himself, they return more modest results than Ozempic, with people only losing up to 5 per cent of their body weight and also suffering various side effects.
Ozempic was developed to help people with type 2 diabetes manage their blood sugar levels but it can also lead to significant weight loss of 15 to 20 per cent of body weight in some people.
The Therapeutic Goods Administration (TGA) has already approved a higher dose of semaglutide, the active ingredient in Ozempic, to be sold as in Australia for weight loss among those with a (BMI) over 30 but this is not yet available due to supply shortages.
Novo Nordisk, the manufacturer of Ozempic, says it has experienced \”stronger than anticipated demand\” leading to worldwide shortages. Desire for the drug has been driven in part by users of social media platforms TikTok and Facebook who have raved about its effectiveness in helping them lose weight.
There have been worldwide shortages of diabetes drug Ozempic due to off label prescribing for weight loss. Source: AAP / Jason Bergman/Sipa USA
Professor Cowley said semaglutide is the first really effective drug for weight loss.
\”So for the first time people who are living with obesity have a pharmaceutical option – they can actually lose meaningful amounts of body weight,\” he said.
How does semaglutide work and what are its drawbacks?
Ozempic\’s active ingredient, semaglutide, works by mimicking a hormone released by the intestine to stimulate insulin secretion and to slow down the movement of food from the stomach to the intestine, both of which reduces blood glucose. The hormone also acts in the brain to induce sensations of fullness.
Ozempic, which is delivered as a weekly injection, is not without its drawbacks though, and can leave people feeling nauseous and even cause vomiting.
Professor Cowley said studies showed many people also regain most of the weight they lose within 18 months of stopping the drug.
Loss of muscle mass is another side effect, and it\’s unclear whether people regain the muscle when they stop using the drug.
It\’s important to keep muscle mass as you get older as it helps to keep people active. Source: Getty / FreshSplash
\”You can imagine you end up in this cycle of weight loss and weight regain … that erodes your muscle mass. And we know that muscle mass is the most important thing to keep as you age,\” Professor Cowley said.
\”Muscle is what keeps you active … and keeps you healthy as you get older.
\”If we\’re driving a cycle of muscle loss, then we\’re actually going to be making a rod to beat ourselves with.\”
While social media posts suggest celebrities and other healthy weight people are also using Ozempic to drop a few kilos, Professor Cowley said the drug had not been tested in people who are not overweight, so the health impacts on them were unclear.
Ozempic posts are prolific on TikTok.
Debate around shortages has \’vilified\’ people with o
besity
The craze around Ozempic has created a negative perception that everyone using the drug for weight loss is being selfish, and the drug should be preserved for the estimated 1.2 million Australians (around 4.9 per cent of the population) who have type 2 diabetes and need it to manage their blood sugar levels.
Director of The Obesity Collective, Tiffany Petre, said people with obesity who had been prescribed Ozempic were being \”vilified\” and blamed for the worldwide shortages.
People with obesity are using Ozempic prescribed off-label because the weight loss version, Wegovy, is not yet available in Australia.
Novo Nordisk, the manufacturer of Ozempic and Wegovy, said more supplies of Ozempic were due to become available in Australia by the end of March but it\’s unclear how long it will take to get Wegovy.
\”Novo Nordisk is working hard to make Wegovy available for patients living with obesity as soon as possible. The timing of its availability in Australia is not yet confirmed,\” a company spokesman said in a statement.
Ms Petre said the debate around who should be using Ozempic had been really harmful and this was not helpful in stigmatising those with obesity.
\”[It] has really shown that stigma is still extremely prevalent and harmful, with people saying that people with obesity don\’t deserve healthcare,\” she said.
\”There\’s been this real misconception that people are just taking Ozempic because they want to be skinny, and of course there are some people on TikTok doing that, but there are people out there that have really serious health conditions linked to their weight like heart disease, arthritis, fatty liver disease, PCOS [polycystic ovary syndrome], and they\’ve been trying to work with their doctors to manage that.\”
But Ms Petre said there was hope the development of Ozempic would also raise awareness about biological drivers of obesity, and correct the misconception that losing weight to improve health was just about willpower.
There\’s been this real misconception that people are just taking Ozempic because they want to be skinny.
The Obesity Collective director Tiffany Petre
Once someone has obesity, Ms Petre said it was more difficult for them to lose weight and keep it off because certain biological processes become dysregulated including metabolism, appetite control and hormone functions.
According to The Obesity Collective, obesity stigma is associated with physical and mental health consequences including depression and anxiety, disordered eating, and decreased self-esteem. It also leads to inequities in employment, health care and educational achievement.
People living with obesity face harmful stereotypes
Andrew Wilson, who is the engagement lead at obesity advocacy organisation, the Weight Issues Network, said there were many stereotypes about people with obesity including that they were fat, lazy and stupid.
\”I feel like we have to really prove ourselves more than other people do because of our weight, I feel we have to go the extra mile to prove that we are good at our job,\” he said.
Andrew Wilson says people living with obesity face stigma. Source: Supplied
Mr Wilson, who is living with obesity, hoped the discussion around Ozempic would make people interested in learning more about obesity and its causes.
\”We know now that obesity is not just as simple as exercising more and eating less, we know there\’s a lot of biological factors, there\’s a mental health component for a lot of people that can be tied to childhood trauma, and injury,\” he said.
Mr Wilson has welcomed more treatment options like Ozempic as long they are readily available. But at the moment this is not the case.
No subsidy for weight loss drugs
Professor Cowley believes the stigma attached to being overweight or obese may be preventing governments from subsidising treatments like Ozempic for those struggling with their weight.
He said Wegovy – the weight loss version of Ozempic – is not included on the Pharmaceutical Benefits Scheme (PBS) and so even if it was available in Australia, people with obesity would be paying a lot more for it, compared to those using it to treat diabetes.
People with diabetes who have a doctor\’s prescription can buy Ozempic for $30 and it\’s even cheaper if they have a concession card.
But those who have obesity with a doctor\’s prescription to use Ozempic for weight loss, have to pay up to $200 for a month\’s supply as they are buying it off-label for a different use.
People are paying up to $200 a month for Ozempic if they want to use it for weight loss.
A spokeswoman for the Federal Department of Health and Aged Care said a medicine can\’t be listed on the PBS unless it is recommended by the independent expert Pharmaceutical Benefits Advisory Committee (PBAC).
The committee assessed an application from Novo Nordisk for PBS listing of Wegovy in March 2022 but came to the conclusion it should not be supported.
In the model
led benefits were highly uncertain, and the listing would not be cost-effective at the requested price. It said any further application should include more information including revised financial estimates.
At the moment no treatments for obesity are eligible for PBS subsidies, although several are registered with the TGA.
Professor Cowley said drugs like Wegovy should be subsidised as losing weight was good for patients, making them healthier and costing the economy less.
In Australia, the proportion of adults who are overweight or living with obesity has increased from 57 per cent in 1995, to 67 per cent in 2017–18. This was largely due to an increase in obesity rates, from almost one in five (19 per cent) in 1995, to just under one in three (31 per cent) in 2017–18, according to the .
\”We don\’t blame people for having problems with gambling, we don\’t blame people for other problems that happen in the brain, but for some reason we want to persecute people who have become obese,\” Professor Cowley said.
\”And because of that stigma, it\’s politically unpalatable to use the public purse to pay for drugs for obesity I believe, but we don\’t provide enough obesity surgery for people either.\”
Professor Cowley hopes to remove the stigma attached to obesity so that people can access the treatments they need.
\”I hope that we can de-stigmatise the disease to the point where we can use PBS to support the interventions, whatever drug people want to use, or whatever surgical people want to use, because it\’s beneficial to society,\” he said.
How do weight loss drugs impact mental health?
Unlike previous weight loss drugs, Deakin University eating disorder researcher Dr Mariel Messer said semaglutide did not seem to be causing mental health related side effects, such as anxiety and mood swings, but people still needed to remain cautious.
Dr Messer said the use of medications like weight loss pills could damage the relationship people had between food and their body.
\”It really provides an over-emphasis on calories as being bad, and weight loss being good,\” she said.
She said the emphasis on weight loss over health might lead to people thinking that weight loss defines them, especially if they get lots of positive comments from friends and family. Individuals may also come to believe they are heavier than they are, or have an over-valuation of their shape. This is a core feature of many eating disorders like binge eating.
\”There\’s evidence [of] psychological outcomes, like increased depression for those that have taken weight loss drugs, but [who] then cease that and then regain that weight,\” Dr Messer said.
As with any medication, Dr Messer said tolerance could also develop so people might need higher doses of the drug for it to have the same effect \”and that can lead into a slippery slope into addiction as well\”.
\”I think we just have to be cautious of prescribing these drugs with the aim of weight loss, but also ignoring the psychological health of the individual,\” she said.
She said it was important that individuals were aware of the importance of healthy eating and exercise even if these things had not helped them lose weight in the past.
\”It\’s not a one-stop solution to [take pharmaceutical weight loss treatments],\” she said.
\”You may lose weight, you may improve your physical health but also be aware that weight loss is not everything and you can value yourself in other ways.\”
What do new drugs like Ozempic mean for \’fat acceptance\’ and \’body positivity\’?
Dr Messer said it would be interesting to see what impact the availability of effective weight loss drugs would have on the and whether there would be even less acceptance of people who were of a higher weight.
\”If we do have these weight loss drugs that decrease these high incidences of obesity, how is that going to change our psychological perception?\” she said.
Organisations such as the National Association to Advance Fat Acceptance in the United States, which aims to change perceptions of fat and end size discrimination, are already warning that drugs like Ozempic risk entrenching stigma and activists fear people may be pressured to take them if they want access to the same rights as those who are non-fat.
Some members of the fat acceptance movement consider the term \”obesity\” to be problematic because it is based on the idea that obesity is a disease to be cured and reinforces stigma.
In contrast, the body positivity movement promotes the acceptance of all bodies regardless of size and other physical attributes, but singer has noted the term had evolved to include all bodies not just the \”big women, big brown and Black women, queer women\” who created it, and they no longer seem to be benefiting from the mainstream success of it.
Lizzo has urged people to uplift the \”big\” bodies that created the body positivity movement. Source: AAP / AP / Charles Sykes
\’No silver bullet\’: Lifestyle intervention should still be the first step
Australian Medical Association president Professor Steve Robson said it was very important for people wanting to lose weight to discuss this with their doctor, in the context of their broader medical history and personal circumstances.
\”There is no silver bullet to tackling obesity and the AMA supports comprehensive and broad public health interventions to prevent obesity,\” Professor Robson said.
\”There is a role for pharmacological treatments for obesity, however, these treatments need to be provided in conjunction with counselling, monitoring and behavioural change interventions.\”
Obesity expert Dr Nicholas Fuller of the University of Sydney, said the first step for anyone seeking to lose weight for health reasons should be lifestyle intervention.
But he acknowledged that maintaining weight loss with diet, exercise and sleep habits, does take time and is not easy.
This makes options like Ozempic enticing to many, Dr Fuller said.
\”As a population, we\’re always looking for that next thing, we\’re always looking for the quick fix, we
want the magic bullet, we want to lose the weight now,\” he said.
But Dr Fuller said drugs like Ozempic should only be used after multiple failed attempts at lifestyle intervention first. He noted Ozempic stopped working once people stopped taking it, and so people still had to make changes to their lifestyle, their eating habits, activity and sleep routine.
As a population we\’re always looking for that next thing, we\’re always looking for the quick fix, we want the magic bullet, we want to lose the weight now.
Dr Nicholas Fuller, University of Sydney
\”You can lose weight and you can keep it off long term through lifestyle intervention, but only if you\’re following evidence-based intervention, not fad diets or weight loss diets that promise that magic cure and give those quick, instant results people are looking for,\” he said.
He said more education was needed to push people towards evidence-based lifestyle interventions, and they needed to see healthcare professionals who knew how to deliver long-term effective care.
Dr Fuller said people needed to set long-term goals that weren\’t just focused on a number on a scale, whether that was wanting to be healthier, or living longer to see their kids grow up.
\”If you\’re looking for a quick fix, you\’re never going to get that long-term result you\’re looking for.\”
Readers seeking support for eating disorders and body image concerns can contact Butterfly Foundation on 1800 33 4673. More information is available at
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