'Victim of his own success': Ozempic's great flaw (2023)

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The drug is approved in Australia to treat type 2 diabetes, but people use it to lose weight. This raises some tough questions about who should get it and why.

Jill Margohealth editor

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The world fell in love with Ozempic and its related treatment, Wegovy.

Demand for these drugs is so intense that there is now a global shortage, and regulators are warning people not to buy counterfeit products online. The lack of supply has also led to conflict and controversy over who should receive these injectable drugs.

The two drugs, made by the same company, are identical except that they are given in different doses. In Australia, Ozempic, 1 milligram, is approved for the treatment of type 2 diabetes. Wegovy, 2.4 milligrams, is approved for the treatment of obesity in adults.

'Victim of his own success': Ozempic's great flaw (1)

But the problem is that only Ozempic is available in Australia.I am wego, it is widely accepted that Ozempic is the most effective drug for people suffering from complications caused by obesity.

So, faced with an obese patient who urgently needs help, should a doctor prescribe Ozempic knowing that there is a shortage and that it is only intended to treat diabetes?

"From my perspective, there is no clear divide between the needs of people with T2 diabetes and the needs of people with obesity," says Professor Jonathan Shaw, Deputy Director of the Baker Heart and Diabetes Institute.

“Both have significant health problems for which these drugs are beneficial. For some people with T2 diabetes, the main reason we use these drugs is to lose weight and help with diabetes.

However, the evidence for the long-term health benefits of these drugs is, at this stage, much clearer for T2 diabetes than for obesity."

Although many people with diabetes are obese, there are also many obese people without T2 diabetes. But they are at risk of developing diabetes, and using an effective drug to reduce body fat, especially middle abdominal fat, reduces the risk of developing diabetes.

(Video) The "Miracle" Weight Loss Drug Ozempic Is Approved. Does It Really Work? | Dr Robert Kushner


Professor John Dixon, world leader in obesity medicine, questions the priority of treating diabetes over obesity. “Since Ozempic works better than anything else available, why would we consider its use in obesity problematic?

“We have had drugs to treat diabetes for decades, and there are several new drugs. We have seen dramatic improvements in the health and well-being of people living with diabetes. It was golden for them.

“But people with obesity, even the most severe forms of obesity, don't have access to any of the drugs listed on the PBS. The only thing they have is very little access to metabolic bariatric surgery in public hospitals.

'Victim of his own success': Ozempic's great flaw (2)

“Today in Australia, 94% of these operations are performed in private hospitals. Therefore, access to people with clinically severe obesity is negligible. This means that effective treatment is negligible.

“Over a million Australians are clinically severely obese and would be eligible for priority bariatric surgery.The biggest problem we have in treating and preventing obesity is stigma.

He says drug companies know they have a better chance of getting a drug approved to treat diabetes than to treat obesity. The same bias applies to government bodies that determine whether a drug should be subsidized.

"There has never been a drug to control obesity on the Australian PBS," says Dixon of the Iverson Health Innovation Research Institute at Victoria's Swinburne University.

He says people have a hard time accepting that obesity is a serious disease and not the result of personal indulgence. It affects the main organ systems, joints and mental health.

"But we ignore the risk of cancer, heart disease and physical disability in clinically obese people."



Ozempic is a medicine without insulin intended to improve blood sugar levels in adults with T2 diabetes. Its main mechanism is significant weight reduction.

Its active ingredient, semaglutide, works to induce satiety. This feeling of satisfaction or "fullness" suppresses the appetite, leading to less food consumption and weight loss.

“Medications approved for obesity in the last decade are not as effective as semaglutide and have more side effects. But diabetics get the best option, while obese people are left out," says Dixon.

(Video) What’s it like taking Ozempic? Patients share their stories

“The world loves these drugs, but the company that makes them simply doesn't have the capacity to produce what the world needs. Most of the stock went to the US, where they charge a higher price than here.”

'Victim of his own success': Ozempic's great flaw (3)

On PBS, Ozempic costs Australians about $42 a month (four injections a week). On a private prescription, the price is around $132 per month.

According to the medical news website WebMD, Ozempic can cost uninsured Americans more than $1,000 a month, with many migrating to Canada to save $700 a month. The Danish multinational that makes the drug, Novo Nordisk, offers promotional prices on its website.

Demand for healthy people

Another factor influencing the offer is its use by healthy people who want to lose a few kilos to feel and look better. In addition to exacerbating shortages, experts say they can harm health.


"They don't know they could be putting their health at risk," says Gary Wittert, professor of medicine at the University of Adelaide and senior consultant endocrinologist at the Royal Adelaide Hospital. The drug is very effective in inducing fat loss, but people also lose lean tissue.

They are stealing from Peter to pay Paul. They will lose muscle and bone mass, and when they stop taking the drug, they will regain fat tissue and more, but not all the muscle and bone will come back,” he says. “It is a drug for people with serious health problems, and that is how it should be used.

The long-term consequences of this loss of muscle and bone mass are unknown. Clinical trials offer five years of data, and while registry data offers more, it remains to be seen what will happen 20 years from now.

'Victim of his own success': Ozempic's great flaw (4)

“In terms of nutrition, if these people eat a suboptimal diet, they don't get the right nutrients. With the drug, they eat less and diet, which won't help them," Wittert says. "Conversely, if you drive a Maserati and you put an ethanol blend in your car and your car doesn't drive well, put less ethanol blend it won't help the situation.

"There just won't be enough of this drug in the world to treat everyone who thinks they are overweight," says Wittert.

"The drug is very well tolerated, but it can cause gastrointestinal side effects, including nausea, leaky gut, and reflux," he adds. “Because it delays gastric emptying, ingested food is not pushed forward at the same rate and can cause reflux.

However, when the drug is used to treat T2 diabetes or severe obesity, Wittert says the effects can be "life-changing."

It targets the relevant biology and lowers blood sugar, reduces weight, and controls food intake in people who cannot do it on their own.

"The bottom line is still optimizing basic health-related behaviors like normalizing sleep, eating smarter, and engaging in resistance exercise to preserve muscle mass," he says. “When you add medicine to this holistic approach, you solve intractable problems. If the basics aren't in place, you're just plugging the cracks."


(Video) 3 Ozempic Dangers You Must Know (weight loss drug)

Victim of his own success.

Professor Jerry Greenfield, head of endocrinology and director of diabetes at St Vincent's Hospital in Sydney, says semaglutide has become a victim of its own success due to its efficacy in inducing weight loss and improving diabetes control.

'Victim of his own success': Ozempic's great flaw (5)

“The supply problems that led to the unavailability of semaglutide and then dulaglutide (another weekly injection) are due to the potency of this class of agents to induce appetite suppression and satiety in people with and without diabetes.

"Prior to the launch of these agents, therapeutic options for weight loss were very limited," he says. “It has been very difficult to get semaglutide for the last year. In recent months, there has been an increase in availability. Given supply issues, semaglutide prescriptions should be limited to people with T2 diabetes, particularly those who were treated before shortages became apparent.

"Some patients previously using semaglutide or dulaglutide had to start other diabetes therapies or switch to daily injections such as liraglutide, which is only available by private prescription without PBS subsidy."

He has seen shortages of other medicines from time to time, but he can't recall ever seeing a shortage of T2 diabetes medicines to such a degree.

But there are similar drugs on the way that should alleviate supply problems. One, called Mounjaro, represents a new class of diabetes drugs. Ozempic activates the hormone receptor; Mounjaro activates that same hormone receptor plus another related receptor.

It was approved for use by the TGA in December, but manufacturer Eli Lilly has yet to confirm when it will be launched and supplied in Australia. Triple agonists, which stimulate three receptors, are also being developed.

Oral versions of the drug are being developed, and the possibility that semaglutide might work inReward Circuits of the Brainand help reduce compulsive and addictive behavior.

As social media influencers continue to tout Ozempic as a weight loss miracle cure, the TGA continues to warn consumers about illegal substitutes as they wait for the shortage to end in July.

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(Video) Why Ozempic for weight loss has doctors concerned
'Victim of his own success': Ozempic's great flaw (6)

Jill Margohealth editorJill Margo is a health editor in the Sydney office. Jill has won numerous awards, including two Walkley Awards, and is an Adjunct Associate Professor in the Faculty of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia.Connect as Jill inGore.Email Jill atjmargo@afr.com

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(Video) Weight loss breakthrough or hype? Examining Wegovy and Ozempic success stories


'Victim of his own success': Ozempic's great flaw? ›

Serious side effects, including allergic reactions, hypoglycemia (low blood sugar), diabetic retinopathy (damage to blood vessels in the eye), kidney failure and other kidney problems, increased thyroid cancer risk, gallstones, and swelling of the pancreas.

What is negative about Ozempic? ›

Ozempic has other common side effects, including nausea, constipation, vomiting, heartburn, gas, headache, and dizziness. Not everyone experiences side effects, and they may be mild for others.

Is Ozempic a high risk medication? ›

This drug has a boxed warning about possible risk of thyroid cancer. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous. In animals, Ozempic can increase the risk of thyroid tumors.

What percentage of people taking Ozempic have side effects? ›

Minimising side effects of Ozempic

By starting on a low dose of 0.25 mg, your body has the chance to get used to the drug before the next dose is increased to 0.5 mg. As a result, less than 1% of Juniper patients have reported side effects.

Is Ozempic safe for long term use? ›

How long are you meant to stay on Ozempic? Because Ozempic is a medication that is used to treat a chronic disease, it's not something designed to be stopped. “Ozempic treats patients who have diabetes, therefore it is meant to be taken indefinitely,” says Dr.

What is safer than Ozempic? ›

Mounjaro has been studied head-to-head against Ozempic. After 40 weeks, people taking it saw a better reduction in hemoglobin A1C levels (average blood sugar over 3 months) compared to Ozempic. And they lost more weight, too. Mounjaro is only approved to treat Type 2 diabetes for now.

Who should not use Ozempic? ›

Do not use Ozempic® if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Will Ozempic reduce belly fat? ›

Will Ozempic or Wegovy reduce belly fat? The answer appears to be yes. That Novo Nordisk-funded study of almost 2,000 overweight or obese adults without diabetes also found their visceral fat — the type that accumulates in the belly — was reduced from baseline with semaglutide, along with their total fat mass.

Is Ozempic worth it for weight loss? ›

Research has proven that higher doses of Ozempic — 2.4 milligrams of semaglutide — are very effective for reducing weight in people with obesity. In one landmark study, people with obesity who used the drug in combination with lifestyle interventions lost about 15% percent of their body weight in 68 weeks.

Do you regain weight after stopping Ozempic? ›

Some individuals may actually gain more weight after stopping an obesity drug than they initially lost, Conde-Knape added. Studies have similarly shown weight rebound in people who stop taking Ozempic.

What organ does Ozempic affect? ›

Drugs such as Ozempic have caused new or worsening kidney disease, including kidney failure, in some people. If you become dehydrated from other side effects of Ozempic, such as vomiting or diarrhea, this could also cause kidney problems. Your doctor may monitor your kidney health closely during your Ozempic treatment.

What foods to avoid on Ozempic? ›

It is recommended that you take Ozempic before meals, rather than after, to minimise any potential side effects from eating high-fat or high-sugar foods. Foods high in fat or sugar include candy, ice cream, doughnuts, processed meats, french fries, fried chicken, any other fried foods, crisps and other fatty snacks.

What happens after you stop taking Ozempic? ›

Ozempic stimulates the release of insulin and lowers blood sugar. When you abruptly stop using it, the amount of glucose in your body can spike, especially if you have diabetes. Some may end up in the ER due to sheer exhaustion from the blood sugar spikes and crashes.

What does Ozempic do to your face? ›

“Ozempic face” is a term for common side effects of the type 2 diabetes medication semaglutide (Ozempic). It can cause sagging and aging of facial skin. A doctor may recommend lifestyle modifications or facial fillers to treat these effects.

Are celebrities taking Ozempic for weight loss? ›

Demand has skyrocketed for the diabetes and obesity treatment Ozempic, as many social media influencers and celebrities are suspected of using the drug as a quick fix for weight loss.

How much weight can you lose in 3 months with Ozempic? ›

About a third of people who take Ozempic for weight loss will lose 10% or more of their body weight. Most people should expect to lose at least 5% of their starting body weight when using Ozempic for weight loss.

What makes Ozempic side effects worse? ›

Some calorie-dense foods, including high-fat and fried foods, may make some side effects of Ozempic worse. Though calorie-dense foods aren't off-limits when taking the medication, they may not be encouraged as part of a weight-loss-promoting diet.

Is Ozempic bad if you aren't diabetic? ›

Ideally, you should not take Ozempic if you do not have diabetes, or if you're pregnant, breastfeeding, or planning on becoming pregnant. Ozempic may cause serious (but rare) side effects, including thyroid C-cell tumors and medullary thyroid carcinoma (MTC).

Is Ozempic safe and effective? ›

Ozempic isn't technically a weight loss medication. But it's considered safe and effective for Type 2 diabetes, and you may lose weight as a side effect of treatment. If you're prescribed Ozempic and you don't have diabetes, this is considered off-label use.

What happens if you stop taking Ozempic suddenly? ›

Ozempic stimulates the release of insulin and lowers blood sugar. When you abruptly stop using it, the amount of glucose in your body can spike, especially if you have diabetes. Some may end up in the ER due to sheer exhaustion from the blood sugar spikes and crashes.


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4. Drug-free Weight Loss That Works Like Ozempic | Defeat Diabetes w Dr Peter Brukner & Dr Paul Mason
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