November 29, 2022 – Weight-loss advice is all over social media, but a trend sweeping TikTok has caused shortages of a key diabetes drug.
Ozempic, a weekly injection that helps increase insulin sensitivity in people with type 2 diabetes, also suppresses appetite, leading to weight loss. Stories of celebrities using the drug off-label to shed a few pounds have sparked an explosion of interest. And now people with diabetes — people whose lives could be saved by the drug — are having trouble finding it.
Kim Kardashian and Elon Musk
In the spring, Kim Kardashian managed a dramatic weight loss to fit into Marilyn Monroe’s dress for the Met Gala. Rumors soon circulated that she had used Ozempic to do this. Just this week, new Twitter owner Elon Musk tweeted about it its own use of Ozempic and its sister drug Wegovy.
diversity called Ozempic “the worst-kept secret in Hollywood — especially given that its most enthusiastic users aren’t pre-diabetic and don’t need the drug.” The rich and famous spend $1,200 to $1,500 a month to get access.
As is so often the case, the high-profile use has triggered a trend. Videos on TikTok with the hashtag #ozempic have accumulated more than 275 million views and #ozempicweightloss more than 110 million.
This raises concerns about who exactly is watching these videos and what message they are getting.
“42 percent of Americans are obese and even more are overweight. It’s affecting our younger employees and our adolescents,” said Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. “They’re looking to TikTok and other social media for help.”
A new study shows how harmful this can be: Researchers analyzed 1,000 videos with hashtags related to diet, food and weight, with over 1 billion views combined. They found that almost all of them contained messages that glorified weight loss and slimness.
Finally an effective weight loss drug
Ozempic is Danish drug company Novo Nordisk’s brand name for semaglutide, which works by mimicking a naturally occurring hormone called GLP-1. It travels to your brain and helps you feel full with less food. This leads to weight loss. In a 68-week study, semaglutide helped people lose an average of 15% of their body weight. But it’s not a miracle cure: you still have to change your eating habits and stay physically active.
The FDA approved Ozempic in 2017 to treat people with type 2 diabetes. Four years later, Novo Nordisk got the green light for a higher-dose version specifically for people with obesity. Wegovy is only approved for use if you have a BMI of at least 27 with one or more weight-related medical conditions, or a BMI of 30 or more without.
“These drugs dominate my practice because they are so effective,” says Amanda Velazquez, MD, director of obesity medicine at Cedars-Sinai Medical Center in Los Angeles. The drug is considered safe, “so most patients are good candidates.”
More demand than supply
As word spread about how well Ozempic and Wegovy worked, social media posts helped drive even more people to seek out the drugs. Now demand is outstripping supply — according to the FDA, starter doses of Ozempic will have limited availability through January.
“In Hollywood, people are losing 10 pounds, getting it for $1,500 a month, and depleting supplies for people who are so obese they have congestive heart failure and diabetes,” says Apovian. “These are people who are going to die, and you’re just taking it away for cosmetic weight loss. That is unfortunate.”
Along with the huge demand, Wegovy also had a disruption in its supply chain. It’s not available in lower doses at all right now, which is helping to drive off-label demand for Ozempic. Novo Nordisk expects these issues to be resolved by the end of the year, with distribution to follow soon after.
The access price
With a list price of $1,350 per month, Wegovy costs as much as many mortgages. And Medicaid, Medicare, and many insurance companies don’t cover it. Although obesity is a disease, the insurance industry tends to treat weight loss as a vanity issue — even if you could find the drug, you might not be able to afford it.
“We see that about half of the prescriptions that we put out aren’t covered,” says Apovian. “And for half that’s covered, we have to do pre-approval, which takes days and is tedious.” In some cases, she says, insurance companies withdraw approval after 3 months if they see not enough weight being lost .
It’s not like you can take Wegovy for 3 months, lose some weight and expect it to stay off. The drug requires real commitment, possibly lifelong. This is because once the semaglutide leaves your system, your appetite will return. In one study, people regained two-thirds of the weight they had lost within a year of stopping.
Many see a double standard in insurance companies’ refusal to cover a drug that could prevent serious illness or death.
“They say it’s not cost effective to give Wegovy to the 42% of Americans with a BMI over 30. Did they say that when statins came out?” Apovian says. “Why are they doing this with anti-obesity drugs? It’s the culture. The culture is not ready to accept obesity for the disease it is.”
Unpleasant side effects
Let’s assume you’re one of the lucky ones – your insurance covers Wegovy, and you may indeed find some. You might find that using it is no walk in the park. Common side effects include gastrointestinal problems such as nausea, vomiting and diarrhea.
“We counteract this by starting very slowly on a low dose of these drugs,” says Apovian. “We only go up when the patient is no longer sick or is getting better.”
Elise Davenport was excited to try Wegovy. “I did some research online. I’m the guy who’s interested in early adoption, gadgets and stuff like that,” says the 40-year-old technical writer. “I wanted to try it because I had tried so many other things that failed or didn’t work long-term.”
With a BMI over 30, Davenport qualified for the drug. She enrolled in an online program that guaranteed insurance coverage and began taking it in October 2021. Initially, the side effects were mild, just a hint of nausea and diarrhea. And the results were impressive. She found it easy to feel satisfied with smaller portions and lost her cravings for sugar and highly processed foods. The weight was dropping, about 5 pounds a week.
It turns out that’s too much, too fast. Apovian and Velazquez say their patients lose more than 2 pounds a week with careful monitoring.
In early December, Davenport’s side effects increased. Due to shortages of lower dosages, the online program was unable to match hers immediately. She was constantly nauseous, so bad that she vomited while brushing her teeth and had to force herself to eat. Some weeks she managed less than 500 calories a day. Her sleep patterns became irregular. And then her depression, which she had been controlled with medication for years, came to a head.
“I remember sitting on my bathroom floor crying, thinking I’d rather carry the extra weight,” she says. “I used to enjoy food a lot, and I didn’t anymore. It was such a joyless experience at that point.”
Eventually her dose was reduced and the symptoms subsided, but her GP encouraged her to stop. By the time she did it in March, she had lost 55 pounds. So far she has recovered about 10.
More than just weight loss
Although Davenport’s experience was not good, with better supervision she would be willing to try again. Seeing how easy it was to eat less with medical help helped reverse years of shame.
“Our culture treats obesity as a moral failure. I realized that doctors and programs had made me feel this way — that I wasn’t doing enough,” she says. “This drug made me realize that there are real physiological things going on in my body, things that are often left out of the conversation.”
Apovian and Velazquez say their patients regularly discover similar things.
“Obesity is not a disease of the will. Drugs are not an easy way out,” says Velazquez. “This is a chronic, relapsing disease and so we should treat it like we treat diabetes, high blood pressure and all these other diseases. We would never withhold medication for people who come in with high blood pressure, tell them to work on their willpower and withhold medication that they would qualify for.”