It is unusual for a prescription drug to make headlines. When a drug does get attention, it is usually for all the wrong reasons. The diabetes drug Ozempic became famous in the Summer of 2023 because pharmacies began running out of it. The story behind the headlines is a cautionary tale about the power of social media and diet culture.
What is Ozempic?
Novo Nordisk A/S is a Danish multinational pharmaceutical company that, in 2017, the US Food and Drug Administration (FDA) approved to market Ozempic, their brand-name version of the diabetes drug semaglutide.
Semaglutide treats type II diabetes in adults. There’s an essential difference between type I and II diabetes that needs to be explained. Type I, or juvenile diabetes, is an autoimmune disease in which the pancreas loses its ability to produce insulin, a hormone critical for metabolizing glucose, a significant energy source. Patients with type I diabetes require injections of insulin to keep their blood sugar levels from becoming too high.
In type II diabetes, which is more common than type I, the pancreas still produces insulin. Still, the patients become insulin-resistant, meaning the pancreas fails to make enough insulin to meet the body’s needs. Like patients with type I diabetes, type II diabetics also have chronically high blood sugar.
Insulin resistance can occur for several reasons; however, the two most common reasons are obesity and inadequate exercise.
Ozempic and other forms of semaglutide work by stimulating the pancreas to make more insulin, which lowers blood sugar. Semaglutide also acts on the part of the brain that regulates appetite and creates the feeling of fullness. Another effect of the drug is to slow down the stomach, causing it to empty more slowly.
A common side effect of semaglutide is that the stomach slows down to stop movement altogether (a phenomenon called gastroparesis), which causes the individual taking the drug to feel nauseous and often leads to vomiting.
However, the ‘most famous’ side effect of semaglutide is that patients taking it tended to lose weight. In 2021, Novo Nordisk took advantage of this side effect and won FDA approval for a higher dose of semaglutide, which they called Wegovy. Nevertheless, Wegovy and Ozempic remained relatively unknown to the non-diabetic public until 2023.
Elon Musk and TikTok
In October 2022, Elon Musk was asked on Twitter why he looked so fit and trim. Musk replied that he had been taking Wegovy, in addition to modifying his lifestyle, and that he had lost 30 lbs. Virtually anything Musk says causes ripple effects worldwide, and his public endorsement of Wegovy was no exception. That same month, Google searches for Ozempic and Wegovy rose geometrically.
The trend accelerated in early 2023 when #ozempic began trending on TikTok. Users on the popular social media platform began posting their experiences with taking Ozempic, including internet influencers. By the Summer of 2023, celebrities in Hollywood were reportedly obtaining Ozempic ‘off-label’ from physicians to lose weight. Reportedly, medical spas in Arizona began dispensing Ozempic and Wegovy. On the retail (i.e., non-prescription) market, prices of these drugs ranged between $1,000 and $1,500 per month.
The Ozempic Shortage
Pharmacies do not possess endless supplies of any medication, prescription or otherwise. When demand for a prescription drug exceeds supply, pharmacies tend to run out of that drug. This phenomenon is what happened with Ozempic in the Summer of 2023. Patients who were prescribed Ozempic to treat their type II diabetes were finding they needed to call as many as five pharmacies to find one that still had the drug on hand.
The evidence is circumstantial; however, the Ozempic shortage appeared to result from excessive off-label use by patients wishing to lose weight.
The government of Australia was one of the first to respond to the shortage. In September 2023, public health authorities recommended that patients be switched to alternative forms of semaglutide until further notice, as the shortages were projected to continue into 2024. Novo Nordisk and other pharmaceutical companies announced they would ramp up production of their semaglutide products to meet the increased demand. The motivation for these moves was that the public would become aware that the weight-loss side effect of semaglutide was not isolated to Ozempic and Wegovy.
Ozempic vs. Rybelsus
A significant drawback of Ozempic is that it must be injected under the skin once weekly. Many patients prefer alternative forms of semaglutide like Rybelsus, which comes in pill form. Rybelsus must be taken every day (as opposed to once per week); however, taking a medication once per day is preferable for many patients. There are no head-to-head comparison trials of Ozempic and Rybelsus; however, the safety and efficacy profiles of the drugs are similar. That is to say that they lower blood sugar and have a modest effect on weight-loss. They are also associated with the side effects of stomach upset, nausea, and vomiting.
The Best Way to Lose Weight
Semaglutide is not a miracle weight-loss drug. Even Wegovy was never intended to be used to lose weight without lifestyle changes. The irony for many patients with type II diabetes is that if they substantially alter their lifestyles and eating habits, they might not need to take medications to control their blood pressure!
To maintain a healthy weight, adopt healthy habits:
Diet. All adults should eat diets that include the following (and in this order of priority): meat and vegetables, nuts and seeds, some fruit, little starch, and no sugar.
Exercise. If you are inactive, seek the advice of a medical professional before starting an exercise program. If given the go-ahead, exercise 3–5 times weekly for at least 30 minutes.
Sleep. Adults require at least 8 hours of sleep a night. Go to bed at the same hour every night. Avoid excessive alcohol and other stimulants in the evening. Most of all, avoid looking at screens like on phones or tablets.
Stress reduction. Mental health is an essential component of overall health. Remove all stressors from life that do not need to be there, and seek the help of a certified professional if you need help.
It turns out that these four healthy habits are mutually reinforcing, and all (like semaglutide) share the side effect of weight-loss. If you have any questions or concerns, seek the advice of a healthcare practitioner.
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