Front Burner - Should everybody be taking Ozempic?

Episode Date: December 11, 2025

It's estimated that as many as 10 per cent of adults in Canada use a GLP-1 type drug like Ozempic. The prescription medicine is used for type 2 diabetes management and increasingly prescribed off-label for weight loss. And this month, for the first time, the World Health Organization has conditionally recommended GLP-1 drugs for the long-term treatment of obesity.But while these drugs have been called a game-changing tool to manage a complex and stigmatized health condition, there’s also a lot of questions about the potential negative impact.With Ozempic’s patent set to expire soon in Canada, and more affordable generic options about to hit the market, a lot more people you know could end up on a weight-loss drug.Today we bring you the rise and risks of GLP-1s with help from Dylan Scott. He is a Senior Correspondent at Vox who covers health.For transcripts of Front Burner, please visit: https://www.cbc.ca/radio/frontburner/transcripts

I'm a bit of a spontaneous traveler, and I don't always know where I'm going to be or how long I'm going to be there. And that's where Aerolo comes in. An e-sim from Aerolo allows me to get internet coverage, whether I need it for a specific country, an entire region, or globally. It's easy to set up and I can top up as I go without having to swap out SIM cards. It's the perfect way for me to stay connected. Just download the Aeroa app, pick your destination E-Sim, including plan length and data amount, install, and you're connected the moment you land. No surprise roaming fees, no airport kiosks, or sketchy public Wi-Fi. Instead, just pay for the data you need.

Stream your playlist, scroll, text, navigate, and video call home, all without watching your phone bill explode. Plus, Aero Lo works in over 200 destinations and is trusted by over 20 million travelers. So, if you have an international trip, download the AeroA app or visit Aero.com. That's A-I-R-A-L-O-com, and use the code Roamsmart for 15% off your first ESIM. Terms apply. This is a CBC podcast. Hi everyone, I'm Jamie Poisson.

In the past 16 weeks, I've lost just under 25 pounds, which is great. Two weeks ago, I was 214. Today, I am 208. That means we've officially hit 40. overall. So you have, I am sure, heard of medications like OZempic, Manjaro, and Wigovi. OZemphic is by far the best-selling drug in Canada. The prescription medicine is used for type 2 diabetes management and increasingly prescribed off-label for weight loss. It's estimated that as many as 10% of adults in Canada use a GLP1 type drug like OZMPIC. And this month, for the first time, the World Health Organization has conditionally recommended GLP1 drugs for the long-term treatment of obesity.

And while these drugs have been called a game-changing tool to manage a complex and stigmatized health condition, there's also a lot of questions about things like intense side effects, dangerously rapid fat and muscle loss, and the potential for abuse of the drug. And with Ozempix patent set to expire soon in Canada and more affordable generic options about to hit the market, a lot more people you know could end up on a weight loss drug. Today, we bring you the rise and risks of GLP-1s with help from Dylan Scott. He is a senior correspondent at Vox who covers health. Dylan, hey, great to have you.

So there's so much to talk about today, but let's start with the latest news. Earlier this month, the WHO issued conditional guidelines recommending GLP1 drugs for the long-term treatment of obesity and adults. This new medicines are a powerful clinical tool offering hope to millions. But let me be clear, medication alone will not solve the obesity crisis. Obesity is a complex disease that requires comprehensive lifelong care. What do you think drove the WHO to do this? What's the big argument for this class of weight loss drugs? So I think first and foremost, the argument starts with obesity is one of our biggest global public health challenges. As the WHO said in its announcement, it contributes to almost four million deaths worldwide every year. And without intervention, rates of obesity are only expected to rise.

And, you know, as we've long known, obesity is associated with a range of health conditions from cardiovascular disease to diabetes to even certain types of cancer. And, you know, even especially as, you know, countries continue to develop and, you know, incomes and living standards tend to rise in other parts of the world. One of the few sort of tradeoffs of that kind of progress is that obesity can become more common in those places. It tends to be a disease of wealthy countries. So I think WHO is looking at that kind of public health reality and recognizing that, hey, we have maybe the most effective intervention that we have ever seen to help people lose weight and go from being obese to a healthier weight. You know, these, as a lot of people, I'm sure know, these GLP ones have proven remarkably effective in that. You know, the first class was in the clinical trials helped people lose like 15% of their body weight. And some of these more recent additions are even more effective pushing that up to 20%. So I think WHO is like, hey, we've got a new medicine that's proving really effective in addressing this global problem. And by drawing attention to it, maybe we could help to, you know, expand access, start thinking about cost and access and how we could get this drug, you know,

not just to the people in the U.S. and Canada, who are already well till being well off, but to people in other parts of the world who would also benefit from having access to these medicines, but maybe wouldn't without somebody like WHO putting their fingers on the scale. Our greatest concern is equitable access. Without concern, concerted action, these medicines could contribute to widening the gap between the rich and poor, both between and within countries. Tell me a little bit more about how it works for people. Like, what did people who have had a successful time on GLP-1's report feeling, I know there's a lot written about this idea of quieting food noise. Yeah, so GLP-1s, as best we understand them, and this is,

you know, we are still kind of learning exactly how these drugs work and why they have the effects that they do. They at least, they work in at least two different ways. One is that like in your, in your guts, in your intestines, where you actually have naturally occurring GLP-1, they help to slow down digestion, make you feel fuller, sooner, and that obviously helps you to eat less. But they also, these artificial GLP-1s that are part of these medications, they also reach the brain in a way that naturally occurring GLP-1 does not. And that also has an effect on like our desire, our dopamine, are those kind of neural pathways that, for example, can, yes, make ultra-processed, very fatty, very sugary foods, super, you know, alluring if you don't, aren't

taking a medication like this. So, yeah, basically it's like, it makes it easier to eat less. It makes, you know, those foods that are bad for you less tempting. And so, yeah, you do hear people talk about how, like, now they can go to the grocery store and walk down the aisles. And it's not that hard for them to ignore that bag of potato chips or that pack of cookies or whatever. And they find it easier to focus on the fruits and vegetables and things that will make them healthier. So that's, you know, and I do think it's worth emphasizing that I think a lot of people are having that experience. And the reason that these drugs are becoming so popular is that everybody knows somebody who's going on them, losing weight, feels good about

themselves. And so that's, you know, that's, I think, a picture of what the positive experience could look like. Just on this issue of desire and tamping down desire, what do we know so far about the potential for these drugs to be used to treat things like drugs and alcohol, porn, gambling addiction, other things that people desire? Yeah, it is. It's one of the most, you know, potentially exciting applications of these drugs. Because of the way they seep through the blood brain barrier and they get into your brain and they disrupt the release of dopamine, they can help to kind of break that feedback loop that leads to compulsive, addictive behaviors. And so we've seen some promising observational studies and data that would suggest that, yeah, if somebody goes

on a GLP1 and they have a substance abuse disorder, it helps them to, you know, stop abuse whether it's alcohol, cigarettes, porn, something like that. I know of, you know, there are clinics here in the United States that have started using GLP-1s in an off-label manner as treatment for those kinds of conditions. And it's because they've seen the effects and they think they are quite promising. So it's still early stages. You know, you want like long-term longitudinal data and preferably data that's produced in like a randomized control trial setting to really be confident.

that these drugs have a big of an effect as we'd like to see with something like substance abuse. But the early returns are really promising. You're seeing more clinicians lean into this use of these drugs. And it does make sense based on what we know about how these drugs can tamp tamp down cravings for, again, fatty, sugary foods that make you unhealthy, that that might also apply to, you know, whether it's opioids, alcohol, cigarettes, or, you know, compulsive behaviors like, uh, gambling porn addiction. I've even seen people like in the internet forums where people talk about their experiences with these drugs saying, like, I used to be such like a shopping addict. And now I don't find myself nearly as tempted to just go on Amazon and scroll until I buy something. Super interesting. And then also there's some very early research being done looking into how

GLP ones might be used to help fight dementia. And just tell me more about that. Yes. This is a really interesting and I think importantly nuanced topic. So yes, there's been. some preliminary studies and just some sort of hypothesizing that, like, hey, these drugs seem to have an anti-inflammatory effect. They seem to slow down cellular death in the brain. And so it might make sense that that would help to stave off the development of dementia or other kinds of cognitive impairment. And they did find that somebody who was taking a GLP-1 medication had a reduce risk of developing dementia compared to somebody who did not. And so that looks really promising and would suggest maybe there's a preventive benefit to being on these drugs.

There's a separate question of, okay, maybe you're an older person who's already started to develop dementia, who already has some kind of mild cognitive impairment. Could these drugs also not only be like a prophylactic against dementia, but actually treat it once it's already taken hold? Now there was, and there was some disappointing news on that front recently. Nova Nordisk, which developed OZMPIC originally, had ran some clinical trials over several years trying to measure exactly that question. If somebody who already has mild cognitive impairment goes on a GLP1, does it slow it down, does it reverse even the progress of that dementia?

And unfortunately, what they found was no. It did not see these major trials, these randomly randomized trials, did not show much of a positive treatment effect for GLP-1s once somebody was already in the early stages of Alzheimer's. So there may be that there's a bit of a distinction here, that it's not going to be something that treats somebody who's already got dementia, but that it could prevent or, you know, delay the development of dementia in somebody who starts taking it younger. It's worth emphasizing with all of this, and I'll probably repeat this a hundred times

in our conversation, that this is very preliminary. These are just early studies. But that's how things look now. It's a nuanced picture, but there is some reason to be optimistic that younger people who do end up taking these drugs for whatever reason could also ultimately be delaying the development of dementia. And candidly, like I've at least heard anecdotally that there are even some doctors who have started to take low doses of GLP1 specifically for their possible cognitive benefits. I'm a bit of a spontaneous traveler, and I don't always know where I'm going to be or how long I'm going to be there, and that's where Aerolo comes in. An e-sim from Aerolo allows me to get internet coverage, whether I need it for a specific country,

an entire region, or globally. It's easy to set up and I can top up as I go without having to swap out SIM cards. It's the perfect way for me to stay connected. Just download the Aeroa app, pick your destination ESIM, including plan length, and data amount, install, and you're connected the moment you land. No surprise roaming fees, no airport kiosks, or sketchy public Wi-Fi. Instead, just pay for the data you need. Stream your playlist, scroll, text, navigate, and video call home,

all without watching your phone bill explode. Plus, AeroLo works in over 200 destinations and is trusted by over 20 million travelers. So if you have an international trip, download the Aero app or visit Aero.com. That's A-I-R-A-L-O.com and use the code ROMSmart for 15% off your first ESIM. Terms apply. Are your pipes ready for a deep freeze? You can take action to help protect your home from extreme weather. Discover prevention tips that can help you be climate ready at keep it intact.com.

So, look, just given that, given much of what you've just said, I just, I wonder how you would respond to somebody listening to this who might be thinking to themselves, well, then should just a massive amount of us be on these things in some degree or another? Yeah, I hear that question. I've seen smart people here in the U.S., like Derek Thompson, formerly of the Atlantic, pose that very question, like, should everybody be taking OZMPIC? And I do think, like, I understand why people are excited. I think these drugs are super exciting. But no, there's no such thing. as a magic pill, as I wrote in one of my recent stories. And any kind of pharmaceutical intervention comes with a risk of side effects, potential downsides. There will be certain people

for whom they don't work. And that is just as true of GLP-1s as it is of any other pharmaceutical drug. When we're talking about side effects here, what are we talking about? Yeah. So there's a, there's a range. You know, we've known since clinical trials that some number of people experience, you know, constipation, nausea, vomiting, which makes sense when, you know, we know that one of the most direct effects of these drugs is slowing down your digestion. And so nausea, vomiting, things like that, it kind of follows naturally that some people might experience that. Now, for some people, it's, you know, something they experience maybe early on and starts to dissipate over time. For other people, it is, you know, it's too severe. They can't tolerate it. And therefore, they're just not really

candidates to go on this kind of a medication. So that's that's the most obvious one. Beyond that, there are, there's been a few like very rare side effects, like they've been linked to an eye condition that like, you know, it's a minuscule chance of it happening, but it is something that's worth being aware of. And then there are, I think most interestingly, there are side effects from losing a lot of weight and losing a lot of weight quickly without necessarily, you know, making the changes to your diet or starting an exercise regimen that could help to protect you against some of the negative consequences of losing weight too fast. So, for example, people may have heard of people losing their hair because they go on Ozempic. That is something that

we've known for a long time can be the consequence of losing weight too fast. And the one thing that I've seen recurring is people being surprised that they feel like they're losing muscle mass, losing strength when they go on a gLP one. And this is, again, something that's been, was identified in the clinical trials, but I don't think it's like a message that's gotten out to the broader public that, like, if you go on these drugs but don't really change anything else about your life in terms of your diet or your exercise habits, you might end up feeling really weak. Like, I've read stories of people who are in their early 30s and say they have trouble walking up the stairs. Wow. And so, you know, in extreme cases, if you lose too much weight,

it can affect your organ function. And I have talked to pharmacists who worked with GLP1 patients who have said, you know, it's not like it's happening all the time, but there are cases where somebody's like severely damaged their organs because they went on these drugs without making those other lifestyle changes. So as one of the doctors I talked to recently for a story, put it, like, losing more weight is not necessarily better. More is. More is. not necessarily better. You want to try to pace your weight loss. You want to make sure that you're eating enough to have a normal amount of energy to be able to do the things that you want to do. You need to do strength training to safeguard your muscles and make sure that they're not,

you know, deteriorating because you're losing all this weight and this energy and not doing anything to offset that. We want to not just have a superficial weight loss that leads to you looking skinnier, even though your body inside is just as unhealthy as it may have been before, but that you're actually improving your health by getting stronger, by getting the right kind of nutrients into your body that will improve your body's health overall, rather than just shooting yourself with the injection once a week and otherwise going about your life as you otherwise had been. That's where problems could arise. I know that this isn't as serious as, you know, organ damage or malnutrition,

but I have heard people talk about a loss of pleasure from food, which is something that, you know, impacts people's quality of life. And I just, I wonder if you could talk to me a little bit about that in this context. Yeah, I think this is one of the big unanswered questions about OZMPIC and the other GLP1 drugs is they do clearly have this effect on like our desire pathways in our brain. And ideally, you know, hopefully maybe it's measured enough where it helps you avoid eating, you know, unhealthy foods, but it does not entirely rob you of your joy of foods or other things that you get enjoyment and pleasure out of. Um, but I have certainly found stories of people who have had exactly the kinds of experiences that you talked about. Like, I've seen, one of the most interesting ones to me, as silly as it might sound is there, because it also kind of intersects with this question of like addictive, uh, compulsive behaviors is there was this one person who talked about how since they had gone on GLP ones, they weren't as tempted to drink caffeine anymore. They didn't, you know, their morning coffee was not bringing them the same kind of pleasure that it used to. And on the one hand, they were like, well, you know, I guess it's good that I don't feel like dependent on my coffee. But on the other hand, that's just like a ritual and, you know, something I enjoyed every morning that helped to start my day. And now I've kind of been robbed of that. And so, you know, I've talked with scientists who study desire and cravings. And what they've told me is this is kind of a big open question. You know, I don't think that there's any risk of anybody walking around being totally zombified. because they're on GLP-1s, but we want to be careful.

You know, removing the desires for certain things, definitely desirable. Removing somebody's desires to work hard, to play with their kids, to do the things that, you know, make life worth living. That's where we would be, where we would be concerned. And to be clear, like, it's not like there's clear clinical trials showing that that could happen. But it's a concern that people who study this stuff, you know, have raised. Right. And so this, again, is one where an area where we just need more research. It's probably a good reason to be careful about dosing and not sort of going to, too aggressively too early in treatments with GLP ones. But yeah, it's, it's a fair concern. And it's, you know, it raises

questions about how do we balance the benefits that these drugs do deliver to people without, you know, losing, you know, something that is, is really fundamentally human. And we're so early in this, in this process, right? Like, of course, the WHO is not recommending this for pregnant people. Right. One of the doctors I talked to said, like, you know, there is a pretty long safety profile. They've been used to treat people with diabetes for about 20 years now. But, you know, people have really only been taking for them for weight loss for about 10 years.

And as he put it to me, 10 years is not 20 or 30 years if people end up taking them for that long. So there are just open questions that we really can't answer with, and we just need more time. So these drugs, they've been pretty expensive, right? $400 to $500 a month, depending on the dosage. Most insurance companies are not covering the drugs for weight loss right. now. So people are often paying out of pocket. And as I mentioned before, the patent for a Zempic is expiring in Canada and cheaper generics are coming soon. Some people have expressed concerns

that a low cost might lead to abuse of the drug. And, you know, is this a drug class that can be easily abused? Just talk to me more about the concerns around this. Yeah, I think, so to be very clear, there is no research that I have seen. or red that would suggest GLP-1s on their own are habit-forming in the way that, you know, opioids or alcohol or nicotine are known to be. But I do think that there's a fair concern that, you know, people, people want to be skinny. People want to lose weight. And so, you know, the temptation to get on these drugs, maybe if you're only like a marginal

case, you know, somebody who's slightly overweight, is going to become higher and higher, the more mainstream they become. Obviously, just like, you know, we have all of these sort of cultural biases and prejudices around being skinny and there's, you know, anorexia, body dysmorphia. These are problems that predate the GLP1 class of drugs. But you could see how they could create a pretty vicious feedback loop where, you know, even skinny people want to get on them because they want to lose more weight or people just keep, you know, stay on them and increase their doses because they feel compelled to just get

skinnier and skinnier and skinnier. And I don't think that that's necessarily the fault of the drugs themselves. Like I said, there's nothing that I have read or seen that would suggest that they are habit-forming in a way that makes you dependent on them from like a biological perspective. But you could see how, like, yes, people would be tempted to misuse them, use them when they're not appropriate, overuse them more because of these cultural ideas we have about skinniness and thinness and what the ideal body looks like as opposed to anything the drugs themselves are doing. to your body. But these, again, are, I think, open questions that will only be able to be answered with more time. The ripple effects of this drug have been really transformative. It's altered the Danish economy where Osempic is made. The maker of Ossempeg is Nordisk, a hundred-year-old Danish company that's grown rapidly in the last couple of years. Norvo is investing billions

of dollars into factories in Denmark. It's creating thousands of new jobs and paying a lot of corporate taxes. And lawmakers are considering Novel's needs when making decisions on things like immigration policy and infrastructure. There was a recent story in the Washington Post about how it's changing how people spend their money and their time. There's been analysis that GLP ones are a disruptor akin to iPhones or Uber. And just talk to me a little bit more about how you think weight loss drugs are changing society overall. I think a couple of things. One is I do think, like, the potential for disruption is enormous. Like we started off this conversation, obesity is one of our longest running, most, you know, most impactful and most difficult to address public health problems.

And so there is going to be, I think, a real temptation to, you know, direct more and more people to taking them. That, you know, it could very well, we could end up in a situation where, you know, a lot of people are taking them. And I do think it's, you know, they end. entered at a really interesting time where, rightfully, we have spent a lot of time trying to educate the public and develop our understanding that, you know, obesity is not a failing of people, you know, refusing to eat right and refusing to exercise. There are all kinds of determinants that help to lead to the development of obesity, whether it's, you know, a genetic disposition to it, whether it's the food environment that you live around. Yeah. And so I think,

you know, we were getting to a much healthier place where we recognize, yeah, that obesity is not a a met personal failing. It's a medical condition that should be treated. And here these amazing treatments come onto the scene, kind of promising really effective weight loss. And it's been interesting to watch how that has very quickly, I feel like, almost kind of turned us back to an old mode of thinking, where thinness and skinniness is once again really prioritized. And I mean, I think you've seen like with celebrity culture and you know there's a lot of talk about like ozempic face and a lot of speculation about like which celebrities who have recently lost a lot of weight have gone on to one of these drugs and i think for some people that's a cause for concern obviously for other people

it creates something to aspire to which is concerning but like that is how some people react to trends like this and so it is it does seem like we're kind of scrambling our relationship to obesity at a time where it seemed like we were finally getting to a sort of healthier conception of this disease. But that does not mean that these drugs are not potentially really valuable. And what they can be that I think is important to emphasize is a jumpstart, first steps towards better weight loss, because there are people for whom dieting and exercising is really difficult and doesn't always work. Dylan, thank you so much for this. This is great. Thank you for having me. All right, that's all for today.

I'm Jamie Puezzo, and thank you so much for listening to Front Burner. Talk to you tomorrow.