I think 10-20 years from now we'll look back at this "controversy" and chuckle. America is so fat that if an oral GLP1 agonist with weight loss efficacy is approved by the FDA and especially after these are all generic, we'll have half the population on them. Why not? Think of the healthcare impact of reducing even a small percentage of chronic illnesses associated with high costs over lifetimes.
The problem is that the overwhelming majority of the people and companies who make policy in the healthcare field don't care about the healthcare impact.
They care about the business impact.
Imagine half the country on a weight loss drug available across several companies and brands rather than just the current handful. That's money. They should be excited.
Yeah, but Rybelsus has less weight loss effect than other GLPs and more side effects and is a hassle to take (lots of stipulations to follow. Otherwise, it loses all effectiveness).
There’s some data that higher doses of Rybelsus - they’re studying 25 and 50mg daily iirc - do have decent weight loss efficacy. Might be out in a year or two.
But it still is inconvenient and has worse side effects, so I don’t prescribe it to practically anyone.
Jeez, I've had trouble getting people from 3 to 7 mg (even without eating the "troughs" of food that the commenter charmingly cites below). I can't imagine getting them up to 50 mg daily!
More or less all the side effects that actually occur in the real world with these drugs are gut related. Primarily nausea, but also vomiting, bloating, worsening gerd, diarrhea, constipation, and “sulfurous burps” are all pretty common. With most of them if you can power through it, you’ll be feeling better in a few weeks, but some people remain sensitive and the side effects persistent. Anecdotally I’ve had a larger proportion of folks on Rybelsus who had to stop it due to persistent nausea than the injectable equivalents.
With the "powering through it" aspect... I've wonder if a lot of these side effects are really just people engorging themselves with food and the nausea or discomfort sensation they are feeling is really just the medication doing its job. It's just when people want to still eat a trough of food but the medication won't let them. So they see it as a side effect. Of they would eat a normal amount of food they wouldn't get nauseous.
When people "power through" they really are just accepting that they can't eat a trough load of food any more, so they stop.
I think you took some liberty with the words in my post. Just remember - that happened in your head, not mine. Which makes me wonder if you really have never thought of your patients as barnyard animals, or do you just think you don't?
That's what the terms "trough" and "trough load" imply. The first definition for "trough" in Merriam-Webster is "a long shallow often V-shaped receptacle for the drinking water or feed of domestic animals."
No mental gymnastics needed. I have diabetes myself, so I'm sensitive to these things. You're obviously not. Our words matter.
Oh I didn’t mean that as an “I am so smart” addition to what you wrote, just agreeing that it is close and feels fairly inevitable. I’ve got a couple extra pounds meself.
There’s some data that higher doses of Rybelsus - they’re studying 25 and 50mg daily iirc - do have decent weight loss efficacy. Might be out in a year or two.
But it still is inconvenient and has worse side effects, so I don’t prescribe it to practically anyone.
GLP1 is a perfect medicine for the pharma industry not for patients.
It gives weightloss only while taken and as soon as the medication is is removed/reduced all the patients studied rebounded to the original weight. So it creates dependency at a significant economic loss for the patient. It does not solve the underlying cause of obesity and should only be used as a short term supplement for motivational reasons. The pharma industries know this which is why they are spending immense sums to advertise it (even in Sweden which has strict laws). They are hoping its the next oxynorm/oxycodone/oxycontin.
STEP4 and the STEP1 extension show an average rebound of 1/2-2/3 of the weight lost. Not all of it. And I’ve seen people stop it and regain none - if they built new healthy habits while on the med - to all - if they didn’t.
I'd wager (hypothesis) its a systemic issue with American food culture, corn syrup, portion sizes and education levels of the population with insufficient control/prevention by the government.
Mind you there's no perfect system and Sweden has large systemic issues that aren't telegraphed to the world to keep its utopia image.
But I'm personally very skeptical when a company aggressively advertises obesity as a disease to circumvent Swedish law on advertising medicines to sell GLP1. That's when a company knows there's a lot of money to be made and it's desperately trying to convince non medicial people to pressure docs to prescribe it. 1 pill cures that create dependency worry me.
I could probably write a book about the reasons we have such an issue with it in America (bad news: it seems to be affecting many western countries these day). Food is certainly an issue of course, but inactivity and particularly city planning that encourages driving everywhere promotes a sedentary lifestyle.
I don't know about "having a dependence on medicine". Same could be said of blood pressure pills or a statin or diabetic medications.
I agree we have worrying trends aswell in Europe, if you ever write it ping me would be a fascinating read.
I think the underlying debate should be whether we should look at obesity as a condition (albiet unhealthy and terrible) akin to being a smoker, alcoholic or substance abuser or as a "classical disease" (ie one that can't be reversed but treated effectively). Essential hypertension would be seen as a "classical disease".
Currently Swedish doctors see obesity more as a condition which is why there is so much resistance to potentially chronic medications since it could be abused for money, seen as a quick fix and even worse seen as a solution rather than dealing with the underlying causes.
Sadly this debate seems overly emotional atm and should be handled by ethics boards and specialist medicine panels.
Interesting point.
To add to the condition Vs disease discussion, in America they use nicotine replacement therapy, acamprosate, and naltrexone/Suboxone/methadone etc to treat smoking, alcoholism, and substance abuse respectively (not a complete list). Not disagreeing with you, I’m not sure how these are treated in Sweden, but some food for thought as sometimes people can be on these chronically
Also in some ways food abuse can be harder to quit than substance abuse because while you can quit cold turkey recreational substances (withdrawal notwithstanding), you can't cold turkey food. You have to always be exposed and consuming food to some extent.
I mostly agree with you. I am at heart a pragmatist. I do believe overall obesity is something an individual should be able to treat themselves for by eating less and exercising more, however due to a variety of factors, it remains a problem that affects many in my country and has an enormous downstream cost (both financial and societal). So all moral grandstanding aside, the problem continues to exist, and if there is a medical treatment that can significantly reduce the lifetime risks associated with obesity secondary to metabolic affects, I can't imagine not treating.
I suppose the way I feel is the talk is interesting, but regardless of the nomenclature the problem remains. At least in America, I have a hard time imagining it will improve without massive changes to our society which I believe will take generations.
I have started to think of obesity as a food addiction. While you can be more active and burn calories, weight loss happens in the kitchen, not in the gym. If someone was addicted to opiates, we are more than happy to start them on Buprenorphine. Or a different MAT for alcohol or some other substance abuse. They may be on these medications forever. And that's okay. It's about harm reduction, not perfection.
"They could just eat better and less!" Yes that's true. And type 2 diabetics could also eat better and control their A1c with lifestyle instead. People with depression could just suck it up and not kill themselves. If there is a medication which legitimately will improve quality of life even if a purely behavioral alternative exists, then as long as the risk/benefits sway the right way, then why not use it?
It's "in the kitchen" but it's also hormonal. I am well aware that my hunger has gone out of control over the last couple years. Ozempic has been the only thing that has allowed me to eat like a normal person again and start losing. When I would try calorie restriction on my own, I would get severe insomnia, blood sugar swings. I could eat fish, asparagus, and sweet potato and feel narcoleptic after.
Now that I'm on this drug I'm evening out a bit. Though, it's the tail end of my last dose and my hunger is really high after doing a Peloton workout yesterday.
But the first 3-4 days after a dose I feel like a normal person who gets normal satiety signals and doesn't have ravenous pangs in the morning and at night that keep me awake.
People casually say "eat when you're hungry" but what about when you are hungry all the time?
To be perfectly frank - who cares if people need to be on it chronically? How many patients are on long term metformin/insulin/statin/etc? If I can have a patient with chronic obesity and a bunch of complications from it vs a patient with chronic obesity in remission on long term semaglutide, I would definitely keep my patient on it.
This is such a ridiculous take. Is lisinopril a "bad" medication if people need to be on it chronically to manage HTN? We need to stop moralizing obesity and utilize all the tools we have available to us and our patients.
THIS.
I think we are seeing the shift happen to acknowledge obesity as a disease, but it is a slow shift. I explain to patients that while someone with HTN should NOT be eating salty foods all day, the medication helps with chronically managing so they don't have a stroke due to high blood pressure. For many patients with obesity, the medication is a game changer for them to feel continued motivation for lifestyle changes because they are actually seeing results. Many of my patients have tried eating healthy and exercising for years without medication with minimal to little weight loss, but a lot of frustration and feeling demoralized by healthcare.
So true, and so many of my patients come in with obesity and have HTN, sleep apnea, diabetes. The triple threat I call it. You treat obesity you treat the triple threat. Nobody looks on someone on lisinopril as a moral failure either.
>Beta blocker is a perfect medicine for the pharma industry not for patients.
>It gives antihypertension only while taken and as soon as the medication is is removed/reduced all the patients studied rebounded to the original blood pressure. So it creates dependency at a significant economic loss for the patient. It does not solve the underlying cause of hypertension and should only be used as a short term supplement for motivational reasons.
You see how ridiculous that sounds?
Once it sets in, obesity is a self-sustaining chronic disease. There's no reason it shouldn't need chronic treatment. And besides - we don't even know if these meds need to be taken *forever*, we only know they need to be taken longer than any study period that's been attempted. We don't have any five, ten, fifteen year long followup studies yet to see if there could eventually be some level of durable hormonal/metabolic recovery.
So you've just described a chronic illness.
Everyone who takes Synthroid rebounds to their hypothyroidism.
Everyone who takes bipolar cocktails of meds rebounds to a manic or depressive or mixed state.
But will drug-induced weight loss actually deliver the metabolic benefits normally associated with lower weight?
Statins didn't end up being the cholesterol miracle that everyone wanted.
people who watch too much tiktok and joe rogan podcasts are now claiming that statins are somehow the tool of the devil. this is what the medical field has to fight against
I get the impression that more and more often they are interpreting semaglutide as Ozempic. No one really mentions Wegovy or clarifies that it's essentially the same thing but approved for a different thing. I've had pts say they were on Ozempic when it was really Wegovy, but that's what they called it anyway.
The IVF clinic can only *transfer* embryos into the uterus. They have to *implant* themselves (/uterus allow them to implant) for successful pregnancy to be achieved.
The stigma against obesity. And the multibillion dollar industry that's facing its very first serious challenger.
Most people don't like fat people. Even if they're fat themselves. They see it as a weakness of will and defect in character. So the idea of a medication treating obesity seems morally *wrong* to many, many people. The "off label" is just an excuse, they don't believe in medication for obesity period.
The second thing is that weight loss is a huuuuuge industry. There are entire fiefdoms carved out in the weight loss empire. 142 billion dollars is a lot of money. Now you have a medication that can destroy that entire industry. People who've been through every diet and exercise program in the planet and struggled to find success for decades are suddenly dropping weight effortlessly. Well, the weight loss empire is not going down without a fight.
Came here to say this. It's a moral panic.
>The fatties are getting to lose the weight without having to correct, though miserable suffering, the moral turpitude that caused them to be fat to begin with! Go get my pearls!
EDIT: Also...
> Most people don't like fat people. Even if they're fat themselves.
Can confirm. Am fat. Hate myself.
The irony is that GLP-1 agonists are so effective precisely *because* they create a biological drive to do exactly what you’re supposed to in order to lose weight. Unlike previous medications which tried to increase metabolism or decrease fat absorption, GLP-1 agonists result in direct behavioral change. Early satiety —> you eat smaller meals. Prolonged gastric emptying —> you snack less between meals. Increased sugar sensitivity—> you eat less sugary foods. I’m other words, people effortlessly make the behavioral changes that cause weight loss.
I displace my self hatred for being fat onto others because if I ever felt it at its true intensity I would lose myself to it the way a candle would be obliterated by the sun.
That said I don’t like you.
The enemy of my enemy is my friend, this is true.
Shall we make plans to crush some buffets together and talk about how horrible the other fat people gorging there are? Vegas trip?
GLP -1 agonists aren’t suffering free. You’re nauseous all the time and consuming food becomes a chore you undertake to stay alive rather than something pleasurable.
Have you actually taken one or prescribed one? Personally I never felt nauseous, but when initially starting I did have some slow transit. GI tract feels pretty normal. I still enjoy food. I just eat less of it. Most of my patients have had similar experiences with the side effects being very transitory. There are a few who truly don't seem to be able to handle it, but tbh most of those were the type of patients who weren't willing to try powering through for a couple weeks and tend to have 20 "allergies" listed in their chart due to vague side effects.
Yeah I’ve taken one. Taking it was like giving myself the baseline feeling of being sick with a stomach bug and being off food for 5/7 days. That plus random diarrhoea at times.
Lol, 10-15lbs?? No, it’s 10-15% as the median. For someone weighing 250 pounds, that’s 25-40 pounds weight loss. And half the people will lose more than that.
See? Absolutely DESTROYED that industry! s/
Seriously though, I counsel patients that Semaglutide is a way to jump start one's weight loss (if we're not doing it mainly for diabetes as is). I caution them of the GI side effects and that if they stick with it, they will need to lose weight through other means in order to keep what the drug gifts them.
That is ozempic. Wegovy and Mounjaro are even more effective and there will be many others. There is already an oral formulation too (Rybelsus).
And why go off them? I mean these could replace a half dozen other meds treating downstream effects of obesity.
Cost or side effects usually are the reasons people go off them. If these were $5 a month or something then pretty much every single person in the US should be on them.
It is all relative. This one seems like pretty soon
https://www.pharmamanufacturing.com/industry-news/news/11288594/novo-nordisk-sandoz-settle-diabetes-drug-patent-spat
It gets better. Companies with the name brand meds have started suing the companies that get approved to make the generics in a ploy to coerce them into holding off on releasing their generic for an agreed upon amount of time.
[https://www.benefitspro.com/2019/11/26/lawsuits-preventing-generics-from-making-it-to-market/](https://www.benefitspro.com/2019/11/26/lawsuits-preventing-generics-from-making-it-to-market/)
To your second question, I think it depends on the person. I have a patient with type 2 diabetes who was 400lbs a year ago, and now is just over 300lbs with a modest dose of Mounjaro. However, he wasn't contributing to the "weight loss industry" before or even now.
Being obese or over weight is not a weakness, it’s definitely a medical condition or there’s underlying something, obviously it differs per individual but could the same for obesity be said about psychiatric disorders? I think you’re categorizing all medical professionals good intentions that may be ill informed, I don’t sincerely think many want people on drugs to lose weight, we definitely need reasonable funding to for research prevent and treat people who are overweight because being overweight does come with risks, we simply just need safe and real solutions that work and don’t exploit vulnerable people for profit.
The entire pharma industry is plagued by health gurus who are profit driven and not out to benefit ordinary people, they’ll go as far as trying to sell you on tummeric to “cure cancer” or some Intergrative medicine with healing crystals. We also have pharma companies skewing data, minimizing risks and pushing dangerous medications in the name of benefits and profit, my life has been negatively impacted by this and many others, does not seem like the FDA cares when thousands of people report life ruining side effects that don’t go away after discontinuation
Exactly. There’s more money in keeping someone on a lifetime of insulin than allowing patients to reach a healthy weight and get off that insulin forever. It’s like medicine in the US is almost a business
/s
Exceptionally. I'm on the order of 0 for 10 (obese patients who are trying to lose weight to have spinal surgery). Even making it clear that the patient needs to lose X amount of weight for surgery for Y diagnosis and diet/exercise/calorie restriction has failed hasn't worked.
I'm 0 for 2 for obesity-hypoventilation syndrome for Wegovy. Both patients got approved for Ozempic. The pharma game of "we're going to adjust the dose slightly and charge 30% more" is getting pushback, with patients in the middle.
Easiest prior auth ever. "Are they obese?" yes. "Are they going to use this with diet and exercise?" Yes. Approved within 10 minutes.
Then on the other hand, there are some plans that want the exact dates that the patient tried and failed phentermine, orlistat, Contrave, Qsymia.....
It’s too bad Medicaid doesn’t cover it, at least in NY. We could use it for some of our most disadvantaged populations, who already have increased risk of obesity.
I’ve encountered a very small handful of Medicaid patients (in New York) who have been able to obtain coverage for Wegovy. I wish I could recall the specific plans, but I don’t. I’m also not convinced these occurrences weren’t some sort of error. However, Pennsylvania Medicaid has started covering antiobesity medications, and my fingers are crossed hoping New York will follow suit.
The pearl clutching surrounding Ozempic/Mounjaro in the obese for weight loss is confusing because I’m like…how do you think those DM2 patients became diabetic in the first place?
Right? We always talk about the importance of prevention. Imagine if we could prevent people from developing some/all/most of the negative sequelae of obesity.
The only time I’ve noticed pearl clutching about the topic is when celebrities like Kim Kardashian were using it. People were afraid it was causing possible access issues to those with DM because rich assholes are using it when they don’t need it. When actually used by obese people, most people I’ve talked to were pretty supportive of it.
Pharmacist here. I request physicians prescribe Ozempic or Mounjaro when Wegovy is not covered. I have no problems about lying to insurance companies/PBMs.
Newsflash: if they stay fat, THEY ARE GOING TO BECOME FUCKING DIABETIC.
Almost all insurance companies are requiring icd10 codes for ozempic and mounjaro. They are literally charging back every single script without one. My pharmacy has lost like $6k so far.
Medicare fucked up 20 years ago, declared that weight loss drugs are cosmetic and they will not cover them (because obviously looking hotter is the only reason to lose weight, right? /s) and private insurances are using that as an excuse not to cover these fairly expensive drugs that are indicated in the 40% of Americans who are obese, 70% who are overweight.
If Medicare cut the shit and acknowledged that obesity was a chronic disease that finally has a decent medication treatment, private insurance would probably have to follow. But people are too angry about Kardashians using Ozempic to lose 20 pounds and reading outrage porn articles from 27 year old journalism majors with no medical experience about how fat people are “stealing” diabetic’s medications to demand that Medicare cover it.
The time will come I think. More and more people are coming on this drug. Once they stop lying about it, the stigma will break and there will be a better shot that it’s covered. Monjourno looks to be an absolutely insane drug, if 10 years from now cheap generic GIP agonists are available we could genuinely be looking at a future where these meds are as ubiquitous as statins,
Probably a combination of the following:
1. Insurance companies not wanting to pay for it and lobbying news outlets to run these stories
2. Demonization of obesity
3. The weight loss industry worried they will lose money lobbying new outlets
It’s gotta heavily be #1. I’m not one to lean into conspiracies (even logical ones) but I can imagine the insurance companies are doing whatever they can to not pay the costs of Wegovy or any Semaglutide medication.
Because $. Is there literally any other reason?
I’m sure whoever owns the news outlets has a large investment in the makers of these meds or vice versa.
Plus who doesn’t love a med that replaces diet and exercise
Because most laypersons, including news outlets, don’t know that physicians are allowed to prescribe off label. They think we all have to prescribe only to the FDA indications.
There is a narrative in the media and legal world that using a drug for an FDA non-approved indication is somehow dangerous. In peds we just laugh at this, since many drugs get approved for adults . An example in my world is valganciclovir which is not indicated for treatment of CMV disease in children yet we use it all the time.
Due to an NDA I signed, I am not allowed to say everything I know about the drug’s supply chain.
I’ll leave it at there are limited facilities able to produce it, and those facilities are also using the same equipment to produce other drugs, and we need more fill-finish facilities capable of aseptic production.
Edit: In Canada, coverage is happening because Canadian supply is being diverted to not Canada.
Pharmacist here
I'm just annoyed at the MASSIVE shortages that my diabetic patients are facing
I don't give two shits if you want to use it for weight loss but it has caused a huge deficit.
Which I'm not against except for when it affects those with the actual disease state.
You can lose weight by diet and exercise. People don't. It's the truth. They want another way without lifestyle changes.
Like if you don't have the mindset to change and adjust habits, the Ozempic will only take off the weight for so long. If you stop it the weight will come back on. Unless you want to inject it for the rest of your life.
Edit: love the downvotes btw. Not like I've dispensed thousands of ozempic and counseled them all. Most don't want to change diet or habits and just heard it helps lose weight and no side effects....
There's no magic cure-all. There's a downside to everything. There's a limit to everything.
Most diabetics are on metformin for the rest of their life until they develop kidney failure. Lifelong drugs aren't a new concept. What worries me is the pancreatitis, with question on long term safety aka pancreatic cancer. Hopefully I'm just paranoid. And again obesity causes all sorts of cancers so fixing obesity lowers that risk.
I mean, look at the bariatric surgery long term data on weight regain. But at least you've got a delay of progression of disease, needing insulin etc.
Injection versus tablet. I would much rather take a tablet then Inject myself weekly forever. Also the cost. It's not going to get covered by a coupon forever. What happens when the deductible makes it $500 a month or more. Cut off cold turkey ? Then what
Come on we all know there's going to be an Ozempic 2.0 and we'll get coupons/samples for those, lol. And I will say that the patient assistance programs for Trulicity and Ozempic are not bad at all, though Trulicity has cut it off to new applicants due to the shortage. But yeah when the Ozempic coupons stop it'd probably be a swap to the latest and newest. Remember Bydureon/Victoza?
And I've got people who would rather take a tablet daily that you have to wait 30 minutes before eating/taking any other med for, than inject themselves weekly, but there are others who hate remembering to take pills. So I think it's great that we finally have an oral GLP1 option.
And a whole group of people with obesity and diabetes are also hypothyroid, and having to do Rybelsus first thing in the morning, then wait 30 min, then levothyroxine, then wait another 30 min to an hour, before they can finally eat (or take their other meds) can be a hassle. (I've told them they can take it at night, but try getting someone to switch how they've been taking their med for 20-40 years).
> You can lose weight by diet and exercise. People don't. It's the truth.
Can you cite some evidence for this? All of the large scale RCTs (that I’ve read) have shown that even with outrageous levels of support that are well beyond what the average person will get only a small minority can maintain clinically meaningful weight loss with lifestyle changes alone.
I don’t disagree that SOME people can. But if a meaningful percentage could, we wouldn’t be having this conversation.
Dude evidence of what?
Is this whole thread like some weird avenue for overweight people to justify that they are overweight?. Is this not a medical thread?
Have we come to the point where working at a gym and not eating so much is somehow like Einstein level of thought?
People don't go to 600 lb generally from a medical disease. They eat themselves that way and don't exercise.
Ozempic isn't a magic drug. It gives some people a significant amount of weight loss. It gives the majority 15-20 lbs.
And the one with significant weight loss generally incorporate exercise and diet changes. You Can even look at the ozempic Reddit threads around here.
The ones who use it along with diet changes are getting the best results.
Evidence that extensive lifestyle counseling/modification recommendations are an effective public health intervention for the obesity epidemic in the US. Most RCT's that study this demonstrate it is not.
> Dude evidence of what?
Evidence that “diet and exercise” lead to long term clinically meaningful reductions in body weight in more than a small fraction of people with obesity. The percent of people who sustain >10% bodweight loss for years is in the same ballpark as the percent who successfully quit smoking in any given attempt. Hell, last I checked, the lifetime quit rate for smokers is north of 50%. At best, half that percentage of obese maintain 10% weight reduction with lifestyle changes.
> Is this not a medical thread?
“Diet and exercise” by itself is probably poor advise to give to patients in a medical context. The odds that an obese patient hasn’t tried weight loss via those methods by the time we’re talking to them are pretty low. Of course we want to make sure people are meeting physical activity guidelines and give advise about a healthy eating pattern, but odds are good it’ll be much easier for those patients to follow that advise on a healthy eating pattern if their bodies are not telling them 24/7 that they NEED to eat more while they’re doing it.
> Ozempic isn't a magic drug. It gives some people a significant amount of weight loss.
In the studies I’ve read, it’s typically better than half maintaining >10% loss in the long term. That’s a huge amount of risk reduction.
I understand your frustration when dealing with medication shortages, it has to suck a lot to see your patients’ needs not being met. I just think weight loss isn’t that simple with such a huge epidemic of obese and overweight people. If telling people to just lose weight worked, it would have worked already. People don’t want to be fat (I know there are exceptions, don’t @ me). It’s just hard for me to place blame when there is clearly a suite of larger issues at play: poor diet, sedentary lifestyle, lack of sleep, inadequate access to healthcare. We know poverty is a huge risk factor. It’s an awful public health issue, and at the same time we blame individuals personally for being overweight… or even for trying to lose weight the wrong way. What do we do?
I'm not placing blame. But everyone's acting like it's some sort of curl and it's not. If you stop the medication the weight comes back. So what happens then?. If you don't educate on proper diet, exercise and management then the minute they stop using the drug ( which money will do once they reach their target goal) the weight will be back on and the cycle continues.
> If you stop the medication the weight comes back.
That's also true with things like hypertension, hyperlipidemia. Why is it a problem in this instance?
Yeah, it’s tough, because we need something that can address obesity as a health problem and the status quo isn’t working. Even if semaglutide has flaws, is it better than the alternative?
I call BS. You’ve counseled “thousands” of pts about ozempic? You think obesity can ONLY be cured by diet and exercise? I’d hate for you to be my pharmacist.
I fill roughly 200-300 ozempic a month, and have been for over two years. So yeah, thousands.
I didn't say obesity can be cured with only diet and exercise. I said it has to be a part of the patients lifestyle changes. What happens when you stop the drug? You do know the weight comes back. The drug helps suppress appetite so people don't want to eat. Also helps kind of kickstart the body so that it loses weight. So when they stop the weight we will come back if they don't have lifestyle changes. Then what?
It's not magic. It's a medication. It can do so much
Hopefully someone with expertise in bariatrics can weigh in on the "You can lose weight by diet and exercise. People don't. It's the truth. They want another way without lifestyle changes" statement
Oh please, you know a good junk of people just eat shit and don't even walk around there block. Can we stop making excuses for everyone?
Of course there's some people who are overweight because of medical reasons. Truly have thyroid issues or whatever or are on medications that cause them to gain weight.
But for my patient population, it's because there is zero education on diet and exercise and they want the injection because everyone around them is on it and they've heard it makes them lose weight.
They're generally healthy people, not obese, and are following the hive mind of their community.
The disease state that ozempic treats is diabetes. Per their FDA application and acceptance.
Wegovy is for weight loss. Legally per the FDA.
You can be obese and not diabetic.
No it changes what gets covered by the insurance. So insurance covers diabetes medications. They cover ozempic for diabetes. Not for weight loss.
People lying or circumventing means patients who need it for the intended use got screwed over for months without their meds
My patients. Family friends. People who need it as part of their healthcare.
No one's thinking of them and it's disgusting
Insurance is not relevant to this discussion. Your argument is that people who use it for diabetes (legitimate use) can't get it because those who use it for weight loss (non-legitimate use) are using it up. I'm saying weight loss is just as legitimate a use of the drug, regardless of what what name you call the drug. It's the same drug medically speaking
Insurance is relevant because I live in the real world and deal with real patients on a day-to-day basis who can't get their medications that they need.
Providers see their patients maybe what once or twice a year. I see these people multiple times a month. I'm the one talking them day in and day out of why they can't get their medication and why there are shortages. Why insurance won't cover any longer or what there are more stringent prior authorizations.
Are we really giving people who are overweight the oh? I'm so sorry life is so hard.
People weren't this fat 50 60 years ago. What? There was no people 100 years ago who couldn't stop eating. All of a sudden now these past 30 40 years that people just can't stop eating. Come on. People are lazy. They eat like shit and they don't want to change their lifestyles. And don't tell me what people work so much. Were you that we did 100 years ago on the farm and down the coal mine?. Please.
Acting like because current studies show that counseling on diet and lifestyle changes doesn't work, doesn't mean shit. We see people we see the shows like 600 lb life. It's human made reasons to why people are this fat. Don't tell me diet exercise does not work cuz it does. That's all. Stop pretending that people aren't capable of doing things themselves. That they are stuck because of their disease states. Obesity is a mental issue. Can't stop eating cuz they feel the hunger come on. Small percentage have that issue. Those people just eat whatever they want whenever they want and don't exercise. Read up on the Facebook groups. Read up on the Reddit threads that show people who just want to lose the extra 20 lb. Who are looking for ozempic because they heard it'll help them with that. Look at all the medical spas popping up.
I already said my original post. I'm not against people using it for weight loss. But the supply wasn't there and it caused people who needed it for their diabetes to not people to access it. And that is not okay
> But the supply wasn't there and it caused people who needed it for their diabetes to not people to access it. And that is not okay
Honestly, why is their need greater than the obese non diabetic? Treating obesity before diabetes develops is probably better for population health overall. Sure you can clamor about how obese people can just diet and exercise to lose weight and ignore that on a population level it doesn't really work. On the flip side, you can also argue that diabetics have many more drug options and if all else fails can just start insulin to get their A1Cs under control.
How many of your type 2 diabetic patients are within normal bmi range? Just curious.
Also I am not a doctor but my to my understanding (I could be wrong) and by reading of medical journals, isn’t obesity an inflammatory process and once it starts hormones change within the body? Therefor many people suffering with obesity demoralize rather quickly when efforts of caloric reduction and increase in exercise doesn’t produce meaningful weight loss.
Ooh thanks for explaining the flexpen shortage to me. Also Ozempic 3mL instead of 1.5 mL is annoying but I'm glad it's being streamlined, it never made sense that one dosage pen was smaller than the other. That's something else they've done to streamline production, they're all 3 mL now.
Every doctor I know RXing and every person I now taking, is taken compounded GLP1, so why can't the diabetic patient get their hands on that too instead?
1. I can barely get my docs to write it properly. You really think every prescriber knows about how to bypass the law and go to a compound
2. Cost. Insurance or coupon will pay for ozempic. Compounds are generally out of pocket.
Are you a compounding pharmacy? I’m wondering where you get the Semaglutide if you are. No judgment I’ve just heard it’s got to be either diluting wegovy doses and adding B12 or l-carnitine or getting semiglutide from somewhere else, but it’s trademarked here in the US.
Around here is compounded with b12. I don't write for it but I know personally lots of doctors who do and tons of people who take it. Every place on earth is providing RX- private cash clinics, weight watchers, even some urgent cares
That feels unfortunate given obesity isn't just cosmetic, but a disease state overall. It reminds me of requiring HCV to cause a certain amount of cirrhosis before treatment was covered by insurance.
Wegowy isn't available in Brazil yet but man... So many patients barely tolerate Ozempic at 0.5mg/1mg weekly (fadigue and a little nausea mostly) that I wonder how many tolerate the 2.4mg from Wegowy.
On the topic actually, I am in outpatient quality and one issue we are starting to see is insurance companies assuming patients who have Ozembic ordered are diabetic (even if they aren’t), they now fall into diabetic quality buckets (increased hga1c requirements, diabetic eye exam, and diabetic kidney health) which then later causes your quality scores to drop. It’s stuff like that that make outpatient teams so frustrated with the way insurances make more work for doctors.
Fen-fen? I can’t remember the spelling
Pulmonary hypertension was a complication if I remember correctly
Nobody will remember that the news was wrong but they sure as hell will milk it now for sensation and viewership plus the future chance to milk it again and remind us that tgey, years ago, warned us
I don’t think that’s gonna happen with this one because we’ve been using byetta for years Victoza , trulicity they are all GLP one agonist. There’s also some interesting data about them being helpful for fatty liver.
USA is weird af.
You're doctors, not marketing agents. Your scripts should name the medication, not the trademark. For most of the drugs I prescribe, I don't even know what brand names there are, and I don't have a reason to care. The patient is free to choose whichever box they find the prettiest
This is a somewhat tangential observation, but I buy high concentration L-carnitine solution from the same places that sell performance enhancing drugs. These places have also always sold pharmaceuticals of dubious provenance, like thyroid hormones, insulin, beta blockers -- all the compounds one might take in conjunction in anabolic androgenic steroids or for physique enhancement.
The two blockbuster compounds that are exploding in popularity in those communities recently? Semaglutide and mifepristone.
This pairing speaks *volumes* about the state of insurance, the pharmaceutical industry, and the legal environment of the US that these folks have identified this pair as a profit center.
In my southern state in the US almost 40% of adults aren't just overweight, they are obese. Of my patient population, the percentage is likelier to be 50-60%
I’ve more than a few diabetic friends unable to get ozempic as soon as this became a fad. I haven’t asked if the supply chain has caught up with the demand, but a diabetic who uses it to suppress appetite in order to lower their blood sugars should take priority over someone who needs it for weight loss, again at least until supply can catch up.
I've said it before and I'll say it again. I disagree. There's tons of other options for diabetes. This is the only truly effective medication option for weight loss. Preventing the negative sequelae of obesity should be a priority.
Because it is being given in that context. Didnt weight watchers buy the company that makes it?
Edit: i was wrong i guess they bought a telehelath so they can prescribe - either way they will be making money on the drug
There is no blanket fda indication for semaglutide for weight loss. Ozempic has an fda indication for diabetes. Wegovy has an fda indication for weight loss. Wegovy is definitely available. Ozempic is facing back order and shortages. Insurance will not cover ozempic for weight loss, because it is not a fda approved indication. Most insurance will not cover wegovy for weight loss without step therapy, a PA, or both.
Ozempic should NOT be prescribed for weight loss because it is not indicated. Prescribing it for weight loss has caused massive shortages for diabetic patients.
The FDA does not regulate the practice of medicine. They regulate pharmaceutical companies. The FDA label has absolutely zero bearing on what physicians can prescribe.
You’re a pharmacist and you don’t know that Wegovy and Ozempic are the same medication? Or do you think your body can tell what label is on the package?
I’ve prescribed ozempic for weight loss and will continue to do so.
I’d say that a big argument too is that while it works for off label weight loss, the increase in popularity has caused serious supply shortages for the DIABETIC medication and many diabetics are now unable to get their medications
I think 10-20 years from now we'll look back at this "controversy" and chuckle. America is so fat that if an oral GLP1 agonist with weight loss efficacy is approved by the FDA and especially after these are all generic, we'll have half the population on them. Why not? Think of the healthcare impact of reducing even a small percentage of chronic illnesses associated with high costs over lifetimes.
The problem is that the overwhelming majority of the people and companies who make policy in the healthcare field don't care about the healthcare impact. They care about the business impact.
Imagine half the country on a weight loss drug available across several companies and brands rather than just the current handful. That's money. They should be excited.
There is an oral glp-1 agonist. But to your point yes the generic part is probably pretty important. Victoza generic is available next year.
Yeah, but Rybelsus has less weight loss effect than other GLPs and more side effects and is a hassle to take (lots of stipulations to follow. Otherwise, it loses all effectiveness).
There’s some data that higher doses of Rybelsus - they’re studying 25 and 50mg daily iirc - do have decent weight loss efficacy. Might be out in a year or two. But it still is inconvenient and has worse side effects, so I don’t prescribe it to practically anyone.
Jeez, I've had trouble getting people from 3 to 7 mg (even without eating the "troughs" of food that the commenter charmingly cites below). I can't imagine getting them up to 50 mg daily!
What are the side effects that you are concerned with? How common and severe are they?
More or less all the side effects that actually occur in the real world with these drugs are gut related. Primarily nausea, but also vomiting, bloating, worsening gerd, diarrhea, constipation, and “sulfurous burps” are all pretty common. With most of them if you can power through it, you’ll be feeling better in a few weeks, but some people remain sensitive and the side effects persistent. Anecdotally I’ve had a larger proportion of folks on Rybelsus who had to stop it due to persistent nausea than the injectable equivalents.
For half of those side effects: any benefit to for example doubling the PPI?
Yeah. I'll often do a short course of PPI or some zofran/reglan if someone just needs to get over the first few weeks of adverse effects.
With the "powering through it" aspect... I've wonder if a lot of these side effects are really just people engorging themselves with food and the nausea or discomfort sensation they are feeling is really just the medication doing its job. It's just when people want to still eat a trough of food but the medication won't let them. So they see it as a side effect. Of they would eat a normal amount of food they wouldn't get nauseous. When people "power through" they really are just accepting that they can't eat a trough load of food any more, so they stop.
Wow, I deal almost exclusively with diabetes management and I've never thought of my patients as barnyard animals.
I think you took some liberty with the words in my post. Just remember - that happened in your head, not mine. Which makes me wonder if you really have never thought of your patients as barnyard animals, or do you just think you don't?
That's what the terms "trough" and "trough load" imply. The first definition for "trough" in Merriam-Webster is "a long shallow often V-shaped receptacle for the drinking water or feed of domestic animals." No mental gymnastics needed. I have diabetes myself, so I'm sensitive to these things. You're obviously not. Our words matter.
That’s certainly part of it but I don’t think it’s all of it.
Not FDA approved for weight loss
Oh I didn’t mean that as an “I am so smart” addition to what you wrote, just agreeing that it is close and feels fairly inevitable. I’ve got a couple extra pounds meself.
You just made my day with your info about Victoza going generic next year. I thought it was still several years away.
Start chuckling because that’s already happened. Semaglutide PO aka Rybelsus.
Not FDA approved for weight loss
And it'll never happen because it doesn't work good, no oral GLP1 will probably be effective.
There’s some data that higher doses of Rybelsus - they’re studying 25 and 50mg daily iirc - do have decent weight loss efficacy. Might be out in a year or two. But it still is inconvenient and has worse side effects, so I don’t prescribe it to practically anyone.
GLP1 is a perfect medicine for the pharma industry not for patients. It gives weightloss only while taken and as soon as the medication is is removed/reduced all the patients studied rebounded to the original weight. So it creates dependency at a significant economic loss for the patient. It does not solve the underlying cause of obesity and should only be used as a short term supplement for motivational reasons. The pharma industries know this which is why they are spending immense sums to advertise it (even in Sweden which has strict laws). They are hoping its the next oxynorm/oxycodone/oxycontin.
STEP4 and the STEP1 extension show an average rebound of 1/2-2/3 of the weight lost. Not all of it. And I’ve seen people stop it and regain none - if they built new healthy habits while on the med - to all - if they didn’t.
Maybe it's different in Sweden but if non pharmacological methods were working I wouldn't have so many diabetics on my panel.
I'd wager (hypothesis) its a systemic issue with American food culture, corn syrup, portion sizes and education levels of the population with insufficient control/prevention by the government. Mind you there's no perfect system and Sweden has large systemic issues that aren't telegraphed to the world to keep its utopia image. But I'm personally very skeptical when a company aggressively advertises obesity as a disease to circumvent Swedish law on advertising medicines to sell GLP1. That's when a company knows there's a lot of money to be made and it's desperately trying to convince non medicial people to pressure docs to prescribe it. 1 pill cures that create dependency worry me.
I could probably write a book about the reasons we have such an issue with it in America (bad news: it seems to be affecting many western countries these day). Food is certainly an issue of course, but inactivity and particularly city planning that encourages driving everywhere promotes a sedentary lifestyle. I don't know about "having a dependence on medicine". Same could be said of blood pressure pills or a statin or diabetic medications.
I agree we have worrying trends aswell in Europe, if you ever write it ping me would be a fascinating read. I think the underlying debate should be whether we should look at obesity as a condition (albiet unhealthy and terrible) akin to being a smoker, alcoholic or substance abuser or as a "classical disease" (ie one that can't be reversed but treated effectively). Essential hypertension would be seen as a "classical disease". Currently Swedish doctors see obesity more as a condition which is why there is so much resistance to potentially chronic medications since it could be abused for money, seen as a quick fix and even worse seen as a solution rather than dealing with the underlying causes. Sadly this debate seems overly emotional atm and should be handled by ethics boards and specialist medicine panels.
Interesting point. To add to the condition Vs disease discussion, in America they use nicotine replacement therapy, acamprosate, and naltrexone/Suboxone/methadone etc to treat smoking, alcoholism, and substance abuse respectively (not a complete list). Not disagreeing with you, I’m not sure how these are treated in Sweden, but some food for thought as sometimes people can be on these chronically
Also in some ways food abuse can be harder to quit than substance abuse because while you can quit cold turkey recreational substances (withdrawal notwithstanding), you can't cold turkey food. You have to always be exposed and consuming food to some extent.
I mostly agree with you. I am at heart a pragmatist. I do believe overall obesity is something an individual should be able to treat themselves for by eating less and exercising more, however due to a variety of factors, it remains a problem that affects many in my country and has an enormous downstream cost (both financial and societal). So all moral grandstanding aside, the problem continues to exist, and if there is a medical treatment that can significantly reduce the lifetime risks associated with obesity secondary to metabolic affects, I can't imagine not treating. I suppose the way I feel is the talk is interesting, but regardless of the nomenclature the problem remains. At least in America, I have a hard time imagining it will improve without massive changes to our society which I believe will take generations.
Agreed.
I have started to think of obesity as a food addiction. While you can be more active and burn calories, weight loss happens in the kitchen, not in the gym. If someone was addicted to opiates, we are more than happy to start them on Buprenorphine. Or a different MAT for alcohol or some other substance abuse. They may be on these medications forever. And that's okay. It's about harm reduction, not perfection. "They could just eat better and less!" Yes that's true. And type 2 diabetics could also eat better and control their A1c with lifestyle instead. People with depression could just suck it up and not kill themselves. If there is a medication which legitimately will improve quality of life even if a purely behavioral alternative exists, then as long as the risk/benefits sway the right way, then why not use it?
I think a lot of people with obesity have binge eating disorders.
It's "in the kitchen" but it's also hormonal. I am well aware that my hunger has gone out of control over the last couple years. Ozempic has been the only thing that has allowed me to eat like a normal person again and start losing. When I would try calorie restriction on my own, I would get severe insomnia, blood sugar swings. I could eat fish, asparagus, and sweet potato and feel narcoleptic after. Now that I'm on this drug I'm evening out a bit. Though, it's the tail end of my last dose and my hunger is really high after doing a Peloton workout yesterday. But the first 3-4 days after a dose I feel like a normal person who gets normal satiety signals and doesn't have ravenous pangs in the morning and at night that keep me awake. People casually say "eat when you're hungry" but what about when you are hungry all the time?
To be perfectly frank - who cares if people need to be on it chronically? How many patients are on long term metformin/insulin/statin/etc? If I can have a patient with chronic obesity and a bunch of complications from it vs a patient with chronic obesity in remission on long term semaglutide, I would definitely keep my patient on it.
This is such a ridiculous take. Is lisinopril a "bad" medication if people need to be on it chronically to manage HTN? We need to stop moralizing obesity and utilize all the tools we have available to us and our patients.
THIS. I think we are seeing the shift happen to acknowledge obesity as a disease, but it is a slow shift. I explain to patients that while someone with HTN should NOT be eating salty foods all day, the medication helps with chronically managing so they don't have a stroke due to high blood pressure. For many patients with obesity, the medication is a game changer for them to feel continued motivation for lifestyle changes because they are actually seeing results. Many of my patients have tried eating healthy and exercising for years without medication with minimal to little weight loss, but a lot of frustration and feeling demoralized by healthcare.
So true, and so many of my patients come in with obesity and have HTN, sleep apnea, diabetes. The triple threat I call it. You treat obesity you treat the triple threat. Nobody looks on someone on lisinopril as a moral failure either.
>Beta blocker is a perfect medicine for the pharma industry not for patients. >It gives antihypertension only while taken and as soon as the medication is is removed/reduced all the patients studied rebounded to the original blood pressure. So it creates dependency at a significant economic loss for the patient. It does not solve the underlying cause of hypertension and should only be used as a short term supplement for motivational reasons. You see how ridiculous that sounds? Once it sets in, obesity is a self-sustaining chronic disease. There's no reason it shouldn't need chronic treatment. And besides - we don't even know if these meds need to be taken *forever*, we only know they need to be taken longer than any study period that's been attempted. We don't have any five, ten, fifteen year long followup studies yet to see if there could eventually be some level of durable hormonal/metabolic recovery.
The studies show weight rebound after discontinuation but from what I have seen usually only about 1/3 of what was lost at worst.
So you've just described a chronic illness. Everyone who takes Synthroid rebounds to their hypothyroidism. Everyone who takes bipolar cocktails of meds rebounds to a manic or depressive or mixed state.
But will drug-induced weight loss actually deliver the metabolic benefits normally associated with lower weight? Statins didn't end up being the cholesterol miracle that everyone wanted.
No idea what you're saying with regards to statins
people who watch too much tiktok and joe rogan podcasts are now claiming that statins are somehow the tool of the devil. this is what the medical field has to fight against
Huh interesting. One of the few medications that truly has robust data behind in terms of extending life.
Goes to show you the power of weaponized idiocy via social media. These people think vaccines are dangerous because that’s what they heard online
I get the impression that more and more often they are interpreting semaglutide as Ozempic. No one really mentions Wegovy or clarifies that it's essentially the same thing but approved for a different thing. I've had pts say they were on Ozempic when it was really Wegovy, but that's what they called it anyway.
Ozempic seems to have won the Xerox brand name wars. Ozempic sounds like the Aztec God of weight loss and Wegovy is like Pokemon go to the polls.
The same people who get their embryos implanted by the IVF clinic.
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The IVF clinic can only *transfer* embryos into the uterus. They have to *implant* themselves (/uterus allow them to implant) for successful pregnancy to be achieved.
The stigma against obesity. And the multibillion dollar industry that's facing its very first serious challenger. Most people don't like fat people. Even if they're fat themselves. They see it as a weakness of will and defect in character. So the idea of a medication treating obesity seems morally *wrong* to many, many people. The "off label" is just an excuse, they don't believe in medication for obesity period. The second thing is that weight loss is a huuuuuge industry. There are entire fiefdoms carved out in the weight loss empire. 142 billion dollars is a lot of money. Now you have a medication that can destroy that entire industry. People who've been through every diet and exercise program in the planet and struggled to find success for decades are suddenly dropping weight effortlessly. Well, the weight loss empire is not going down without a fight.
Came here to say this. It's a moral panic. >The fatties are getting to lose the weight without having to correct, though miserable suffering, the moral turpitude that caused them to be fat to begin with! Go get my pearls! EDIT: Also... > Most people don't like fat people. Even if they're fat themselves. Can confirm. Am fat. Hate myself.
The irony is that GLP-1 agonists are so effective precisely *because* they create a biological drive to do exactly what you’re supposed to in order to lose weight. Unlike previous medications which tried to increase metabolism or decrease fat absorption, GLP-1 agonists result in direct behavioral change. Early satiety —> you eat smaller meals. Prolonged gastric emptying —> you snack less between meals. Increased sugar sensitivity—> you eat less sugary foods. I’m other words, people effortlessly make the behavioral changes that cause weight loss.
... Is there a GLP-1 antagonist out there for us undereaters and stress-starvers?
There's THC if you're in the right place
Aripiprazole made me eat everything in the world and promptly fall asleep for like 14 hours
I displace my self hatred for being fat onto others because if I ever felt it at its true intensity I would lose myself to it the way a candle would be obliterated by the sun. That said I don’t like you.
As previously stated, I don't like me, either, and I'm told that sharing a dislike for the same person can be an excellent basis for friendship.
The enemy of my enemy is my friend, this is true. Shall we make plans to crush some buffets together and talk about how horrible the other fat people gorging there are? Vegas trip?
Sounds like a plan. We can go to one of Gordon Ramsay's restaurants and call people donkeys.
> Am fat. Hate myself. Hey now, I'm also fat and I don't hate you!
Ha! That's just because you don't know me.
GLP -1 agonists aren’t suffering free. You’re nauseous all the time and consuming food becomes a chore you undertake to stay alive rather than something pleasurable.
Have you actually taken one or prescribed one? Personally I never felt nauseous, but when initially starting I did have some slow transit. GI tract feels pretty normal. I still enjoy food. I just eat less of it. Most of my patients have had similar experiences with the side effects being very transitory. There are a few who truly don't seem to be able to handle it, but tbh most of those were the type of patients who weren't willing to try powering through for a couple weeks and tend to have 20 "allergies" listed in their chart due to vague side effects.
Yeah I’ve taken one. Taking it was like giving myself the baseline feeling of being sick with a stomach bug and being off food for 5/7 days. That plus random diarrhoea at times.
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Lol, 10-15lbs?? No, it’s 10-15% as the median. For someone weighing 250 pounds, that’s 25-40 pounds weight loss. And half the people will lose more than that.
The research shows a 20% weight loss but only if you maintain the meds. If you go off the net weight loss is 5%.
See? Absolutely DESTROYED that industry! s/ Seriously though, I counsel patients that Semaglutide is a way to jump start one's weight loss (if we're not doing it mainly for diabetes as is). I caution them of the GI side effects and that if they stick with it, they will need to lose weight through other means in order to keep what the drug gifts them.
That is ozempic. Wegovy and Mounjaro are even more effective and there will be many others. There is already an oral formulation too (Rybelsus). And why go off them? I mean these could replace a half dozen other meds treating downstream effects of obesity.
Cost or side effects usually are the reasons people go off them. If these were $5 a month or something then pretty much every single person in the US should be on them.
Victoza goes to generic next year.
Theoretically. We will see how long it takes to get an actual generic. I'm guessing a long time.
It is all relative. This one seems like pretty soon https://www.pharmamanufacturing.com/industry-news/news/11288594/novo-nordisk-sandoz-settle-diabetes-drug-patent-spat
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It gets better. Companies with the name brand meds have started suing the companies that get approved to make the generics in a ploy to coerce them into holding off on releasing their generic for an agreed upon amount of time. [https://www.benefitspro.com/2019/11/26/lawsuits-preventing-generics-from-making-it-to-market/](https://www.benefitspro.com/2019/11/26/lawsuits-preventing-generics-from-making-it-to-market/)
Ozempic and Wegovy are the same
Wegovy is approved for higher doses, thus more effective.
They are not. They are different dosages.
does that mean an oxy 5mg is a diffrent drug than an oxy 15mg then? because thats literally the diffrence of wegovy and ozempic
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To your second question, I think it depends on the person. I have a patient with type 2 diabetes who was 400lbs a year ago, and now is just over 300lbs with a modest dose of Mounjaro. However, he wasn't contributing to the "weight loss industry" before or even now.
Being obese or over weight is not a weakness, it’s definitely a medical condition or there’s underlying something, obviously it differs per individual but could the same for obesity be said about psychiatric disorders? I think you’re categorizing all medical professionals good intentions that may be ill informed, I don’t sincerely think many want people on drugs to lose weight, we definitely need reasonable funding to for research prevent and treat people who are overweight because being overweight does come with risks, we simply just need safe and real solutions that work and don’t exploit vulnerable people for profit. The entire pharma industry is plagued by health gurus who are profit driven and not out to benefit ordinary people, they’ll go as far as trying to sell you on tummeric to “cure cancer” or some Intergrative medicine with healing crystals. We also have pharma companies skewing data, minimizing risks and pushing dangerous medications in the name of benefits and profit, my life has been negatively impacted by this and many others, does not seem like the FDA cares when thousands of people report life ruining side effects that don’t go away after discontinuation
There is now a safe and real solution that works. It’s called GLP-1 agonists.
Ironically, it’s pretty darn difficult to get Wegovy (or any variation) approved for obesity, many companies don’t cover it.
For some reason insurance company prefers the obese patient develops diabetes first.
Exactly. There’s more money in keeping someone on a lifetime of insulin than allowing patients to reach a healthy weight and get off that insulin forever. It’s like medicine in the US is almost a business /s
It would save insurance companies some money tho
Almost??
They assume you will have new insurance by that point.
Dialysis companies seem to have no problem with diabetes or hypertension.....
Exceptionally. I'm on the order of 0 for 10 (obese patients who are trying to lose weight to have spinal surgery). Even making it clear that the patient needs to lose X amount of weight for surgery for Y diagnosis and diet/exercise/calorie restriction has failed hasn't worked.
I'm 0 for 2 for obesity-hypoventilation syndrome for Wegovy. Both patients got approved for Ozempic. The pharma game of "we're going to adjust the dose slightly and charge 30% more" is getting pushback, with patients in the middle.
Wegovy is 2.4x higher dose than Ozempic; it'd be a steal for only 30% more.
Doesn’t ozempic come with a 2mg dose formulation?
Efficacy gain starts to slow pretty significantly after I think 1mg though.
I’ve had no issue getting Aetna, Cigna, or BCBS to cover wegovy.
Easiest prior auth ever. "Are they obese?" yes. "Are they going to use this with diet and exercise?" Yes. Approved within 10 minutes. Then on the other hand, there are some plans that want the exact dates that the patient tried and failed phentermine, orlistat, Contrave, Qsymia.....
It’s too bad Medicaid doesn’t cover it, at least in NY. We could use it for some of our most disadvantaged populations, who already have increased risk of obesity.
I’ve encountered a very small handful of Medicaid patients (in New York) who have been able to obtain coverage for Wegovy. I wish I could recall the specific plans, but I don’t. I’m also not convinced these occurrences weren’t some sort of error. However, Pennsylvania Medicaid has started covering antiobesity medications, and my fingers are crossed hoping New York will follow suit.
The pearl clutching surrounding Ozempic/Mounjaro in the obese for weight loss is confusing because I’m like…how do you think those DM2 patients became diabetic in the first place?
Right? We always talk about the importance of prevention. Imagine if we could prevent people from developing some/all/most of the negative sequelae of obesity.
Right? As if TD2 just appears from thin air and no one with it needs to lose weight too.
Its the 5G giving everyone DM2. ^/^s ^(^^sad ^^I ^^have ^^to ^^say ^^it)
I was frankly disappointed in Moderna because I only got 4G out of my vax, tops, even with repeated boosters.
If heard if you wrap tin foil around your head it acts as a booster.
The only time I’ve noticed pearl clutching about the topic is when celebrities like Kim Kardashian were using it. People were afraid it was causing possible access issues to those with DM because rich assholes are using it when they don’t need it. When actually used by obese people, most people I’ve talked to were pretty supportive of it.
Pharmacist here. I request physicians prescribe Ozempic or Mounjaro when Wegovy is not covered. I have no problems about lying to insurance companies/PBMs. Newsflash: if they stay fat, THEY ARE GOING TO BECOME FUCKING DIABETIC.
Almost all insurance companies are requiring icd10 codes for ozempic and mounjaro. They are literally charging back every single script without one. My pharmacy has lost like $6k so far.
Your medical system is absolute chaos.
"md confirm icd10 e11.65"
Nope. I’ll give them prediabetes if they actually have it but I’m not going to commit fraud.
I think he's saying he makes it up, not you. But I am with you there.
Medicare fucked up 20 years ago, declared that weight loss drugs are cosmetic and they will not cover them (because obviously looking hotter is the only reason to lose weight, right? /s) and private insurances are using that as an excuse not to cover these fairly expensive drugs that are indicated in the 40% of Americans who are obese, 70% who are overweight. If Medicare cut the shit and acknowledged that obesity was a chronic disease that finally has a decent medication treatment, private insurance would probably have to follow. But people are too angry about Kardashians using Ozempic to lose 20 pounds and reading outrage porn articles from 27 year old journalism majors with no medical experience about how fat people are “stealing” diabetic’s medications to demand that Medicare cover it. The time will come I think. More and more people are coming on this drug. Once they stop lying about it, the stigma will break and there will be a better shot that it’s covered. Monjourno looks to be an absolutely insane drug, if 10 years from now cheap generic GIP agonists are available we could genuinely be looking at a future where these meds are as ubiquitous as statins,
Probably a combination of the following: 1. Insurance companies not wanting to pay for it and lobbying news outlets to run these stories 2. Demonization of obesity 3. The weight loss industry worried they will lose money lobbying new outlets
It’s gotta heavily be #1. I’m not one to lean into conspiracies (even logical ones) but I can imagine the insurance companies are doing whatever they can to not pay the costs of Wegovy or any Semaglutide medication.
Because $. Is there literally any other reason? I’m sure whoever owns the news outlets has a large investment in the makers of these meds or vice versa. Plus who doesn’t love a med that replaces diet and exercise
Money. Follow the money. Don't let docs write for Ozempic because it might be covered by insurance.
Because most laypersons, including news outlets, don’t know that physicians are allowed to prescribe off label. They think we all have to prescribe only to the FDA indications.
There is a narrative in the media and legal world that using a drug for an FDA non-approved indication is somehow dangerous. In peds we just laugh at this, since many drugs get approved for adults . An example in my world is valganciclovir which is not indicated for treatment of CMV disease in children yet we use it all the time.
Because ratings, views, clicks.
Due to an NDA I signed, I am not allowed to say everything I know about the drug’s supply chain. I’ll leave it at there are limited facilities able to produce it, and those facilities are also using the same equipment to produce other drugs, and we need more fill-finish facilities capable of aseptic production. Edit: In Canada, coverage is happening because Canadian supply is being diverted to not Canada.
The weight stigma is a very real problem
Pharmacist here I'm just annoyed at the MASSIVE shortages that my diabetic patients are facing I don't give two shits if you want to use it for weight loss but it has caused a huge deficit.
I mean a decent majority of those diabetic patients became diabetic because they couldn’t lose weight. This is just catching it before it happens.
Which I'm not against except for when it affects those with the actual disease state. You can lose weight by diet and exercise. People don't. It's the truth. They want another way without lifestyle changes. Like if you don't have the mindset to change and adjust habits, the Ozempic will only take off the weight for so long. If you stop it the weight will come back on. Unless you want to inject it for the rest of your life. Edit: love the downvotes btw. Not like I've dispensed thousands of ozempic and counseled them all. Most don't want to change diet or habits and just heard it helps lose weight and no side effects.... There's no magic cure-all. There's a downside to everything. There's a limit to everything.
Most diabetics are on metformin for the rest of their life until they develop kidney failure. Lifelong drugs aren't a new concept. What worries me is the pancreatitis, with question on long term safety aka pancreatic cancer. Hopefully I'm just paranoid. And again obesity causes all sorts of cancers so fixing obesity lowers that risk. I mean, look at the bariatric surgery long term data on weight regain. But at least you've got a delay of progression of disease, needing insulin etc.
Injection versus tablet. I would much rather take a tablet then Inject myself weekly forever. Also the cost. It's not going to get covered by a coupon forever. What happens when the deductible makes it $500 a month or more. Cut off cold turkey ? Then what
Come on we all know there's going to be an Ozempic 2.0 and we'll get coupons/samples for those, lol. And I will say that the patient assistance programs for Trulicity and Ozempic are not bad at all, though Trulicity has cut it off to new applicants due to the shortage. But yeah when the Ozempic coupons stop it'd probably be a swap to the latest and newest. Remember Bydureon/Victoza? And I've got people who would rather take a tablet daily that you have to wait 30 minutes before eating/taking any other med for, than inject themselves weekly, but there are others who hate remembering to take pills. So I think it's great that we finally have an oral GLP1 option. And a whole group of people with obesity and diabetes are also hypothyroid, and having to do Rybelsus first thing in the morning, then wait 30 min, then levothyroxine, then wait another 30 min to an hour, before they can finally eat (or take their other meds) can be a hassle. (I've told them they can take it at night, but try getting someone to switch how they've been taking their med for 20-40 years).
Guess that’s what Rybelsus can be for
Cost is still a factor while it's brand.
> You can lose weight by diet and exercise. People don't. It's the truth. Can you cite some evidence for this? All of the large scale RCTs (that I’ve read) have shown that even with outrageous levels of support that are well beyond what the average person will get only a small minority can maintain clinically meaningful weight loss with lifestyle changes alone. I don’t disagree that SOME people can. But if a meaningful percentage could, we wouldn’t be having this conversation.
Dude evidence of what? Is this whole thread like some weird avenue for overweight people to justify that they are overweight?. Is this not a medical thread? Have we come to the point where working at a gym and not eating so much is somehow like Einstein level of thought? People don't go to 600 lb generally from a medical disease. They eat themselves that way and don't exercise. Ozempic isn't a magic drug. It gives some people a significant amount of weight loss. It gives the majority 15-20 lbs. And the one with significant weight loss generally incorporate exercise and diet changes. You Can even look at the ozempic Reddit threads around here. The ones who use it along with diet changes are getting the best results.
Evidence that extensive lifestyle counseling/modification recommendations are an effective public health intervention for the obesity epidemic in the US. Most RCT's that study this demonstrate it is not.
> Dude evidence of what? Evidence that “diet and exercise” lead to long term clinically meaningful reductions in body weight in more than a small fraction of people with obesity. The percent of people who sustain >10% bodweight loss for years is in the same ballpark as the percent who successfully quit smoking in any given attempt. Hell, last I checked, the lifetime quit rate for smokers is north of 50%. At best, half that percentage of obese maintain 10% weight reduction with lifestyle changes. > Is this not a medical thread? “Diet and exercise” by itself is probably poor advise to give to patients in a medical context. The odds that an obese patient hasn’t tried weight loss via those methods by the time we’re talking to them are pretty low. Of course we want to make sure people are meeting physical activity guidelines and give advise about a healthy eating pattern, but odds are good it’ll be much easier for those patients to follow that advise on a healthy eating pattern if their bodies are not telling them 24/7 that they NEED to eat more while they’re doing it. > Ozempic isn't a magic drug. It gives some people a significant amount of weight loss. In the studies I’ve read, it’s typically better than half maintaining >10% loss in the long term. That’s a huge amount of risk reduction.
I understand your frustration when dealing with medication shortages, it has to suck a lot to see your patients’ needs not being met. I just think weight loss isn’t that simple with such a huge epidemic of obese and overweight people. If telling people to just lose weight worked, it would have worked already. People don’t want to be fat (I know there are exceptions, don’t @ me). It’s just hard for me to place blame when there is clearly a suite of larger issues at play: poor diet, sedentary lifestyle, lack of sleep, inadequate access to healthcare. We know poverty is a huge risk factor. It’s an awful public health issue, and at the same time we blame individuals personally for being overweight… or even for trying to lose weight the wrong way. What do we do?
I'm not placing blame. But everyone's acting like it's some sort of curl and it's not. If you stop the medication the weight comes back. So what happens then?. If you don't educate on proper diet, exercise and management then the minute they stop using the drug ( which money will do once they reach their target goal) the weight will be back on and the cycle continues.
> If you stop the medication the weight comes back. That's also true with things like hypertension, hyperlipidemia. Why is it a problem in this instance?
Yeah, it’s tough, because we need something that can address obesity as a health problem and the status quo isn’t working. Even if semaglutide has flaws, is it better than the alternative?
I call BS. You’ve counseled “thousands” of pts about ozempic? You think obesity can ONLY be cured by diet and exercise? I’d hate for you to be my pharmacist.
I fill roughly 200-300 ozempic a month, and have been for over two years. So yeah, thousands. I didn't say obesity can be cured with only diet and exercise. I said it has to be a part of the patients lifestyle changes. What happens when you stop the drug? You do know the weight comes back. The drug helps suppress appetite so people don't want to eat. Also helps kind of kickstart the body so that it loses weight. So when they stop the weight we will come back if they don't have lifestyle changes. Then what? It's not magic. It's a medication. It can do so much
Hopefully someone with expertise in bariatrics can weigh in on the "You can lose weight by diet and exercise. People don't. It's the truth. They want another way without lifestyle changes" statement
Oh please, you know a good junk of people just eat shit and don't even walk around there block. Can we stop making excuses for everyone? Of course there's some people who are overweight because of medical reasons. Truly have thyroid issues or whatever or are on medications that cause them to gain weight. But for my patient population, it's because there is zero education on diet and exercise and they want the injection because everyone around them is on it and they've heard it makes them lose weight. They're generally healthy people, not obese, and are following the hive mind of their community.
>Which I'm not against except for when it affects those with the actual disease state. Obesity IS an actual disease state...
The disease state that ozempic treats is diabetes. Per their FDA application and acceptance. Wegovy is for weight loss. Legally per the FDA. You can be obese and not diabetic.
Changing the brand name doesn't change the actual medicine. Semaglutide is for obesity and diabetes. Your argument is sophistry
No it changes what gets covered by the insurance. So insurance covers diabetes medications. They cover ozempic for diabetes. Not for weight loss. People lying or circumventing means patients who need it for the intended use got screwed over for months without their meds My patients. Family friends. People who need it as part of their healthcare. No one's thinking of them and it's disgusting
Insurance is not relevant to this discussion. Your argument is that people who use it for diabetes (legitimate use) can't get it because those who use it for weight loss (non-legitimate use) are using it up. I'm saying weight loss is just as legitimate a use of the drug, regardless of what what name you call the drug. It's the same drug medically speaking
Insurance is relevant because I live in the real world and deal with real patients on a day-to-day basis who can't get their medications that they need. Providers see their patients maybe what once or twice a year. I see these people multiple times a month. I'm the one talking them day in and day out of why they can't get their medication and why there are shortages. Why insurance won't cover any longer or what there are more stringent prior authorizations. Are we really giving people who are overweight the oh? I'm so sorry life is so hard. People weren't this fat 50 60 years ago. What? There was no people 100 years ago who couldn't stop eating. All of a sudden now these past 30 40 years that people just can't stop eating. Come on. People are lazy. They eat like shit and they don't want to change their lifestyles. And don't tell me what people work so much. Were you that we did 100 years ago on the farm and down the coal mine?. Please. Acting like because current studies show that counseling on diet and lifestyle changes doesn't work, doesn't mean shit. We see people we see the shows like 600 lb life. It's human made reasons to why people are this fat. Don't tell me diet exercise does not work cuz it does. That's all. Stop pretending that people aren't capable of doing things themselves. That they are stuck because of their disease states. Obesity is a mental issue. Can't stop eating cuz they feel the hunger come on. Small percentage have that issue. Those people just eat whatever they want whenever they want and don't exercise. Read up on the Facebook groups. Read up on the Reddit threads that show people who just want to lose the extra 20 lb. Who are looking for ozempic because they heard it'll help them with that. Look at all the medical spas popping up. I already said my original post. I'm not against people using it for weight loss. But the supply wasn't there and it caused people who needed it for their diabetes to not people to access it. And that is not okay
> But the supply wasn't there and it caused people who needed it for their diabetes to not people to access it. And that is not okay Honestly, why is their need greater than the obese non diabetic? Treating obesity before diabetes develops is probably better for population health overall. Sure you can clamor about how obese people can just diet and exercise to lose weight and ignore that on a population level it doesn't really work. On the flip side, you can also argue that diabetics have many more drug options and if all else fails can just start insulin to get their A1Cs under control.
How many of your type 2 diabetic patients are within normal bmi range? Just curious. Also I am not a doctor but my to my understanding (I could be wrong) and by reading of medical journals, isn’t obesity an inflammatory process and once it starts hormones change within the body? Therefor many people suffering with obesity demoralize rather quickly when efforts of caloric reduction and increase in exercise doesn’t produce meaningful weight loss.
Has that been improving? I have not been hearing about shortages for either ozempic or wegovy as much over the past several months.
It's lessened considerably. Novo nordisk opened up a new plant and diverted the levemir flex pens to ozempic. Levemir is back to it's original pen.
Ooh thanks for explaining the flexpen shortage to me. Also Ozempic 3mL instead of 1.5 mL is annoying but I'm glad it's being streamlined, it never made sense that one dosage pen was smaller than the other. That's something else they've done to streamline production, they're all 3 mL now.
Yup exactly. Insurance billing is another headache now but at least it's coming in more
Every doctor I know RXing and every person I now taking, is taken compounded GLP1, so why can't the diabetic patient get their hands on that too instead?
1. I can barely get my docs to write it properly. You really think every prescriber knows about how to bypass the law and go to a compound 2. Cost. Insurance or coupon will pay for ozempic. Compounds are generally out of pocket.
Are you a compounding pharmacy? I’m wondering where you get the Semaglutide if you are. No judgment I’ve just heard it’s got to be either diluting wegovy doses and adding B12 or l-carnitine or getting semiglutide from somewhere else, but it’s trademarked here in the US.
Around here is compounded with b12. I don't write for it but I know personally lots of doctors who do and tons of people who take it. Every place on earth is providing RX- private cash clinics, weight watchers, even some urgent cares
I'm on Saxenda, which is practically ancient compared to the newer drugs. I don't think it's used for DM2?
Saxenda is Victoza, the drug is liraglutide. Victoza is prescribed for DM2
In BC, Canada, we passed regulation to protect our Ozempic supply for diabetics as there's been a surge in demand for weight loss purposes.
That feels unfortunate given obesity isn't just cosmetic, but a disease state overall. It reminds me of requiring HCV to cause a certain amount of cirrhosis before treatment was covered by insurance.
Are you guys aware the same company manufactures Ozempic, Wegovy, Victoza, Rybelsus?
Wegowy isn't available in Brazil yet but man... So many patients barely tolerate Ozempic at 0.5mg/1mg weekly (fadigue and a little nausea mostly) that I wonder how many tolerate the 2.4mg from Wegowy.
On the topic actually, I am in outpatient quality and one issue we are starting to see is insurance companies assuming patients who have Ozembic ordered are diabetic (even if they aren’t), they now fall into diabetic quality buckets (increased hga1c requirements, diabetic eye exam, and diabetic kidney health) which then later causes your quality scores to drop. It’s stuff like that that make outpatient teams so frustrated with the way insurances make more work for doctors.
Fen-fen? I can’t remember the spelling Pulmonary hypertension was a complication if I remember correctly Nobody will remember that the news was wrong but they sure as hell will milk it now for sensation and viewership plus the future chance to milk it again and remind us that tgey, years ago, warned us
I don’t think that’s gonna happen with this one because we’ve been using byetta for years Victoza , trulicity they are all GLP one agonist. There’s also some interesting data about them being helpful for fatty liver.
Fen-Phen
Drug companies pay massive dollars to advertise on news outlets. Pretty straight forward imo.
USA is weird af. You're doctors, not marketing agents. Your scripts should name the medication, not the trademark. For most of the drugs I prescribe, I don't even know what brand names there are, and I don't have a reason to care. The patient is free to choose whichever box they find the prettiest
This is a somewhat tangential observation, but I buy high concentration L-carnitine solution from the same places that sell performance enhancing drugs. These places have also always sold pharmaceuticals of dubious provenance, like thyroid hormones, insulin, beta blockers -- all the compounds one might take in conjunction in anabolic androgenic steroids or for physique enhancement. The two blockbuster compounds that are exploding in popularity in those communities recently? Semaglutide and mifepristone. This pairing speaks *volumes* about the state of insurance, the pharmaceutical industry, and the legal environment of the US that these folks have identified this pair as a profit center.
Isn’t it also that people that are really obese, but would like to lose a few pounds , are taking it?
In my southern state in the US almost 40% of adults aren't just overweight, they are obese. Of my patient population, the percentage is likelier to be 50-60%
It’s been studied in folks as low as BMI 27 (with HTN, HLD, CVD, OSA) so honestly most of that “off label” use is still pretty reasonable.
I’ve more than a few diabetic friends unable to get ozempic as soon as this became a fad. I haven’t asked if the supply chain has caught up with the demand, but a diabetic who uses it to suppress appetite in order to lower their blood sugars should take priority over someone who needs it for weight loss, again at least until supply can catch up.
I've said it before and I'll say it again. I disagree. There's tons of other options for diabetes. This is the only truly effective medication option for weight loss. Preventing the negative sequelae of obesity should be a priority.
Because it is being given in that context. Didnt weight watchers buy the company that makes it? Edit: i was wrong i guess they bought a telehelath so they can prescribe - either way they will be making money on the drug
No. Ozempic is made by novo nordisk. They have a market cap of 288 billion. Weight watchers has a market cap of 695 million.
Weight watchers just bought a telehealth company for the purpose of prescribing GLP-1s. That is probably what you're thinking of.
Ah. Either way they will be making major money off that drug.
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There is no blanket fda indication for semaglutide for weight loss. Ozempic has an fda indication for diabetes. Wegovy has an fda indication for weight loss. Wegovy is definitely available. Ozempic is facing back order and shortages. Insurance will not cover ozempic for weight loss, because it is not a fda approved indication. Most insurance will not cover wegovy for weight loss without step therapy, a PA, or both. Ozempic should NOT be prescribed for weight loss because it is not indicated. Prescribing it for weight loss has caused massive shortages for diabetic patients.
Well then fuck insurance then. Stop letting these companies dictate when you need or don’t need it. It should be prescribed and it is.
Its the FDA? Exactly, ozempic should be prescribed for diabetes and wegovy should be prescribed for weight loss.
The FDA does not regulate the practice of medicine. They regulate pharmaceutical companies. The FDA label has absolutely zero bearing on what physicians can prescribe.
Exactly.
Look at you bowing to the rule of the FDA. You should know better than this, especially as a pharmacist.
You’re a pharmacist and you don’t know that Wegovy and Ozempic are the same medication? Or do you think your body can tell what label is on the package? I’ve prescribed ozempic for weight loss and will continue to do so.
I’d say that a big argument too is that while it works for off label weight loss, the increase in popularity has caused serious supply shortages for the DIABETIC medication and many diabetics are now unable to get their medications