The recent unprecedented demand for weight loss medication means that drugs such as Wegovy, Mounjaro and Zepbound have most likely become household names. The ingredient in Wegovy is called semaglutide, which is also used in the antidiabetic medication, Ozempic.
An alternative, tirzepatide, going by brand names Mounjaro or Zepbound, was equally well received in the weight loss market.
Just a halo-effect or something deeper?
In order to understand some of the factors propelling demand for weight loss medications, we must first understand obesity as an insufficiently understood, widespread chronic disease. Obesity is linked to comorbid conditions such as Type 2 Diabetes, hypertension (high blood pressure), heart failure, cancer and more.
Studies have also shown that the relationship between excess weight and poor mental health is reciprocal. People with mental health issues are multiple times more likely to develop obesity
Endless accounts of impressive weight loss results, vanquished hunger pangs and slimmer waistlines may lead us to (perhaps understandably) feel that this is nothing more than an exceptionally well-executed marketing campaign.
While it may be true that these drugs are being promoted with pin-point precision by big pharma, if we look a little deeper, there could be some real long-term health benefits for at least a segment of the affected population.
Studies are being conducted continuously to discover new and unexpected health benefits of GLP-1 medications such as Wegovy, Mounjaro and Zepbound. These include:
- Reduced risk of heart attack and cardiovascular disease
- Reduced risk of cancer
- Protect against neurodegenerative diseases such as Alzheimers or Parkinsons, owing to an anti-inflammatory effect of the medication
- Curbing alcohol use
Some of the mechanisms by which GLP-1 medications offer protection require further research. However, it is understandable to see that the risk of comorbid conditions such as heart disease and cancer reduces when weight is reduced.
A brief summary of how these medications work
Semaglutide (Wegovy, Ozempic)
Belonging to a class of medications called glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, semaglutide mimics the action of the natural hormone, GLP-1, which is secreted by the intestines after a meal. The drug binds itself to certain receptors in the pancreas, which are then stimulated to release insulin in order to lower blood sugar levels after eating.
Semaglutide also helps delay gastric emptying, which means blood sugar is released more slowly into the bloodstream, thereby reducing a post-meal blood sugar spike. Improved glycaemic control in turn leads to better satiety and a lower appetite. It further supports appetite suppression by interacting with parts of the brain which manage hunger signals.
Tirzepatide (Mounjaro, Zepbound)
Tirzepatide is known as a dual agonist as it targets both GLP-1 receptors, like semaglutide, and GIP (glucose-dependent insulinotropic polypeptide) receptors. GIP is another hormone which works in tandem with GLP-1 to stimulate an insulin response, improve glycaemic control and satiety. Studies comparing both medications suggest that the dual action of tirzepatide may make it more effective in weight and blood sugar management than semaglutide.
However, it is important to remember that with any weight loss medication, appropriate lifestyle changes must be adopted alongside the treatment in order to see lasting results.
Going off-label
Ozempic was being widely prescribed off-label to treat obesity. Extensive media hype and celebrity success stories further fuelled demand and led to a shortage of Ozempic. The shortage became so rampant that people with diabetes were unable to fulfil their prescriptions, prompting authorities to eventually ask clinicians to stop prescribing Ozempic for weight loss.
Nevermind, because soon enough, along came Ozempic’s more glamorous sibling, Wegovy! Approved for weight management by the FDA in June 2021, the much sought after wonder-drug became the new sheriff in town, that too at a higher strength than Ozempic.
Pharmacies raced to stock up on Wegovy, clambering to get the best prices for resale. The medication became widely prescribed, often without sufficient health and ID checks* in place and often without adequate support offered.
*Simplyweight clinics only ever prescribe medication after a qualified healthcare professional has reviewed the patient health screening form and we have collected ID. Currently, our lead bariatric physician, Dr Rajeswaran supports all our medication patients if they should ever come to us with any concerns or queries.
Celebrity voices
From Oprah to Elon Musk, an increasing number of celebrities are unabashedly opening up about using weight loss medications. What was once viewed as something to be kept secret and be ashamed of, is now being discussed more honestly.
It would be understandable for people in the public to not want to share this part of their lives in order to avoid ridicule and judgement. However, resentment arises when people feel like they are being misled into believing that those incredible weight loss results were achieved solely due to changes in lifestyle.
There is nothing inherently right or wrong about using weight loss medication to improve one’s health, especially if they have really tried other solutions and are struggling with themselves. Provided that the medications are sold legally and there is proper guidance and monitoring, there isn’t a need to hide their usage. We know they’re out there, we know they are popular and we know they are also helping a lot of people. Perhaps it’s time to remove some of that stigma.
Limited availability of lower doses
Patients starting on a new weight loss medication are required to start with lower doses first, so that their bodies can adjust and better manage any side effects. Therefore, when these starter doses are more scarce than higher doses, a bottleneck is formed, preventing new patients from being prescribed the medication. This is particularly the case with Wegovy, where the lower 3 doses were noted to be in limited supply.
Some clinicians and pharmacists expressed frustration at not being able to fulfil prescriptions for their patients or move them to the next dose. If the gap between taking medication is too long, the patient may be required to revert back to the lowest dose to reacclimatise, further exacerbating the shortage.
Supply chain challenges
Both Novo Nordisk and Eli Lilly have invested billions of dollars in developing new facilities to ramp up production. Despite their commitment to expanding manufacturing capacity, it takes time to build so much infrastructure and make it operational. Novo Nordisk has recently announced that they will be acquiring Catalent, in order to gain more production facilities without having to build them. In the meantime, the gap in supply remains.
Interestingly, numerous competitors in countries such as India and China are already working hard towards developing generic versions of these hero drugs. This is sure to keep all big players on their toes.
What should patients do?
Now that we have discussed some of the main factors behind these shortages, the key question is, what should affected patients do?
It’s essential to discuss your needs with your healthcare provider and ask them what other options you might have. If exploring an alternative medication, it’s important to check if they have been approved by the FDA and understand that all medications are accompanied by certain side effects. Avoid purchasing medication from dubious providers who don’t do health screenings, don’t provide any additional support and are not qualified or capable of addressing all your questions. The up-front cost may appear lower, but the same people are likely to become inaccessible should you ever need help later.
Looking to the future
With the pharmaceutical industry striving to rectify these shortages by either building or purchasing new facilities, we are likely to see improved supplies by the end of 2024 and in years to come.
Until the time comes when the seemingly insatiable demand for weight loss medications can be met, healthcare providers and patients must steer through these uncharted waters together. This includes considering alternative approaches to weight management that don’t rely on pharmacological treatments.
There is an increasing appetite for understanding our bodies better and optimising health outcomes. The industry is continually investing in research to learn more about the underlying causes of obesity and in turn, providers are also coming up with new and innovative solutions to address the problem. With an ever-expanding range of diverse and accessible treatments coming to the market, we feel that the future looks promising for people seeking to manage this difficult condition effectively.
Kiruthika Rajeswaran,
Co-Founder & Creative Owl
