In December 2017, Novo Nordisk received Federal Drug Administration (FDA) approval for Ozempic, generically known as semaglutide, as an injectable treatment for adults with type II diabetes. Diabetes and obesity are serious issues that should receive the medical attention it needs, but especially with the surge of influencers and non-obese individuals who are solely interested in Ozempic for its minimal-effort, weight-loss effects, there is speculation from medical experts that the semaglutide shortage is exacerbated by non-diabetic and non-obese patients who are willing to pay for Ozempic out-of-pocket. Ozempic works by mimicking GLP-1 (glucagon-like-peptide-1), a naturally occurring incretin hormone, which lowers blood glucose by simultaneously increasing glucose-dependent insulin secretion and inhibiting glucagon release [1]. Furthermore, semaglutide has side effects like weight loss because it slows gastric emptying, induces satiety, and reduces cravings [2].
In recent years, Ozempic has garnered attention in news headlines across the globe as a “miracle drug” for weight loss by celebrities and social media influencers [2], resulting in global shortages for the medication. In addition to Ozempic, other drugs are also available for weight loss such as Wegovy (semaglutide) and Zepbound (tirzepatide). Wegovy and Ozempic are both manufactured under Novo Nordisk to market injectable semaglutide, but unlike Ozempic, Wegovy has been approved by the FDA in June 2021 specifically as a weight loss drug and is sold in higher doses [3]. Shortages and supply issues were most apparent after Wegovy was approved by the FDA for weight loss in 2021. Ozempic and Wegovy are marketed differently but are produced from the same active ingredient/compound [4].
For background, considerable research has been published within the past few decades on the increasingly apparent obesity epidemic in the United States, which may fuel the increased demand for weight loss drugs. Looking at the percentage of obese and overweight adults in the United States, 41.9% of adults age 20 and older have obesity and 73.6% of adults age 20 and older are overweight or obese [5]. The contributors to the obesity epidemic are multifactorial, including easy accessibility to ultra-processed foods, sedentary lifestyles, genetic predisposition [6]. However, since obesity has serious health consequences like cardiovascular disease, stroke, joint and muscular disorders, gastrointestinal disorders, type 2 diabetes, hypertension, etc [7], it is no surprise that more adults are interested in losing weight.
Studies have supported the notion that a modest weight loss of 5-10% improves health in systolic and diastolic blood pressure and HDL cholesterol in overweight and obese patients [8], and since current weight loss drugs like Ozempic and Wegovy are expected to help individuals lose 12% and >15% of their body mass, respectively [9], many patients are seeking out the “miracle drug.”
Knowing that Ozempic and Wegovy are heavily promoted and used by celebrities and social media influencers alike, contributing to the widespread shortage, what are the ethical concerns and repercussions of drugs like Ozempic? Some say that weight-loss drugs rehash diet culture, and may pose dangers to those who are at risk for eating disorders, or are recovering from an eating disorder. Since weight loss drugs are meant for long-term usage, those who stop taking the medication often gain back their weight, especially when there are no lifestyle changes in the picture. In other words, weight loss drugs have a yo-yo effect when stopped because semaglutide drugs in particular suppress appetite and induce satiety. Weight regain can be emotionally and physically stressful, so it is important to stay away from weight loss drugs for short-term purposes (i.e. cosmetic reasons). Furthermore, these medications may be useful for patients with obesity, but it is critical to understand that these medications should not be used to reinforce, perpetuate, or amplify the idea of weight stigma [10].
One of the main criticisms with the Ozempic usage is that Ozempic’s weight loss side effect is used as a selling point for individuals without type II diabetes. Off-label prescriptions are common in the United States (i.e. Prescribing Ozempic for weight loss purposes rather than for type II diabetes), but priorities of physicians and medical providers should be re-adjusted to minimize “irresponsibly prescribing” the medication to patients who do not have type II diabetes or obesity because it interferes with accessing the medication to those who currently rely on Ozempic [11].
Not strikingly, the increase in off-label prescriptions for Ozempic were due to major shortages of Wegovy. In August 2022, Novo Nordisk announced that Wegovy has been less accessible because the high, unprecedented product demand could not match its current supply constraints [3]. Wegovy has the same active ingredient as Ozempic, so obese patients who were relying on Wegovy have been prescribed Ozempic as an alternative. Other than “irresponsible prescriptions,” Ozempic has been in high demand because it has a substantially lower retail price and is more likely to be covered by insurance companies [12]. Whereas Wegovy has a monthly list cost of $1,350 [13], Ozempic has a monthly list cost of $934 [14]. In terms of insurance coverage, Wegovy or other weight loss drugs are either not covered or less likely to be covered by insurance companies despite meeting FDA criteria because Wegovy is approved for weight-loss rather than for type II diabetes. Medicare is prohibited from covering weight-loss drugs according to a legislation passed in Congress in 2003 [15].
What actions could people take to navigate through the shortage? Dr. Katherine Saunders, a physician specialized in the care of patients with obesity and weight-related medical complications, says that what needs to change is threefold. Prices need to be lowered, insurance coverage needs to be broadened to include weight loss drugs, and more prescribers need to be held responsible for prescribing weight-loss drugs inappropriately [4]. Shortage concerns are expected to be reduced with the introduction of other competitor drugs from pharmaceutical companies like Eli Lilly, which has recently received FDA approval for Zepbound in November 2023. In all, there are health benefits to using these medications like lowered blood sugar and modest weight loss, but until companies like Novo Nordisk match the rising demands during our current shortage and insurance companies start insuring for weight loss drugs, physicians and healthcare providers should organize their priorities and responsibly prescribe Ozempic to patients who are in dire need of these medications, including those with type II diabetes and obesity.
1. “Introduction.” Clinical Review Report: Semaglutide (Ozempic): (Novo Nordisk Canada Inc.): Indication: For the Treatment of Adult Patients with Type 2 Diabetes Mellitus to Improve Glycemic Control, in Combination with Metformin (Second-Line Treatment), and in Combination with Metformin and Sulfonylurea (Third-Line Treatment) [Internet], Canadian Agency for Drugs and Technologies in Health, 2019. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK544009/.
2. “Ozempic for Weight Loss: Does It Work, and What Do Experts Recommend?” Cultivating-Health, https://health.ucdavis.edu/blog/cultivating-health/ozempic-for-weight-loss-does-it-work-and-what-do-experts-recommend/2023/07. Accessed 24 Mar. 2024.
3. “Ozempic Shortage: What People With Diabetes Need to Know.” EverydayHealth.Com, 4 Dec. 2023, https://www.everydayhealth.com/type-2-diabetes/ozempic-shortage-how-a-weight-loss-fad-has-slashed-access/.
4. “Physician Discusses Surge in Demand for Weight-Loss Drugs and Risks in Using Them.” PBS NewsHour, 28 Dec. 2023, https://www.pbs.org/newshour/show/physician-discusses-surge-in-demand-for-weight-loss-drugs-and-risks-in-using-them.
5. FastStats. 27 Dec. 2023, https://www.cdc.gov/nchs/fastats/obesity-overweight.htm.
6. Overweight and Obesity - Causes and Risk Factors | NHLBI, NIH. 24 Mar. 2022, https://www.nhlbi.nih.gov/health/overweight-and-obesity/causes.
7. Fruh, Sharon M. “Obesity: Risk Factors, Complications, and Strategies for Sustainable Long‐term Weight Management.” Journal of the American Association of Nurse Practitioners, vol. 29, no. Suppl 1, Oct. 2017, pp. S3–14. PubMed Central, https://doi.org/10.1002/2327-6924.12510.
8. Ryan, Donna H., and Sarah Ryan Yockey. “Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over.” Current Obesity Reports, vol. 6, no. 2, June 2017, pp. 187–94. PubMed Central, https://doi.org/10.1007/s13679-017-0262-y.
9. UCHealth, Katie Kerwin McCrimmon. “Wegovy vs. Ozempic: The Truth about New ‘weight-Loss’ Drugs.” UCHealth Today, 5 Apr. 2023, https://www.uchealth.org/today/wegovy-vs-ozempic-the-truth-about-new-weight-loss-drugs/.
10.“Ozempic and Eating Disorders: Why Experts Are Raising Concerns.” Healthline, 15 Mar. 2023, https://www.healthline.com/health-news/ozempic-and-eating-disorder-risks.
11. MD, Robert H. Shmerling. “What Happens When a Drug Goes Viral?” Harvard Health, 21 Feb. 2023, https://www.health.harvard.edu/blog/what-happens-when-a-drug-goes-viral-202302212892.
12. “How To Get Ozempic: Eligibility Criteria, Cost And More.” Forbes Health, 4 Mar. 2024, https://www.forbes.com/health/weight-loss/how-to-get-ozempic/.
13. Wegovy® (Semaglutide) Injection 2.4 Mg List Price & Insurance Coverage Explained | NovoCare®. https://www.novocare.com/obesity/products/wegovy/let-us-help/explaining-list-price.html. Accessed 24 Mar. 2024.
14.Ozempic® (Semaglutide) Injection 0.5 Mg, 1 Mg, 2 Mg List Price & Insurance Coverage Explained | NovoCare®. https://www.novocare.com/diabetes/products/ozempic/explaining-list-price.html. Accessed 24 Mar. 2024.
15.Medicare Doesn’t Cover Obesity Drugs, but 76% of Older Adults Think It Should. https://ihpi.umich.edu/news/medicare-doesnt-cover-obesity-drugs-76-older-adults-think-it-should. Accessed 24 Mar. 2024.