The drugs Ozempic and Wegovy, although developed to treat diabetes, have become wildly popular outside its original target population because it seems to be highly effective in reducing weight as well. This has resulted in it becoming harder for diabetics to gain access to the drugs as well as their price rising.
US senator Bernie Sanders has long been a critic of the pharmaceutical industry and how it charges highly inflated prices in the US that are available for much less elsewhere in the world. He has been successful in pushing for the cost of insulin and asthma inhalers to be drastically reduced and now he is targeting Ozempic and Wegovy.
The blockbuster weight-loss drugs Wegovy and Ozempic are arguably as omnipresent in the American zeitgeist as Taylor Swift or the iPhone. The drugs and others in its class are associated with the sparkle of Hollywood, on the lips of Oprah and considered transformative by doctors.
But the giant market for drugs like Wegovy, including not just the roughly 11% of adults who have diabetes but also the 42% of adults who have obesity, has conjured one of the demons of American healthcare – price.
Americans paid 10 times more for Ozempic than patients in the United Kingdom in 2023 – $936 a month compared with $93. Wegovy costs Americans $1,349 a month, compared with $296 in the Netherlands (the drug is not yet available in the UK).
That wild discrepancy has captured the attention of one of the drug industry’s loudest critics, the US senator Bernie Sanders.
…“What we’re focusing on right now is what may end up being one of the best-selling pharmaceutical products in the history of humanity, and that is Ozempic and Wegovy,” said Sanders. “These are very important gamechangers helping people with diabetes and obesity.”
Sanders is preparing to square up against the chief executive of the Danish pharmaceutical giant that makes both drugs, Novo Nordisk. Under threat of subpoena, its CEO, Lars Fruergaard Jørgensen, agreed to testify before the same committee in September. But even for Sanders, the challenge is formidable.
“You’re taking on a company which will make billions of dollars every single year, many billions of dollars from the US, on just this product,” said Sanders. “So, do I think this is going to be a difficult challenge? I do.”
The catch with using these drugs to lose weight is that although they seem to be very successful in doing so, you cannot stop using them. It turns out that if you do stop, much of the weight comes back.
As director of the Washington Centre for Weight Management and Research, Domenica Rubino has become frustrated with growing perceptions over the last three years that weight loss drugs such as Novo Nordisk’s Ozempic and Wegovy, and Eli Lilly’s Mounjaro, are permanent cures for obesity.
“Obesity is not like an infection where you take antibiotics and you’re done,” says Rubino, sighing. “It’s not any different than hypertension or diabetes or the many other chronic illnesses that we deal with, where you have to use chronic medication.”
…After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients’ original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks.
…The main theory for why the majority of patients regain weight so rapidly when they stop taking medication is because the regions of the brain relating to appetite are still dysregulated, priming the person to overconsume. GLP-1 drugs only mask this dysregulation, and when their effect is removed, their food cravings soon return.
“People don’t always appreciate this,” says Rubino. “I try to explain that these are chronic medications, but I think everybody secretly feels, ‘Yeah, but you know what, I’m different, and once I hit my weight goal, I’ll be ok.’ But the reality is, the brain is quite powerful.”
But this may not be the only explanation. Martin Whyte, an associate professor of metabolic medicine at the University of Surrey, explains one possible theory as to why people tend to regain weight after they stop these medications. The doses of GLP-1 provided by semaglutide and tirzepatide are far greater than the body would naturally expect to receive, he says, which may suppress the body’s ability to secrete GLP-1 on its own. As a result, people’s hunger may return even more voraciously when they cease their doses, he explains.
“What may be happening, and we don’t know for sure, is that when you stop them, your body’s left in a GLP-1 deficit which has a major impact on the satiety signal going to the brain,” says Whyte.
The problem with weight is that once fat cells are created in the body, usually in adolescence, they never go away, they just shrink or grow larger as one’s weight fluctuates.
Researchers have found that the number of fat cells in your body is set during adolescence and remains constant through adulthood, regardless of whether you gain or lose weight. The findings may help to explain why it can be so hard for some people to drop pounds and keep them off.
Although scientists have long suspected that the number of fat cells stays stable during adulthood—shrinking or swelling as the body’s weight changes—they had no accurate and safe method for tracking the longevity and turnover of fat cells in the human body.
…The researchers also examined fat cells in biopsies from nearly 700 adults of various ages and weights. They compared their data to that from a previous study of children and adolescents and found that fat cell numbers quickly climb through the teen years. Overweight children seem to gain more fat cells than normal-weight children. But fat cell numbers level off and stabilize in adulthood.
The scientists then looked at how fat cells change after severe weight gain or loss. Non-obese men who added significant pounds had a boost to fat cell size but no change in number. Later weight loss caused the fat cells to shrink but not vanish. Likewise, people who lost weight after stomach-stapling surgery had the same number of fat cells 2 years later. The cells, though, were smaller because they contained less fat, or lipids.
“If you are overweight and you lose weight, you still have the capacity to store lipids because you still have the same number of fat cells,” says Buchholz. “That may be why it’s so hard to keep the weight off.”
People who are overweight are sometimes viewed, by people who are not, as weak and not having the willpower to consume less. That is unfair. Yes, willpower is a factor but people who are overweight require much greater willpower than those who are not, because the level of enzymes that signal if one is full is much higher for them. The level of food intake needed to reach the state of feeling satiated is much higher, and hence they are constantly feeling hungry in ways that thin people are not. It is an issue of biology, not psychology.
We need to also get rid of the stigma associated with weight. The goal should be to be healthy, not thin. Weight is a problem only if it affects someone’s health and prevents them from doing the things that they would like to do.
But as long as being thin is viewed by society as being desirable in itself, the appeal of weight loss drugs is going to be very strong. Diabetics are reconciled to the fact that there is no cure as yet for their condition and that their treatments must be continued indefinitely, but people who seek to lose weight using these drugs are not as aware and may be in for a rude financial shock when the lifetime costs are factored in.
I’m always surprised that every article makes the point that stopping a drug means the symptoms will come back. Well…duh? Stop taking meds for high blood pressure and the blood pressure climbs. Stop taking meds for high cholesterol and cholesterol climbs. Stop taking meds for multiple sclerosis and the symptoms return.
As for the cost of the drugs; yes, that’s obscene. I used to help out a handicapped neighbor who has since passed--in particular, running errands. Among other meds, she was on one of the earlier generations of blood sugar-controlling injectibles (Victoza). Because I picked up her meds from the pharmacy for her, I was there a few years back when it was $200/month, and within a year, was up to $1200/month. This was even before the hype for weight loss, when it was just a diabetes medication.
As for obesity, it’s never as simple as calories in<calories out. The brain and the gut are engaged in a dance, and if there are any miscues, as Mano points out, it's much harder for someone to lose weight than for someone whose body chemistry is balanced.
One thing not mentioned in the OP: Adverse effects
https://en.wikipedia.org/wiki/Semaglutide#Adverse_effects
Possible side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, indigestion/heartburn, dizziness, abdominal distension, belching, hypoglycemia (low blood glucose) in people with type 2 diabetes, flatulence, gastroenteritis, and gastroesophageal reflux disease (GERD).[15] It can also cause pancreatitis, gastroparesis, and bowel obstruction.[35]
The US FDA label for semaglutide contains a boxed warning for thyroid C-cell tumors in rodents.[13][14][15][25] It is unknown whether semaglutide causes thyroid C-cell tumors, including medullary thyroid carcinoma, in humans.[13][14][15][25][36]
BTW, there’s been speculation Trump has been on those drugs.
(Hopefully so, given those possible side-effects)
I was wondering if these drugs make you lose *fat*, exclusively, or if they only make you lose *weight*. There’s a big difference: if you start eating a large calorie deficit (withought a lot of different and specific kinds exercise), your body loses any kind of tissue, which includes both muscle and fat.
This, as young ballerinas have found, is very dangerous, because one organ that loses muscle is your heart. Your heart muscle actually thins down until the heart is much weaker, and so several young ballerinas died of heart attacks just from suddenly standing up.
Also, the more muscle anywhere in your body that you lose, the more your basal metabolic rate goes down, as muscle tissue consumes a lot of calories. So when you stop the drug, you have so little muscle and your metabolic rate is so low that even a very small amount of daily calories is in excess, and you can gain weight, more than you weighed initially.
If the drugs only suppress appetite, I’ll bet it’s weight lose, not loss of fat only. Dangerous, unhealthy, and not (as noted) permanent!
garnetstar: https://en.wikipedia.org/wiki/Semaglutide#Mechanism_of_action
John Morales @2: Many of the side effects are temporary and can be controlled by increasing the dosage gradually. A lot of people are happy with these medications, side effects and all.
anat, that’s nice to know.
Me, since I am neither diabetic nor need to lose bodyweight, I’ll pass on the temporary and manageable side effects.
And, hey, if they’re happy to be on those “medications” on a persistent basis at whatever cost, good for them.
(Gotta be better than a gastric sleeve, no?)
—
Anyway. My comment was motivated by this:
“The catch with using these drugs to lose weight is that although they seem to be very successful in doing so, you cannot stop using them.”
I was suggesting that may not be the only catch.
[I don’t use Viagra, for similar reasons]
Katydid @#1,
I agree with you that it should not, in general, be surprising that when you stop using a drug, the symptoms that were being treated by it would return.
But I think that many people do not understand the mechanics of weight loss. They may think that the drugs destroy fat cells so that the number of such cells actually get reduced when they lose weight.
Liposuction destroys fat cells.
Mostly done for cosmetic, not for health reasons, but still.
Sometimes, the harvested fat is then injected back, as in, say, a BBL.
But it’s not quite a tissue transplant.
After a while, the body absorbs the injected fat.
(Ah, vanity!)
[PS do not watch an actual liposuction procedure unless you are not that bothered by deliberate mechanical damage to the body and attendant gore
To be fair, it’s based on (supposedly) informed consent and under anesthesia.
So, you know, these drugs aren’t quite so bad.
(Tough shit about your smelly farts, but hey… manageable, no?)
[related]
https://www.mcgill.ca/oss/article/health-nutrition-history-quackery/enigmatic-dr-kellogg
@9, Mano: Okay, yes, I see your point. I think that’s probably a general statement and accurate for that percentage of the population that doesn’t think very deeply about anything.
Then there’s also the lack of education on critical thinking and science. There’s a commercial on tv that shows a man in fitness clothes jogging through town. He passes a shop with some man screaming that he got ripped eating nothing but hot dogs. Or the summer Starbucks commercial showing young, thin, attractive people guzzling down super-sugared drinks and smiling as their children drink those drinks. There’s a cohort of people who believe all of this is good health.
@13, John Morales; you do realize that just because a side effect MIGHT happen, it doesn’t HAVE TO happen, right? My neighbor who was on the first-gen semaglutide for diabetes never had any of the side effects that might happen. OTOH, had she let her high blood sugar go unchecked, she could have lost a limb or gone blind.
@8 John Morales
Lord knows you are already a big enough dick as it is.
John, thanks for the semiglutide link, but, it doesn’t specifically answer my question.
Suppressing appetite does mean, of course, that you get into a large calorie deficit, and, as the article says, you do lose weight, much of it consisting of fat. So yes, as it says, you do lose fat.
But, if that’s all these drugs do, suppress calorie intake, then you lose muscle as well. There’s no mechanism in just suppressing appetite that causes *only* fat loss. From that article, the mechanism will lead to muscle loss as well. Which is a bad thing.
garnetstar, when you weigh less your body needs to make less of an effort to support you and move you around, so at least some muscle loss is not a problem. The question is how much muscle loss is too much.
“As for obesity, it’s never as simple as calories in<calories out"
Ah, the old "the first law of thermodynamics doesn't apply here" argument.
If it was that simple there'd be no money in it, so it's vital we all understand that it's very, very complicated.
steve @17, that’s a phallusy.
garnetstar re the fat loss or not
What happens in any weight loss programme is that your fat cells become smaller, the number of fat cells you have remains the same, and remains pretty consistently the same once you finish adolescence. This is one of the reasons it is so easy to put on wieght again, those cells are just waiting to be blown up with fat again, and also why some people find it harder to maintain a healthy weight, they literally have more fat cells, so starve your teenagers! /slight sarcasm at the end there.
Appetite and metabolic rate are complex, but weight is still a matter of burning what you take in. In order to gain a molecule of fat, a molecule of fat )or constituent atoms) must be taken in and stored.
(The only exception to caloric intake that I can think of is water weight, and while there are some disorders of fluid retention which add to this, their prevalence is quite low. A person who is fat is almost certainly fat due to caloric intake and not water.)
Holms, perhaps inform yourself.
There are numerous metabolic and systemic problems that affect weight, without even considering “food deserts” and other socioeconomic and location problems.
Caloric intake is but one thing.
Also, people are not bomb calorimeters.
Jazzlet has a point; not always, but certainly sometimes applicable.
Or, it depends.
Here, for you:
https://www.youtube.com/watch?v=GQJ0Z0DRumg
Proteins, fats, carbohydrates, alcohols… all burned and metabolised differently.
For example, proteins use a not-insignificant portion of their calories merely to be processed into bio-available matter.
Anyway, you are conflating mass with fatness, not that you should be embarrassedted.
Still.
[now, this is subtle. Notice what I did not embed, and what I did embed]
@Holms, 23:
No. You’re thinking mass when you should be thinking energy. If you ingest 2500 calories and expend 2000 calories, that excess 500 calories has to go somewhere -- first law of thermodynamics. In the body’s case, the mechanism for storing excess ingested energy is by depositing fat, with the idea that in lean times when food’s less available, it can be called upon.
Similarly, if you ingest only 1500 calories but expend 2000 calories, that extra 500 calories has to come from somewhere -- first law of thermodynamics again. And the only place it can come from is by converting the mass of your body (usually fat, but as has been established, in a pinch your body will convert muscle mass to energy too).
One can of course get into the weeds of complications of the metabolism, but ultimately no amount of blather can contradict an iron law of the universe -- you can’t create energy out of nothing, and you can’t destroy energy. Ingest more energy than you expend, and it MUST remain in your body in one form or another. Ingest less energy than you expend, and the energy you expend MUST come from somewhere, and the only place it can come from is your body. I have yet to see any information from any reputable source that contradicts the first law of thermodynamics. Therefore, if I’m presented with someone who contends that they “can’t lose weight”, I am forced to conclude they’re either eating too much or not doing enough exercise.
#25 John
I did, I studied biology at university. You?
#28 son
No, I used molecules and atoms deliberately. The body has no ability to create or destroy them, only to rearrange them. The energy you talk about comes from them -- changing their configuration to liberate energy ending in an electron transport chain and a proton pump in a mitochondrion; or to store it long term probably as a fatty acid.
And whatever is done with it, it is only there for the body to play with because the person ate it.
Well, yes. And their configuration when they arrive in the body is rather important. Specifically, they have to arrive in the body in a configuration that has stored energy in a form that the metabolism and liberate it.
Consider: a teaspoon of sugar contains more energy than a teaspoon of water and a pencil lead. Why? The atoms involved are precisely the same ones, are they not? (Carbon, hydrogen, oxygen). The proportions are not exactly the same… but you could in principle do the sums and come up with an amount of water you’d need to drink and the amount of graphite you’d need to eat to consume the atomic equivalent of a teaspoon of granulated sugar.
The ENERGY balance is what matters, NOT the atoms, and the graphite and water don’t come with any calories, do they? They’re no USE to you.
My god, of all the things to fixate on. The phrasing “In order to gain a molecule of fat, a molecule of fat )or constituent atoms) must be taken in and stored” hints at food, wouldn’t you think? Maybe even takes it as assumed?
Computer science, philosophy, logic, pure and applied math, some astronomy, some psychology.
No biology.
(So, what is it about which you imagine I am incorrect?)
The post was silly from the first line.
“The drugs Ozempic and Wegovy, although developed to treat diabetes, have become wildly popular outside its original target population because it seems to be highly effective in reducing weight as well.”
Nah, seems about right to me.
“The sildenafil compound was originally developed by Pfizer for the treatment high blood pressure (hypertension) and angina pectoris (chest pain due to heart disease). During the heart clinical trials, researchers discovered that the drug was more effective at inducing erections than treating angina.”
In passing,
“Minoxidil was first introduced as an antihypertensive medication and the discovery of its common adverse event, hypertrichosis, led to the development of a topical formulation for promoting hair growth.”
—
[Feeling lazy. Just select the text, context-click for “search”, if you want sources. All genuine quotations]
Historically:
“Thousands of people suffered serious heart and/or lung damage after taking the diet drugs fenfluramine (Pondimin) or dexfenfluramine (Redux). Levin Sedran & Berman served as Co-Lead Counsel in the Fen-Phen (Diet Drugs) litigation, a case that resulted in a class settlement valued at over $7.65 billion.”
Look: if you’re taking pills with (possible only!) side-effects just to lose weight, it better be medically-indicated, not just faddish.
My point (again!): it’s not just about the expense and the evanescence of its effects, not even about the (possible only!) side-effects, but about peer pressure and plain old vanity.
(There is no possible medical reason for BBLs)
Oh, and of course, Big Pharma $$$.
(That should have gone without saying, but it’s Holms at hand, so…)
Well yes -- that was MY point. That the atoms and molecules (the mass) are NOT the issue -- the ENERGY contained in their specific configuration is the key. And the difference between food and not-food is precisely that -- is there ENERGY in it that my body can use, or not? (I leave it as an exercise for the bored to argue whether such things as salt are food, being as they are the sort of trace minerals vital to the continued functioning of the energy transfer machinery without themselves containing any energy).
#34 etc John
You have lost the thread. Hint: you asked me a question in a reply to my post at #29, which was in reply to yours at #25. You asked me what you were wrong about in our conversation, and I responded to that specific question.
#40 son
None of this is relevant to my #23.
But, Holms, you wrote “the post”, in the comment threads to the post at hand. 🙂
I can’t help it if you want to play the pronoun game.
I surely answered about the post, no?
(Heh)
—
OK, so… what was I wrong about, in your estimation?
(In my comment, which is not the post)
And, come on!
“The post was silly from the first line.” is not super-informative, is it?
(Vague bluster is what I get, alas)