The Decibel - The weight loss drug everyone’s talking about

Episode Date: January 4, 2023

Ozempic and other semaglutide drugs have been hailed as a very effective treatment for obesity, but shortages, affordability and doctors’ willingness to prescribe it are still keeping people who might benefit from it off the drug.Health reporter Carly Weeks explains how the drug works and how it may force our society to rethink how we perceive obesity.Questions? Comments? Ideas? Email us at [e-mail]

A new drug to treat obesity has become a viral sensation on TikTok. I started Ozempic before Kim K and here are my thoughts. All right, you guys, so what it's like the first day after I do my Ozempic shots? You have to make yourself eat. Good morning, kids. This is my Ozempic update. You might be asking yourself, is this a drug that's available in South Africa? Ozempic is the original name. Ozempic is approved for obesity.

Let's see my picture. Let's go show up for a medicine. Ozempic. You're right, we are so much more than the number on our scale, so I will elaborate why I am taking Ozempic and why this journey has been so difficult for me. Ozempic has helped people lose weight and it raises a lot of questions about how we treat and how we think about obesity.

Carly Weeks is The Globe's health reporter, and she's here to tell us more. I'm Mainika Raman-Wilms, and this is The Decibel from The Globe and Mail. Carly, thank you so much for talking to me today. Of course. People maybe have seen an ad or an article or even a TikTok video about a drug called Ozempic. So, Carly, can you just start by explaining what is Ozempic? Ozempic is part of a new class of medications that are used to treat type 2 diabetes as well as obesity. And that last part is kind of where we get into a lot of the debate and controversy.

So I'll back up a little bit. Ozempic is the brand name of a drug that's called semaglutide. That is the generic name of a drug produced by Novo Nordisk. It is, without getting into too much of the background, it's a GLP-1 class of drug. So it essentially mimics one of the body's natural hormones and helps control blood sugar. And so that's why it was approved in 2018 in Canada for the treatment of type 2 diabetes. But during the use of this drug, it became very apparent that people taking it were also losing weight. So the drug has also been approved in Canada for the treatment of obesity. That's a separate drug, that's called Wagovi, but that drug is not available in Canada. It was supposed to be fall 2022. There's been such a run on that drug around the world that it's in shortage,

it's unclear when it will make it to Canada. So in the meantime, a lot of people have been as Ozempic and Wegovy. And if people can't get Wegovy, they're actually using Ozempic then for weight loss. But you say it's created such a stir here. Why is that? Like, what are the results, I guess, that people are seeing from this? So in clinical trials, the ones that were sort of specifically looking at weight loss, people were losing 10, 15, and even higher amounts in terms of percent looking at weight loss, people were losing 10, 15 and even higher amounts in terms of percent of body weight loss. That is huge. The people in these trials would also get

things like, you know, counseling, you know, dietary advice. They would be, you know, encouraged to do physical activity. But there was also a placebo group. So people that were getting sort of fake drugs that were getting the same type of counseling, those individuals lost on average about 3% of their body weight. And that's consistent. That's something that has long been known that is very difficult for lifestyle alone, those kinds of changing diet and exercise to help people lose really significant amounts of weight over the long term. That's why we have such this huge dieting industry, because it is very difficult for people to lose weight on the road. This drug appears to really, really kick things into a whole new gear, basically by harnessing

one of the body's old hormones and helping it reduce that feeling of hunger that they get. One doctor was saying to me that it basically stops that starvation response that a lot of people who are living with obesity have. The brain is sort of telling you that you're starving, you need to eat. This drug interrupts that response. And really, it's the first time maybe ever that we've had a weight loss drug or an obesity drug that has worked this well ever. And just to get back to, I guess, like how this works. So you're saying it actually stops people from feeling hungry. Is that a big part of what causes weight gain, that people naturally feel hunger when they

don't need to eat? There are so many different causes of obesity. And I think it's worth just pointing out and highlighting that obesity is a real and pervasive chronic illness. So this is an area that is very difficult for people to get treatment. It's very difficult for them to have doctors that understand obesity as well. And I think that we sort of as a society tend to really think about issues of obesity and weight in terms of vanity. You know, how do you look in the mirror? So you said in the clinical trial, people were taking this drug at the same time as changing their diet and exercising and those lifestyle changes. How does this drug work, though? Like, how does someone take it and how regularly? So this is not a drug that you take orally. This is actually an injection, a once weekly injection that you will take essentially for life

in the trials. People that stopped taking the drug gained the weight back. So this is basically you're signing up for life for this kind of a treatment. You take it at home, but you have to get used to the idea of injecting yourself. There are a number of side effects that have been linked to this drug as well. Every drug comes with side effects and this drug is no exception. So some of the notable ones, and I've talked to a lot of doctors about this as well, what they're seeing. So because it kind of interrupts that hunger response, it has gastrointestinal effects. A lot of the symptoms tend to be gastrointestinal in nature. So a lot of people experiencing things like nausea, diarrhea,

constipation, a lot of those things that you would expect you to get with a drug interacting with your gut. But there can be more serious ones as well, pancreatitis, some other more severe problems coming along. There's a question about whether or not there could be a link to thyroid cancer, thyroid tumors, because in lab animals, there was an increase in that seen in clinical trials. So again, no suggestion that that's happening in humans, but people who are taking the drug are really urged to look for any changes in their ability to swallow, anything going on with their thyroid. Some of the physicians I speak to say that basically with proper counseling, for instance, because you don't feel hungry when you wake up, some people will end up not eating and then binge later in the day, which can lead to a whole

cascade of gastrointestinal effects. So counseling can really play a big role in reducing a lot of those side effects. And they say there's actually been maybe too much emphasis on side effects that's potentially dissuading people from seeking treatment. Because some of those side effects do sound serious, though. So I guess that's an individual trade-off that people kind of have to weigh. Carly, you said that you basically have to continue taking this drug for life in order to keep those results. How much does the drug cost? And this is where we get to some of the issues that are emerging around access. So according to experts that I've spoken to, it tends to be around $300 a month for this drug. That may not sound like a ton, but think about the fact that a lot of people don't have coverage. They might be paying

out of pocket. And also it's worth pointing out again, a great deal of people living with obesity are living in low-income situations. They may not have access to that kind of money. No province covers any obesity medication at all. And there are three other obesity medications that have already been on the market. They're not as successful as this one, but they're still there. So it's very difficult for some of the people who are most affected by obesity to get any form of treatment. And it looks like there's not going to be any exception made for Wagovi, this obesity version of this new weight loss drug. Now, Ozempic, the diabetes version of the drug,

is approved by many plans, but then it really becomes a matter of individuals and whether or not they're going to get approved. So for instance, I spoke to one woman who, she's pre-diabetic, she's living with obesity, her employer's insurance plan won't cover her for Lisdenpic because she's not diabetic. So there's a lot of access issues and inability of patients to access it, which a lot of physicians tell me they believe is rooted in the idea that obesity has long been seen as an individual moral failing instead of a chronic disease that just is worthy of treatment. Do we know how much this drug is being prescribed right now?

So hard to say exactly how many patients are taking the drug and how many patients are not getting access to the drug. The market for Ozempic in Canada is massive and has gone up a huge amount since it came on the market in 2018. So basically more than $800 million in prescriptions were dispensed from retail pharmacies in Canada in 2022. So I mentioned a bit earlier that this has become a big thing on TikTok and there's lots of videos you can find about Ozempic. Why has this become such a big thing on that platform? Like, what are the kinds of things that are out there about it? Yeah, it really has exploded on social media.

So many people are posting sort of their Ozempic journey, their Wagovi journey, and taking photos of themselves, videos of themselves, injecting the medication into their stomachs week by week and showing their results. And some of them are quite jaw-dropping, people who've lost a ton of weight, people who are sort of borderline influencers now kind of showing off their weight loss. There's been some controversy about this, people that are really boasting about a drug, the suggestion of whether or not they could be getting paid to do so by the company. We haven't been able to identify any of that in our reporting. It's a very difficult area to actually police as well.

So I think there are some legitimate issues there about how much people are maybe talking about this in a promotional capacity. At the same time, a lot of physicians that I've spoken to and people who are advocates in the obesity community push back on this negative reaction to how viral this drug has gone. They're saying that this is really indicative of how desperate people are for answers, for treatment when it comes to obesity, and that this really speaks to that need that people have for treatment, for recognition, for this community that's out there to kind of rally together and say, here's something that may work. And they're saying that might be why you're seeing such a viral response to this. And we will get to some of that as we go on. But I think it is important that you emphasize the fact that we're talking about

debilitating obesity here as a medical condition. This is not kind of a vanity project. This is actually something serious. Exactly. And in almost every interview, the same phrase keeps coming up that everyone has been told that they need to eat less and move more eat less and move more and this drug has really busted that myth wide open kind of once and for all and i think that's why so many people you know i hesitate to use words like game changing and revolutionary but i don't think in my you know many years doing health there's been so so much excitement over a drug and its potential for changing how we see a disease. And certainly there's been examples of drugs that have

done this in the past. You know, a lot of doctors I've spoken to have compared this to the arrival of statins for the treatment of high cholesterol, Prozac for the treatment of depression, and kind of changing how we perceive mental illness. So this is maybe a moment where we really start to look at this disease differently. We'll be right back. I guess I want to ask you about, we've kind of been talking about obesity as a disease here. And I want to ask you directly about this, Carly. Like we all have varying degrees of fat on our bodies, but what makes obesity a disease? Like why is this something we need to treat?

That's a really great question. And there has been more pushback against this idea that obesity should be medicalized. Some people say, you know, that we need to embrace people no matter how they look. So I think there's a couple of caveats to that. According to the experts I interviewed, you can be slightly overweight and it has no impact on your health. You can be obese, which is basically a measure of your body mass index and your waist circumference. But oftentimes people who are carrying a very excess amount of weight, a big amount of extra weight, will experience problems with their health as a result. So it's very

unlikely, it's very rare for people to be obese and to not have some health problems as a result. So joint pain, high blood pressure, some forms of cancer are linked to obesity as well. So that's really where a lot of the discussion maybe should be centered, which is around how do we help people that are living with the effects of obesity? It's impacting their health. Some people have mobility issues. They're unable to, you know, even cleaning themselves. It's a debilitating condition that is undertreated. When we talk about obesity, like how widespread is obesity in Canada? So nearly one in three Canadians are living with obesity, which is a staggering number. And I think if we were talking about any other chronic disease, we would be, you know,

putting us on the front page every day. I mean, this is a huge amount of people who are living with a disease that will impact their health, their longevity, their ability to live their life to the fullest. The fact that so few people have access, there's only a couple of dozen physicians who are licensed in the treatment of obesity in Canada. Bariatric surgery is very difficult to get, also very unlikely for people living with obesity to be on medication. A lot of primary care physicians have never received any training in obesity, even though a lot of their patients will be living with this disease. Doesn't that seem like a gap there? Why is that possible? It's a massive gap. According to the people who live and breathe this stuff every day,

it's rooted in weight bias. Obesity is still not recognized as a chronic illness. It's still seen as something that is the fault of a person who can't control their eating habits or who doesn't move enough, when really it's such a complex array of factors. And when you look around at our society, so if you are a person who is living in a low income area with little access to fresh fruits and vegetables, because maybe there's no grocery store nearby, what is really cheap and easily accessible? Fast food, highly processed food, which is so satisfying, but has huge amounts of calories and makes it really easy to gain weight and really makes it much more difficult to take all the steps necessary to lose weight. It's a really complex disease. We don't even fully understand it yet. And I think

that's part of what's going on here. And I think that it's so much easier to dismiss it as something that is on the individual rather than on us as a society. Yeah. And so really the idea here is then to see obesity as a public health problem, not as a personal individual failing. Yeah. And I think that that's something that, you know, when you start to look around at the way Ozempic is being talked about on social media, in the media generally, you start to really get this narrative that here is a drug that fat people are taking away from diabetics, that the Kardashians are using to lose weight. It's so selfish of them. By the way, no Kardashian has ever talked about this drug in public or let alone having taken it. It's already

become a really toxic discussion around ozentic. Instead of talking about obesity as a disease that needs to be treated, we're framing this as people who are too lazy to take care of themselves or taking away a life-saving medication from those who really deserve it. Yeah. Carly, how is obesity actually defined? So in Canada, there's actually some new guidelines that came out. I think it was last summer. So essentially, obesity, the diagnosis comes down to a couple of factors. So a person's body mass index, which is sort of your height and your weight combined and calculated, in addition to your circumference, like your waist circumference, and also combining that with what impact it has on your health. So it's not just that you're carrying extra weight

or an extra, you know, your body mass index is too high. You know, body mass index has long been controversial. Yeah, I was going to ask you because it's been criticized recently, right, for being very imperfect for a way to judge someone's health there. Yeah, it's highly problematic. You know, people with a higher body mass index can be healthy. So I think it's, you know, these are not perfect measures. But at the same time, because there is no perfect measure of obesity, that's why I think a lot of doctors are kind of saying, it's not like you can take a blood test for obesity. It's really kind of looking at the impact it's having on their overall health and

making a determination from there. And that's why people are really being advised to speak to their physicians about this. I'm curious. It sounds like you've spoken to people who are on Ozempic. What do they have to say about it? So it is, for a lot of people, life-changing in a word. I'm thinking of one person that I spoke to in particular who has struggled for her entire life with being able to lose weight, being overweight to the point where she is immobile.

She can't leave the house without a wheelchair or a walker. She also doesn't like people looking at her. So she doesn't go out in public unless it's for a medical appointment. She finally realized that she needed to take action because she saw that basically her husband was housebound as well because he was her caretaker. She's been on Ozempic, has lost nearly 100 pounds um and is still going strong she's able to like start to see a life for herself again uh being able to leave the house being able to take care

of herself less aches and pains her blood pressure is back to normal almost huge unbelievable changes that she never would have been able to do on her own because she has never been in the decades that she's been on this earth she's in her 60s has never been able to lose on her own because she has never been, in the decades that she's been on this earth, she's in her 60s, has never been able to lose a significant amount of weight on any diet that she's tried. She's a person who's living with obesity, who's a living example of how this is not about a personal decision to eat more, to move less. This is about a medical condition and treatment. When we talk about obesity in today's world, we know obesity rates in Canada have gone from single digits in the 1980s, I think, to nearly 30% of all Canadians in 2018, according to Stat Canada. Why has that number increased so much?

I guess I'm wondering, are we actually getting bigger, or are we measuring things differently? What's happening there? Yeah, that's a really great point. And I think that looking at those numbers, a lot of people will look back and say, well, see, this clearly is on the individual because 20, 30 years ago, most of us were not obese. There's something wrong with the individual. Whereas a lot of physicians and experts who study this will actually reframe that and say that our environment is more conducive to obesity than ever. People are sedentary. They're working on

jobs where they're sitting or standing for long periods, very little physical activity. There's easy, ready access to cheap, processed, high-calorie foods. Think about the design of low suburbs or subdivisions where people live. There may not even be sidewalks in some areas. It's not conducive to walking. People have to drive to get their groceries. They drive to get to where they need to go or take transit. It's very difficult for people to really be active and to really ward off. So if you're a person who is at risk for being overweight or have obesity, there are so many factors that are working against you in our society today, more so than I think at any point in our history.

Carly, thank you so much for taking the time to speak with me today. Thank you for having me. That's it for today. I'm Mainika Raman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show, Kasia Mihailovic is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.