How Should We Handle a Drug That’s Both a Medical Necessity and a Weight-Loss Hack?
Reading Time: 7 minutesThe Complicated Truth Behind Hollywood’s Favorite Weight-Loss Hack, Why are celebrities taking Ozempic?
By now, you’ve probably heard of Ozempic: the brand-name of a medication meant to treat Type 2 diabetes. Ozempic and its cousin Mounjaro (along with Wegovy, meant to treat obesity) work by mimicking a hormone called GLP-1, effectively lowering blood sugar levels. But these drugs can also tweak hunger signals in the brain, making people feel full, or generally disinterested in food. And that’s what’s made these drugs popular for already slim people looking to lose weight—including, of course, in Hollywood.
What does it mean when a drug can profoundly alter weight, health, and our relationship with food? On Sunday’s episode of What Next: TBD, I spoke with Matthew Schneier, feature writer for New York magazine, about the rise of Ozempic. Our conversation has been edited and condensed for clarity.
Lizzie O’Leary: In your story, you wrote about a medical conference when precursors to these drugs were introduced—and the doctors in the audience were stunned by how well they worked. Tell me more about how doctors have received these medications.
Matthew Schneier: I think it is really a mark of the incredible enthusiasm they have for these drugs, and more for the results. One doctor I spoke to, who’s the chief scientific officer of the American Diabetes Association, was describing being at a scientific meeting when results were announced for one of the predecessor GLP-1 drugs. He said that there really were cheers in response to what these drugs could do. For cardiovascular health, it really did feel like a game changer. From speaking to the medical community, these GLP-1s really were a significant step forward in the treatment of diabetes and associated conditions, including obesity and weight management.
When did they hit the market in a widespread way?
It’s a complicated answer, because there are a number of GLP-1s. Ozempic was approved in 2017 and started being prescribed around then, and it was a success initially. But, as it has penetrated the market, as doctors and prescribers have become more aware of it, and now certainly as the wider public has become more aware of it, it has really exploded in a wild way. I spoke to a number of people working at medical analytics firms and they said to me, ‘When new drugs are brought to market or indications expanded, you do often see an uptick in prescriptions and usage.’ But one doctor I spoke with said, ‘I’ve never seen anything like this.’ And the numbers are eye-opening: There were 1.2 million prescriptions filled for just the drug Ozempic this past December. That was up 64 percent from the December before. That’s just one of these three drugs. The operating profits of Novo Nordisk, the company that produces Ozempic and Wegovy, are up 58 percent since 2017, when Ozempic was first brought to market.
Maybe it seems obvious that a drug that makes you lose weight would be popular in an industry where being thin is not just an advantage, but often a requirement, and where off-label prescriptions can be easy to come by. When did Ozempic—and its cousins—take over Hollywood?
It happened slowly and then all at once. Part of the story of this drug is that it has become really a name-brand in the sense of public recognition. One doctor I spoke with said, ‘Not since Botox or Viagra has a drug like Ozempic come along that people instantaneously know and ask for by name.’ When you think about things like Botox and Viagra, I mean, those have essentially entered the vernacular.
Robert Gabbay, the chief science officer of the American Diabetes Association, told me this is the first diabetes drug to be viral in the age of social media. The more Hollywood it gets, the more it blows up culturally coast-to-coast; the more it blows up culturally coast-to-coast, the more Hollywood people realize it may be an option for them—and so on. It’s safe to presume that some of these celebrities are getting it prescribed to them, and so their numbers are being adequately reflected in the prescriptions, but some are getting it through other means, and there’s no real easy way to quantify that.
But the drugs aren’t cheap. How much are people paying for them?
If you’re getting Ozempic from your doctor, the list price is about $900 a month, depending on where you’re getting it—there may be manufacturer coupons, there may be different deals with pharmacies. Wegovy and Mounjaro tend to be a little bit more than that, sort of in the $1,000 to $1,300 a month average.
As the drugs become more popular for weight loss, there are lots of stories about diabetics who can’t fill their prescriptions. What happens if you’re a diabetic who needs these drugs but can’t get them?
It’s a real concern, and there is certainly anecdotal evidence that, at least last year, people who needed it for diabetes were having a hard time getting it. Part of that was a supply chain issue, there were some issues with the production chain. Officers from the company said very clearly, ‘We expected this drug to do well. We did not expect it to do so well. Had we known that, we might have built the supply chain in a different way.’ I certainly spoke to patients who said to me, ‘I was shunted from pharmacy to pharmacy looking for this medication.’ Doctors told me their patients were emailing them nearly constantly saying, ‘I can’t fill this prescription. What do I do?’ People were cutting doses in half to stretch them out. It’s hard to know if that was a direct result of specifically people taking it off-label, but I think it’s completely fair to say it was absolutely a knock-on effect of the drug’s incredible popularity, which was driven by both on- and off-label use.
There’s a statistic in your story that blew me away: 81 percent of prescriptions for these drugs are written for women. On the one hand, women are constantly bombarded with messages that we aren’t thin enough, and it felt depressing that those numbers meant maybe we were giving in to that pressure. On the other hand, a lot of people—people whose doctors have advised them to lose weight—have testified that these drugs finally helped them do it after years of struggling. And now, they feel freer and healthier and better about themselves.
One thing that’s important to bear in mind is as much as it is a drug that people are using off-label for reasons that we might consider less than medical or cosmetic, it’s also a drug that is having a really significant effect on people’s well-being, people who may have struggled with these issues for years, if not their entire lives. The statistic about 81 percent [of people] receiving these medications [being women] startled me as well. Generally speaking, women seek medical care more readily and more frequently than men do, so, some of that comes into play. I do think that while men also struggle with body image, we know that this is a problem that disproportionately affects women and girls.
Wegovy has been approved for use in patients as young as 12. The American Academy of Pediatrics revised its obesity treatment guidelines at the very beginning of this year to basically OK, if not outright encourage, the use of medications to deal with obesity. So that also is a kind of collision course between this medicalized treatment and the messages we are bombarding young girls with on social media, general media, and culture.
A lot of doctors are really excited about the potential of these drugs to treat obesity, something that affects roughly 42 percent of Americans, according to the CDC. And obesity can come with all kinds of downstream health effects like high blood pressure and heart disease. Were the doctors you spoke to frustrated by the Hollywood weight loss drama surrounding these drugs?
I want to be very careful, and I also want to continue to underscore, I am not a doctor, this is not medical advice. Doctors, and especially endocrinologists and those with subspecialty in obesity, will tell you there are associated health risks to obesity and being overweight.
That is not to say that anyone who is overweight or obese is by definition unhealthy. And it’s certainly not to say that anybody who is within a normal weight category or underweight is themselves healthy—health is a matrix and there are a million factors that inform all of these things.
That said, in broad strokes, the potential for medical problems associated with obesity—cardiovascular problems, diabetes problems, things like this—is real. I think the reason that doctors are prescribing these medications, especially to diabetic patients, is not specifically for the weight loss, but that is a non-incidental side effect. If diabetics need to manage their blood sugar, managing blood sugar is easier when weight is under control.
One important wrinkle is that these drugs haven’t really been on the market long enough and tested enough in a nondiabetic population to know all of their side effects.
Generally speaking, these drugs are well tolerated. That is generally speaking. Almost every patient I spoke with had some side effects ranging from mild to significant. They typically lessen as your body adjusts and you take some time to move up in dosage. The most common ones include nausea, vomiting, diarrhea, and constipation. Some people also mentioned fatigue; some people also mentioned headaches. It’s every patient and doctor’s in-consultation decision whether the side effects are worth the benefits.
One other thing that comes through in your story is the secrecy and shame around taking these drugs. It’s almost like an injection—rather than some grueling regimen of workouts and calorie restriction—is seen as cheating.
I think it’s twofold. One, I think there is the ethical murkiness around some of these people taking this medication in an off-label way. No one wants to brag that they’re taking a medically necessary drug out of the hands of people who need it for medicine. Secondly, we culturally have a very complicated relationship with diet and exercise and kind of the ‘right’ and ‘wrong’ ways to manage body weight. There still seems to be the long hangover of this idea that the ‘correct’ diet is one that is effortful and painful, and that there’s a sort of moral benefit to losing weight that way. I think some people either feel or fear that others will feel that losing weight via injectable drug feels like a kind of unnecessary, unfair shortcut.
There’s also something that feels very American or individualistic about these drugs as a kind of weight-loss solution. They’re not addressing an inequitable food system. It’s not helping people get preventive care earlier in their lives. It’s an injection; it’s an injection you can buy. I’m not sure what to do with that. I’m not sure where it fits into that puzzle.
Diabetes in America affects tens of millions of people. This is a major issue—and also, not unrelatedly for these drug companies, a major market and a major opportunity. And so, while it’s very easy, and maybe to some extent correct, to worry that this is a patch on a necessary larger solution, I think it’s also possible to look at these drugs and see that for the people who need them, they’re providing a good and necessary service. And when used appropriately and within a doctor’s care, they shouldn’t be stigmatized, and they shouldn’t be a source of shame.
If you or someone you know is struggling with an eating disorder, the NEDA Helpline is available online, or via text or over the phone at 1-800-931-2237.
Reference: https://slate.com/technology/2023/03/ozempic-debate-hollywood-weight-loss-diabetes.html
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