Is it cheating to lose weight with drugs?（1/3）

Mutsuko Ohnishi, MD.

Internal medicine physician in Boston, USA

"O-O-O-Ozempic..." a rhythmic and uplifting tune. This is the commercial song for the type 2 diabetes medication "Ozempic" that I, living in Boston, frequently see on TV. It's worth noting that the U.S. and New Zealand are the only countries that allow direct-to-consumer (DTC) advertising for prescription drugs, which has sparked much debate.

The weight loss effect of Ozempic has been a major topic of conversation in the U.S. The Boston Globe reported on March 21, 2023, "First came the weight loss. Then started the Ozempic drama. Things intensified after Hollywood and TikTok discovered Ozempic as a miracle weight loss drug."

Not just in Hollywood, but the medical community is also paying close attention to Ozempic. With about 42% of adults in the U.S. being obese, what dramas are unfolding around Ozempic?

About Ozempic

Ozempic (generic name: Semaglutide), like Wegovy, belongs to the class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists. It mimics the action of the gut hormone GLP-1, which suppresses appetite by acting on the brain, slows down digestion by reducing gastric movement, and promotes insulin secretion (helpful in lowering blood sugar) while inhibiting the secretion of glucagon, a hormone that raises blood sugar.

In the U.S., Wegovy, containing a higher dose of Semaglutide, has been approved by the FDA as a weight loss medication. Meanwhile, Ozempic has been approved as a treatment for type 2 diabetes but also results in weight loss.

In Japan, Ozempic has been approved as a treatment for type 2 diabetes, and Wegovy was launched on February 22, 2024.

Using Ozempic off-label, i.e., not for type 2 diabetes but for weight loss, can cost about $1,000 a month. Nevertheless, as reported by the Boston Globe on October 24, 2023, "Despite resistance from insurance companies and concerns that it might be too early to measure long-term side effects, sales of this new class of appetite suppressants called GLP-1 are predicted to exceed $18 billion this year, far surpassing the $8 billion forecast for cholesterol medication sales, including cheaper generic drugs."

Obesity as a Disease to Be Treated

A report by doctors at New York University Grossman School of Medicine in the Journal of the American Medical Association on November 28, 2023, indicates that obesity increases the risk of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and early death. A 5%–10% weight loss can improve systolic blood pressure in hypertensive patients by about 3mmHg and lower hemoglobin A1c in type 2 diabetes patients by 0.6%–1%.

In 2013, the American Medical Association recognized obesity as a chronic disease.

Yet, many people do not view obesity as a disease and consider it "their fault." The New York Times, on January 19, 2023, featured an interview by journalist Lulu Garcia-Navarro with Dr. Fatima Cody Stanford, an obesity medicine specialist at Harvard Medical School and Massachusetts General Hospital.

Garcia-Navarro, who has struggled with obesity since adolescence and tried every weight loss method, says, "As anyone with a larger body will tell you, there's a lot of shame and guilt associated with being overweight. Most people see it as a problem of willpower or motivation, and so did I," "Using Semaglutide, I lost 75 pounds (about 34 kg) and it changed my life. My relationship with food has completely changed," "However, as these drugs become more popular, intense cultural debates have emerged about who should use them," "People taking Ozempic for weight loss are being criticized."

Dr. Stanford explains, "Unfortunately, because we don't recognize obesity as a disease, there's a misconception that people with obesity have brought it upon themselves. But that's wrong," "We never hesitate to treat patients with hypertension. We never hesitate to treat patients with diabetes or high cholesterol. But suddenly, when it comes to obesity and we bring up treatments, it's seen as a bad thing. Why wasn't it bad for the other diseases? That's where our bias lies."

The 'Shame' Side Effect of Obesity Medications

Moreover, the New York Times, on June 14, 2023, featured Eileen Isotaro, who started dieting at 14 and went through diet after diet, saying, "I felt driven by the urge to eat," "Craving food felt like a panic," "The mental shame was severe." After consulting with the University of Michigan's weight management clinic and being prescribed Wegovy, Isotaro lost 50 pounds (about 23 kg).

Like other patients at the clinic, Isotaro still battles the fear of being criticized for taking injections for obesity treatment rather than finding the willpower to lose and maintain weight. Yet, she says, "this medication changed my life."

There are people at the same clinic reluctant to admit using Wegovy, fearing being seen as "cheating."

Despite being a groundbreaking medication, many people stop using Semaglutide within a year.

This article is a translation of Japanese MRIC published on Dec 18, 2023