November 29, 2022 — There’s weight-loss advice everywhere you look on social media, but one trend sweeping TikTok has led to a shortage of an important diabetes drug.
Ozempic, a weekly injection that helps increase insulin sensitivity in people with type 2 diabetes, also reduces appetite, leading to weight loss. Stories of celebrities using the drug off-label to lose a few pounds has led to an explosion of interest. And now diabetics – the people whose lives could be saved by the drug – are having a hard time finding it.
Kim Kardashian and Elon Musk
In the spring, Kim Kardashian made a significant weight loss to fit into a Marilyn Monroe dress at the Met Gala. Rumors soon began circulating that she was going to do so Ozempic is used To do that. Just this week, new Twitter owner Elon Musk tweeted about it own use Ozempic and its sister drug, Wegovy.
diverse Ozempic has been called “the worst in Hollywood—especially considering its most enthusiastic users are neither diabetic nor in need of the drug”. The rich and famous spend $1,200 to $1,500 a month for access.
As often happens, prominent usage sparked a trend. The videos are tagged on TikTok #retweet It has accumulated over 275 million views, and # ozymbicozen loss It has more than 110 million.
This raises concerns about who exactly is watching these videos, and what message they are getting.
42% of Americans are obese, and even more are overweight. “This affects our young adults and teens,” says Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. “They are looking to TikTok and other social media for help.”
A new study shows how damaging that can be: Researchers analyzed 1,000 videos with nutrition, food, and weight-related hashtags, with more than 1 billion views combined. They found that almost all of them included messages glorifying weight loss and being thin.
Finally, an effective weight loss drug
Ozempic is the Danish drug company Novo Nordisk’s brand name for semaglutide, which works by mimicking a naturally occurring hormone known as GLP-1. It travels to your brain and helps you feel full when you eat less. This leads to weight loss. In one 68-week study, semaglutide helped people lose an average of 15% of their body weight. But it’s not a miracle drug: You still have to change your eating habits and stay physically active.
The U.S. Food and Drug Administration approved Ozempic to treat people with type 2 diabetes in 2017. Four years later, Novo Nordisk received the green light for a higher dose meant for people with obesity. Wegovy is only approved for use if your BMI is at least 27 with one or more weight-related diseases, or if your BMI is 30 or greater with none.
“These medications dominate my work, because they’re so effective,” says Amanda Velasquez, MD, director of obesity medicine at Cedars-Sinai Medical Center in Los Angeles. The drug is considered safe, “so the majority of patients are good candidates.”
More demand than supply
As word spread about how well Ozempic and Wegovy were working, social media posts helped lead more people to seek out the drugs. Now demand exceeds supply – according to the FDA, starting doses of Ozempic will be limited through January.
“In Hollywood, people lose 10 pounds, gain it for $1,500 a month, and drain the stores for people who are so obese that they have congestive heart failure and diabetes,” Abovian says. “These are the people who are going to die, and you’re walking away from it just for cosmetic weight loss. That’s unfortunate.”
In addition to the huge demand, Wegovy also had a disruption in its supply chain. Currently, it is not available at all in lower doses, which helps drive the off-label demand for Ozempic. Novo Nordisk expects to resolve these issues by the end of the year, with the next distribution shortly after.
Access price
With a list price of $1,350 per month, Wegovy’s cost is worth many mortgages. And Medicaid, Medicare, and many insurance companies don’t cover it. Although obesity is a disease, the insurance industry treats weight loss as a vanity issue — so even if you can find medication, you may not be able to afford it.
“We see that nearly half of the prescriptions we write are not covered,” Abovian says. “And for the half that’s covered, we have to do a pre-authorization, which takes days, and it’s tedious.” In some cases, she says, insurance companies withdraw permission after 3 months if they don’t see enough weight coming off.
It’s not like you can take Wegovy for 3 months, lose some weight, and expect to keep it going, too. Medication requires a real commitment, potentially one that will last a lifetime. This is because once semaglutide leaves your system, your appetite returns. In one study, people regained two-thirds of the weight they lost within a year of stopping.
Many see a double standard in insurance companies refusing to cover a drug that could prevent serious illness or death.
“They’re saying it’s not cost-effective to give the 42% of Americans with a BMI over 30 Wegovy. Did they say that when the statins came out?” Abovian says. “Why would they do this with anti-obesity agents? It’s the culture. The culture is not ready to adopt obesity as the disease.”
Unpleasant side effects
Let’s say you’re one of the lucky ones – Wegovy is covered by your insurance, and you can actually find some. You may discover that using it is not a walk in the park. Common side effects include gastrointestinal problems such as nausea, vomiting, and diarrhea.
“The way we counter that is by starting very slowly on a low dose of these medications,” Abovian says. “We only go up when the patient is no longer feeling sick or getting better.”
Elise Davenport was excited to try Wegovy. “I did my research online. I’m kind of into early adopters, tech gadgets and stuff,” says the 40-year-old tech writer. “I wanted to give it a try because I’ve tried so many other things that either failed, or didn’t work in the long run.”
With a BMI over 30, Davenport qualified for the drug. I signed up for an online program that guaranteed insurance coverage and started taking it in October 2021. At first, the side effects were mild, just a touch of nausea and diarrhea. The results were impressive. I found it easy to feel satisfied with smaller portions and lost cravings for sugar and processed foods. Weight decreased, approximately 5 pounds per week.
It turns out that this is too much, too fast. With close monitoring, Abovian and Velasquez say their patients lose more than 2 pounds each week.
By early December, Davenport’s side effects were increasing. Due to a shortage of lower doses, the online program was unable to adjust them immediately. She was feeling nauseous the whole time, a feeling so bad that brushing her teeth made her vomit and she had to force herself to eat. Some weeks, I managed under 500 calories a day. Her sleep patterns became erratic. Then her depression, which had been kept under control for years by medication, escalated.
“I remember sitting on my bathroom floor crying, thinking I’d rather hold the extra weight,” she says. “I used to enjoy food a lot, and I don’t have anything like that anymore. It was quite a fun experience at that point.”
Eventually, her dose was reduced and her symptoms eased, but her primary care physician encouraged her to stop. By the time she did, in March, she had lost 55 pounds. To date, I have recovered almost 10 years.
More than just losing weight
Even though Davenport’s experience wasn’t as good, with better observation she’ll be willing to try again. For one thing, seeing how easy it was to eat less with medical help helped undo years of shame.
Our culture treats obesity as a moral failure. I realized I was made to feel this way by doctors and programs — because I wasn’t doing enough,” she says. “This medication made me realize that there were legitimate physiological things going on in my body, things that often get left out of conversation.”
Abovian and Velasquez say their patients regularly discover similar things.
“Obesity is not a disease of willpower. Medications are not the easy way out,” says Velazquez. “This is a chronic, relapsing medical condition, and because of that, we have to treat it how we treat diabetes, high blood pressure, and all these other conditions. We will never stop medication for individuals with high blood pressure, and tell them to work on willpower and stop medications they qualify for.”
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