Ozempic helps people lose weight. But who should be able to use it?

Semaglutide, bought within the types of Ozempic and Wegovy, shot into public consciousness as an efficient weight-loss remedy final yr, thanks to spruiking from social media influencers and people reminiscent of Elon Musk.The sudden enhance in demand for the drug for weight reduction has induced a worldwide scarcity. Producing the drug — delivered as a weekly self-administered injection — entails a novel manufacturing set-up, so it would take a while to re-establish a world provide. It’s anticipated again in Australia on the finish of March.Semaglutide (within the type of Ozempic) is an efficient remedy in managing kind 2 diabetes — and the scarcity has left some people with diabetes struggling to discover pharmacies with their remedy in inventory. For many people with diabetes, Ozempic has managed their blood sugar (and infrequently additionally helped them lose weight) extra successfully than different drugs.Due to the scarcity of Ozempic, Australian GPs have been suggested in opposition to prescribing it to deal with weight problems.However, semaglutide within the type of Wegovy is designed particularly for weight reduction. United States and Australian regulators have just lately authorized Wegovy for that function, although it hasn’t been obtainable for use in Australia to date.When the scarcity is resolved and semaglutide is as soon as once more obtainable in Australia for these with diabetes, it is unclear who will be able to entry it for weight reduction. Patients and medical doctors are additionally asking how a lot they’ll pay, and what function it would play in managing weight problems.How does it work?Semaglutide works in a number of methods, together with rising emotions of fullness by performing on urge for food centres within the mind and slowing abdomen emptying.It impacts the secretion of insulin and glucagon, which is why it’s so efficient in diabetes.It additionally reduces the chance of coronary heart assaults and strokes. Other weight-loss medication up to now have diminished weight however elevated the chance of dying from a coronary heart assault, which made them total too harmful.Studies present semaglutide helps 66-84 per cent of people who use the drug to lose weight, making it more practical than different medication on the marketAfter two years, sufferers utilizing it nonetheless profit by not regaining their misplaced weight — however provided that they’re nonetheless taking the drug.Disappointingly, as soon as stopped, sufferers discover a gradual regain of up to two-thirds of the load they misplaced. So primarily, semaglutide works solely whereas taking it — it “manages” however doesn’t “remedy”.Semaglutide is supposed to be an add-on, not a alternative, for train and a nutritious diet.Research on the remedy has all the time been finished along with a nutritious diet and train, as that’s thought of finest follow. So we do not know what occurs in case you simply take the remedy with out additionally beginning or sustaining a wholesome way of life. We do know train is key to preserving weight off over time.What are the unintended effects?Semaglutide may cause nausea, bloating, constipation and diarrhoea.Questions have been raised across the threat of pancreatitis, and thyroid and pancreatic cancers. So far the analysis is reassuring, nevertheless, these are all uncommon, so it is unlikely we are going to know if there may be any vital enhance for some years to come.How a lot does it price?One of the most important limitations to semaglutide for weight reduction is the price. Although sufferers spend much less on meals whereas taking it, in 2022 (when it was extra simply obtainable in Australia) it price round $130 a month.It might be pricier as soon as provide points are mounted, as a result of the producer, Novo Nordisk, is spending tens of millions of {dollars} constructing new amenities to meet the elevated demand. We know that train is key to preserving weight off over time.(Unsplash: Jeremy Stewart)In the United States, costs are already over US$1,000 a month except lined by insurance coverage.Australians with diabetes will proceed to be able to entry the drug on the Pharmaceutical Benefits Scheme (PBS) for the standard price of a script. However, if used for weight problems, it could be on a non-public prescription, so the price remains to be unknown.Obesity is extra widespread amongst people with decrease incomes. So from a public well being perspective, these who would profit essentially the most might least afford it. This lack of fairness should be wrestled with if this remedy turns into extensively used for weight problems administration. Subsidising on the PBS for weight reduction is one choice.What are the downsides?A severe concern is the potential for semaglutide to be utilized by people who are usually not overweight, significantly these with consuming problems. Because it suppresses urge for food, it might allow people to starve themselves in an unhealthy approach.Obesity is outlined as a physique mass index (BMI) of over 30, and chubby is BMI of 25-30. Yet there are studies of people with BMIs lower than 25 utilizing it to drop “only a little bit of weight”.The psychological and social strain to be skinny is a robust driver, significantly in a society that ceaselessly stigmatises weight problems. People might even see semaglutide as a approach of “treating” their physique picture points.Another concern is the influence on having fun with meals. Patients really feel full after just some bites, making meals with mates awkward, and generally limiting their social life.Why have medical doctors prescribed it for weight reduction?First-line weight problems administration should all the time be way of life interventions: enhancing your food plan and getting extra train, with the assistance of a multidisciplinary workforce.But when that is inadequate, sufferers’ choices are restricted. The handiest is bariatric surgical procedure. Although surgical procedure is usually properly tolerated, it’s an irreversible lifelong change.Once the semaglutide entry points are resolved, Australian regulators should search enter from the neighborhood and from medical doctors, and think twice concerning the function the drug should play in Australia’s administration of weight problems and weight reduction.In addition to equitable entry and safety for these with physique picture points, we are going to want clear, evidence-based tips that take into account the psychological and social influence of the drug.Natasha Yates is an assistant professor of common follow at Bond University. This piece first appeared on The Conversation.

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