The Ozempic Shortage Fuelled By Weight Loss Goals

Hi everyone, I’m Sarah.

B: & I’m Becca! And you’re listening to Unsavory. 

S: When this episode comes out, it will actually be Boxing Day! So we hope everyone is having a nice, relaxing holiday time with their family and friends. Maybe taking a nice, snowy podcast walk with this episode :)

B: and gearing up for a happy new year! 

S: Ah yes, the new year. Perfect segue! The time of year when many people are feeling motivated to set new resolutions and make a change, often a health-related change. Which is why we typically like to cover something diet or weight-loss related, because there is a whole lot of nuance around these topics that is worth discussing, and often, some scandal! 

B: Absolutely. January can feel like a great time for a reset…after the holidays and a break from work things. But sometimes the expectation for change around this time of the year can be a bit overwhelming. So if you haven’t set any resolutions, no worries! If you want to set personal goals, you can set them anytime of the year. OR not.

S: Yes, be a rebel and set them now! Or set them never! So, today’s story is a little bit different for us!! It isn’t really a scandal or a crime but it is a hot topic right now…

B: It definitely has scandal potential though…

S: It does. It just feels like we’ve been down this path before… 

We’re talking about Ozempic, the new “miracle” weight loss drug that’s been rocketed into high demand after being touted by tiktok influencers and Beverly Hills medical spas. The catch? It’s not actually meant for weight loss and there are concerns that those who really need it might have difficulty accessing it. 

B: That sounds pretty dang scandalous to me!

S: It’s not quite scandalous yet but it’s… nuanced. You’ll see. Content warning: This episode will have quite a bit of discussion about intentional weight loss, which we don’t actually talk about too often on the podcast, so if that’s something you find difficult to listen to or doesn’t align with your personal values or goals, skip this one! It’s okay, we have tons of episodes that feature fascinating stories that are not weight-related at all. You ready Becca?

B: Let’s do it!

Intro Music

Shout out to my sources: I used quite a few different articles and thought pieces that are all linked in the shownotes on Unsavory.com, but the main ones I used are a NYT article by Dani Blum entitled What Is Ozempic and Why Is It Getting So Much Attention?, an article on HealthMatch By Claire Bonneau entitled Ozempic Is NOT A Weight Loss Drug — Despite What Social Media Users Suggest, a National Geographic article entitled What to know about Ozempic, TikTok’s favorite weight loss drug by Allie Yang, and a wonderful article by friend of the podcast, Abby Langer entitled Are Weight Loss Medications and Bariatric Surgery Effective?

We had to cover this topic because it is all over social media right now and we wanted to hopefully some nuance into the mix of information out there, and  we are not endocrinologists or pharmacists this is definitely a nutrition-adjacent topic! But it’s important to note that the use of this class of drugs for weight loss is relatively new so information featured in this podcast could change in the future as more studies come out and as more people have had the chance to use the medication long-term. 

Weight and weight loss and body shape always seem to be hot topics in Western society and people are always looking for a quick fix. And who can blame them! Changing your body shape can be very difficult and losing weight is not something that is equally difficult for everyone. There are many factors that make it more difficult for some people to lose weight. We’ve covered some of the most scandalous “quick fixes” on the pod before, like the alkaline diet, the weigh down diet, fruitarianism, breatharianism, and even the tapeworm diet. Typically, any sort of “lose weight quick” scheme or protocol works by rapidly dropping water weight and muscle mass at the start (B: usually in the form of diarrhea), and then person goes off the diet or protocol, the weight is gained back quite quickly. One of the unfortunate side effects of this weight cycling phenomenon is the impact it has on someones relationship with food, they may start to distrust themselves around food and enter a cycle of restriction and overeating that can be distressing and not supportive of the individuals overall health goals. 

Any experienced social media user can attest that there are endless diets, supplements, meal plans, and even pharmaceuticals promising rapid weight loss, many lacking scientific evidence and rarely producing long term effects. Losing weight in a safe and sustainable way can take a very long time and requires a multi-pronged lifestyle approach to health behaviour change, and yet, year after year, season after season, along comes a new magic bullet to lose weight. 

B: It might be the world’s biggest scam.

It’s truly impossible to keep up. And 2022 has been a doozy of a year when it comes to diet culture and body trends, as we’ve seen headlines touting the return to the “heroin chic” figures of the 90s, we also saw a return to 90s fasion trends that involve low rise jeans and torso-bearing shirts, and now we have tiktok influencers, celebrities and tech moguls alike singing the praises of a new diabetes medication, Ozempic, and it’s weight loss counterpart, Wegovy (Weh-go-vee). 

Now, I’m pretty skeptical by nature, but like most things in the nutrition/health world, the case with Ozempic and is not so black & white! I think something like a hot new weight loss medication seems really scandalous for a couple of reasons. First, they have a pretty bad track record, that’s undeniable and I’ll tell you a little bit more about it in just a sec. Historically, they’ve generally been ineffective at best, dangerous at worst. I also think weight loss medications are seen as the ultimate “quick fix”, and because some people still believe that weight is something that can be completely controlled by the individual, which isn’t always the case, a pill could be seen almost like a short cut or a moral failure, which it’s not. We know that when it comes to weight, multiple factors are at play, many of which are beyond individual control, including genetics, childhood habits, medical conditions, the physical environment you live in, your mobility, and even your hormones. 

Given this complexity, it makes sense that weight loss medications are nothing new. People have been searching for a quick fix since the dawn of time. Some of the first quick fixes for weight loss are described by Soranus of Ephesus, a Greek physician, in the second century. He prescribed elixirs of laxatives and diuretics, as well as heat, massage, exercise, and low calorie diets to help people lose weight. This remained the mainstay of treatment for millenia and his techniques are not obsolete today. But in the 1920s and 1930s, new treatments began to appear. A thyroid medication that was effective for the treatment of hypothyroidism became popular for weight loss, but it had only a modest effect and mimicked the symptoms of hyperthyroidism as a side effect with users experiencing heart palpitations and difficulty sleeping. Didn’t last. 

In the 60s and 70s, Amphetamines like dexedrine (aka Adderall) were widely used.

The problem with amphetamines is that they have the potential to be addictive and can have some pretty serious side effects like high blood pressure and psychosis. 

B: Urgh that makes me think of the medication Vyvanse - which is an amphetamine that’s used for ADHD treatment. It can decrease appetite pretty drastically and was recently approved for binge eating disorder. BUT what the people prescribing this for binge eating don’t realize is that the moment the medication wears off you’re more at risk for exactly what you were trying to avoid in the first place. Not to mention that it doesn’t address the key issue AT ALL.

Once people realized that ampetimines weren’t all they were cracked up to be, the next big weight loss pill was something called Phen-Fen in the early 90s, which could be a whole Unsavory episode in and of itself. Phen-Fen was eventually discontinued for it’s effects on the heart after being linked to several deaths. 

There is another drug called Orlistat that is still available and has been shown to cause modest weight loss by causing malabsorption of dietary fats by inhibiting lipases, which are the enzymes that help our body digest fat. One of the main side effects of this drug is oily bowel movements, which sounds a bit slimy, but can be avoided by following a low-fat diet. 

B: That sounds less than desirable

Right? I’m sure you’d never become constipated, which I guess is a plus. But in comparison to some of the weight loss drugs of the past, Ozempic and Wegovy actually appear to be safer and more effective. 

So what exactly is Ozempic?

Ozempic is a diabetes medication created by Danish pharmaceutical giant Novo Nordisk. It’s gained traction in recent years for its ability to lower blood sugar and improve levels of glycated hemoglobin (also known as A1C) which is a measure of blood sugar levels over a 3 month period. So, for those living with diabetes, the positive effects of Ozempic can be life changing and improve their diabetes management long term which can help prevent some of the more severe complications of diabetes. And there is some pretty great research about the safety and benefits of Ozempic. For example, when combined with a healthy diet and regular exercise, Ozempic has also been shown to improve blood sugar and lower the risk of stroke, heart attack, or death in adults living with type 2 diabetes. Note that even there, in that snippet from the Ozempic website, it says “when combined with a healthy diet and regular exercise”. 

Ozempic is administered as a once-weekly injection. So I remember learning about it in my diabetes placement because it can be really helpful for individuals with diabetes who also have a hard time swallowing pills (dysphagia) or remembering to take daily medications (memory issues), the once weekly injection is very convenient. 

Sounds wonderful! So why is it only rising to popularit now?? Well, the FDA first approved Ozempic for diabetes management in 2017, only 5 years ago. That’s younger than my cats. 

One of the major side effects of Ozempic is weight loss, and yes, this is a side effect because it is not the main purpose of the medication. The Ozempic website it clearly states “Ozempic is not for weight loss” and Ozempic has not been approved by the FDA for weight loss. 

But it does cause some weight loss and that can be an attractive feature of the medication for those who have struggled to lose weight for health reasons, but also for celebrities trying to meet and maintain unrealistic body standards and tech moguls trying to shed a few pounds. Not surprisingly, there’s a market here. So in 2021, the FDA approved another version of the drug from Novo Nordisk that contains a higher dose of the active component, called semaglutide, under the brandname Wegovy. Unlike Ozempic, Wegovy has been approved by the FDA for weight-loss in patients with a BMI above 30 or a BMI above 27 if they have a weight-related comorbidity like high blood pressure, type 2 diabetes, or high cholesterol. 

So how do Wegovy and Ozempic work? 

Ozempic and Wegovy belong to a class of medication called semaglutide which helps lower blood sugar levels and regulate insulin release, which is crucial for people with Type 2 diabetes. The drug imitates a naturally occuring hormone in the human body called glucagon-like peptide-1 or GLP-1 that we produce in our intestines when we eat and it helps signal feelings of fullness. Semaglutide is a GLP-1 receptor agonist, which means it can bind to our GLP-1 receptors and have a similar effect. So when someone takes semaglutide, it actually helps lower appetite by signaling to our bodies that we feel full and it slowing down the passage of food from the stomach to the small intestine. Basically, it makes people taking the drug feel fuller faster. Many people actually tend to feel nauseous, bloated, and really unable to eat like they used to. Some have described feeling almost repulsed by food and unable to eat or drink what they’d like. For some patients taking the medication, foods that used to be really exciting to them are no longer exciting and they find themselves thinking about food a lot less.

B:  Oh that’s kind of sad. I find so much joy in food. So this stuff is basically just pushing people to stick to a low calorie diet? 

S: It’s essentially removing the drive to eat or eat a lot. Which as a dietitian, I’d love to see some more research about the long-term effects of this medication because our hunger and satiety cues are there for a reason. We feel hunger because our body requires nutrition and it’s signalling to use that we should eat. I’m always wary of anything that messes with those hunger cues, even like in the last episode I did about eating competitions, which is about ignoring or altering hunger cues in a completely different way. Those hunger cues are a wonderful thing when they’re working properly. So I think on something like Ozempic or Wegovy, where you’re intentionally increasing your feelings of satiety and therefore decreasing the length of your hunger signals, you’d have to be really conscious about making sure you’re consuming nutrient-dense foods with your reduced appetite to avoid any nutrient deficiencies. But unfortunately, the drug hasn’t been around that long. Remember, Ozempic was approved in 2017 (not for weight loss) and Wegovy was only approved for weight loss in 2021. 

B: Great point! Which makes me wonder what foods might seem the most appetizing on this medication. Because if I’m feeling nauseous, simple carbs are usually the way I go. 

Toast and gingerale for me! There are a ton of what I eat in a day on ozempic videos and for the most part it looks like people would prepare whatever they normally eat, but then only be able to eat a really small amount. Like two pieces of toast but then their only eating half and feeling full. 

Now, the evidence that exists suggests that Wegovy works for weight loss for most people! The FDA’s approval of Wegovy was based on the results of the STEP clinical trial, which stands for Semaglutide Treatment Effect in People with Obesity. These trials were conducted by the drugs manufacturer, Novo Nordisk, and Wegovy’s safety and efficacy were studied in four 68-week (so over a year), randomised, double-blind, clinical trials with around 4,500 participants. Three of the four studies (Studies I, II and III) were placebo-controlled trials, while the fourth study was a placebo-withdrawal trial.

B: Refresh my memory on a placebo withdrawal.

I had to look this up too. A placebo-withdrawal study is when participants receive a test treatment for a specified time frame. At the end of that period, participants are randomly assigned to continue treatment with the test treatment or with a placebo (so they would start the group on Wegovy and then after a certain period of time, some would continue and others would unknowingly switch to a placebo). 

B:  Right right 

In Studies I, II and III, about 84%, 67% and 85% of Wegovy-treated patients respectively experienced losing 5% or more of their body weight, compared to 31%, 30% and 48% of placebo-treated patients respectively at 68 weeks. 

B: Proof that the placebo effect is real.

I know! It’s so true, basically 30-50% of those receiving the placebo also lost weight. Step 1 actually found that the mean reduction in body weight over the 68 weeks was about 15% of their body weight. It was concluded that Wegovy was safe and overall well-tolerated throughout the studies, with the most prevalent adverse event being gastrointestinal issues. The most frequent side effects reported in patients treated with Wegovy during the clinical trials were nausea, diarrhoea, vomiting, constipation, stomach discomfort, headache, tiredness, dizziness, bloating, hypoglycemia in T2D, gas and heart burn. Sounds unpleasant, but seems to be effective at least in the short term. 

A study published in April 2022 which sought to examine changes in body weight and cardiometabolic risk factors upon the termination of the drug, found that after a year people had regained about two-thirds of the weight they had lost and the positive changes they had seen in cardiometabolic risk factors like blood pressure, blood lipids, HbA1c, and C-reactive protein had reverted to baseline after about 120 weeks since discontinuing. These findings reinforce the need to continue treatment in order to maintain the benefits of the medication.

B: Oh wow…back to baseline?! So it’s really much more of a short term solution if you can’t continue the treatment.

Exactly. Like so many other quickfixes, we don’t have enough data to say if it works long term or not. And once someone stops taking a medication that is basically suppressing their appetite, and their appetite returns, it’s very likely that they’ll gain the weight back. 

The “scandalous” issue with Ozempic and Wegovy is not whether it works or not, but instead, who is using it, who has access to it, and why. Remember, Ozempic is not approved for weight loss, Wegovy is. Ozempic is currently only approved for diabetes management. 

First of all, this medication is expensive. For someone without any insurance coverage of the drug, Ozempic costs about $1,000 and Wegovy costs about $1,600 for a 30-day supply. (B: YESH). Secondly, the medication has not been significantly studied in people without diabetes or excess weight. These drugs were not designed for people who want to be super thin, but unfortunately, rumours are swirling that that is exactly what might be happening, especially in Hollywood. 

As an observer of diet culture in the media over the past 3 decades of my life, I see that the pendulum of body trends is swinging back towards ultra thin, and the fact that there’s a new quick fix in town to help people go from already thin bodies to ultra thin bodies, is a scary thought. There are rumours that Kim Kardashian used Ozempic to fit into her Marilyn Monroe dress. Kim K has not confirmed this, but she did tell Vogue that she lost 16lbs in 3 weeks to fit into the dress. It all feels very 90s. We’ve been here before folks and it wasn’t great!!

On TikTok, the hashtag #Ozempic has been viewed over 465.3 million times, with people expressing shock over their medication-induced weight loss and swapping stories about side effects. That’s a loooooot of people using a drug for weight loss that isn’t approved for weight loss. 

Interest in the medication was further boosted when Elon Musk was asked on Twitter “Hey, @elonmusk what’s your secret? You look awesome, fit, ripped & healthy. Lifting weights? Eating healthy?” and he responded “fasting” and “Wegovy”. 

And he isn’t the only one. An article in the Guardian speaks with a California doctor, Dr. Daniel Ghiyam, who owns a medical spa and he’s quoted as saying “Everyone’s on it. A lot of celebrities are on it. Anyone who’s not talking about it, is on it.”

Despite only being approved by the FDA for human use since 2017, Ozempic has gone from being a relatively unknown diabetes medication to a household name in very high demand. 

B: But if Ozempic isn’t approved for weight loss, how is everyone getting it?

Off-label prescriptions! So a doctor can prescribe a medication for benefits beyond the primary intended use. Plus, there are “medical spas” and compounding pharmacies that make “knock off” versions of medications. Novo Nordisk actually issued a warning earlier about compounded semaglutide saying it doesn’t supply ingredients to compounders. Novo Nordisk actually holds the patent on semaglutide and it is suing some companies for patent infringement. There have also been some FDA recalls from compounders who have mixed semaglutide with supplements. So definitely not something you want to be getting off brand, but when demand is high, there can be supply shortages, just like we’re seeing now! 

Ozempic and Wegovy have been listed by the FDA as medications in short supply. Wegovy was approved for weight loss in those who qualify, but due to high demand it quickly ran out, and so Ozempic was next in line. 

In the spring, Novo Nordisk, reported difficulty keeping up with the skyrocketing demand. In Australia, recommendations were made to physicians, who were instructed to prioritize Ozempic’s use in the on-label treatment of type 2 diabetes. Considering 11.3% of the US population and 10% of the Canadian population lives with diabetes, prioritizing the use of Ozempic for its actual use, diabetes management, is very important. 

B: Do we have an Ozempic shortage in Canada? 

No, Canada’s doing okay at the moment. The shortage seems to be mostly affecting the US and Australia. 

But then there’s the side effects…

While most of the side effects are mild and gastrointestinal, Ozempic does have a boxed warning. A boxed warning, commonly referred to as a “black box” warning, is the most serious type of warning mandated by the U.S. Food and Drug Administration (FDA). They are prominently featured in the labeling of drugs to warn prescribers about serious adverse reactions or special problems. The FDA issued this boxed warning because Ozempic has been shown to cause thyroid tumors and thyroid cancer in animals. It isn’t known if Ozempic can cause thyroid tumors or medullary thyroid cancer in humans. 

B: Oh no…

Both Ozempic and Wegovy name gastrointestinal issues like nausea, vomiting, diarrhea, and constipation as among their most common side effects.  Many users find that even small amounts of food/drink can make them feel nauseous and full, even just water. For this reason, dehydration is a serious concern. Constipation is also a serious concern, as people are eating less coupled with slower gastric motility. 

B: What a nightmare

Online forums have plenty of stories from Ozempic users whose relationship with food has changed, not only physiologically, but psychologically. People describe missing food and hating food at the same time, feeling repulsed by food. Or wanting to eat food, ordering a beautiful steak at their favourite restaurant and not being able to have more than a few bites. 

There is something a little scandalous and unsettling about a weight loss medication that makes food so unappetizing that you don’t want to eat. Humans need food.  

Summary

There are so many personal reasons why someone might choose to take Ozempic or Wegovy. As with all medical decisions, the choice to take a medication is best left between you and your primary physician. Weight loss can be challenging and starting Ozempic or Wegovy might provide people with the motivation they need to embrace further healthy lifestyle changes. I spent some time scrolling through tiktok and watching videos of peoples personal experiences, and there are plenty of people who describe a lifelong struggle with weight that led to their decision to take the medication. Ozempic or Wegovy are not for everyone, but I do think that it can be helpful for many. Of course, new information could come out at anytime, as this drug hasn’t been around long enough to study the very long term effects of what is essentially a medically-induced very low calorie diet. 

Given that New Years is the classic time that individuals resolve to make a health-related behaviour change, people might find themselves looking for a quick fix. Things in the world of weight loss are not always straightforward, and the path to success is not always clear and will look different for each and every one of us. 

B: And quick is usually not sustainable. As these medications have also proved.

One thing I do recommend though, even if your goal is weight loss, is shifting the focus away from the number on the scale or on your clothing, and focussing more on how you feel as you make healthier choices. 

Are you sleeping better? Moving easier? Feeling stronger? Breathing better? Having more energy? Regular bowel movements? 

There are so many markers of health that don’t involve tracking numbers and when you shift your focus to these other aspects, it can be easier to stay motivated. 

B: I love that! Focusing on specific numbers can often mean you’re missing the bigger picture. Most of the things you just named off are a better representation of health than weight loss anyways. Great episode! I came into it knowing very little about these medications - and I do feel like their sale for weight loss teeters the line of being extremely scandalous.

Happy New Year!