November 29, 2022 — Weight loss advice is everywhere you look on social media, but a trend sweeping TikTok has led to shortages of a major diabetes drug.
Ozempic, a weekly injection that helps boost insulin sensitivity in people with type 2 diabetes, also suppresses appetite, leading to weight loss. Stories of celebrities using the off-label drug to shed pounds have sparked an explosion of interest. And now people with diabetes — people whose lives could be saved by the drug — are struggling to find it.
Kim Kardashian and Elon Musk
In the spring, Kim Kardashian pulled off a dramatic weight loss to fit into Marilyn Monroe’s dress for the Met Gala. Soon, rumors began to circulate that she Used Ozempic to do it. Just this week, new Twitter owner Elon Musk tweeted about own use of Ozempic and its sister drug, Wegovy.
Variety dubbed Ozempic “Hollywood’s worst-kept secret — especially since its most enthusiastic users aren’t pre-diabetics and don’t need the drug.” The rich and famous spend $1,200 to $1,500 a month to access it.
As often happens, high profile usage sparked a trend. Hashtagged videos on TikTok #ozempic have amassed over 275 million views, and #ozempicweightloss has more than 110 million.
This raises concerns about who, exactly, is watching these videos and what message they are getting.
“Forty-two percent of Americans are obese and even more overweight. It affects our young and our teens,” says Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. “They are turning to TikTok and other social media for help.”
A new study shows just how damaging it can be: Researchers analyzed 1,000 videos with hashtags related to nutrition, food and weight, with more than a billion views combined. They found that almost all of them included messages glorifying weight loss and slimming.
Finally, an effective drug for weight loss
Ozempic is Danish pharmaceutical company Novo Nordisk’s brand name for semaglutide, which works by mimicking a natural hormone known as GLP-1. It travels to your brain and helps you feel fuller with less food. This leads to weight loss. In a 68-week study, semaglutide helped people lose an average of 15% of their body weight. But it’s not a miracle drug: you still have to change your eating habits and stay physically active.
The FDA approved Ozempic to treat people with type 2 diabetes in 2017. Four years later, Novo Nordisk received the green light for a higher-dose version aimed specifically at obese people. Wegovy is approved for use only if you have a BMI of at least 27 with one or more weight-related conditions, or a BMI of 30 or more without any.
“These drugs dominate my practice because they’re so effective,” says Amanda Velazquez, MD, director of obesity medicine at Cedars-Sinai Medical Center in Los Angeles. The drug is considered safe, “so the majority of patients are good candidates.”
More demand than supply
As word spread about how well Ozempic and Wegovy worked, social media posts prompted even more people to seek out the drugs. Now demand is outstripping supply – according to the FDA, starting doses of Ozempic will have limited availability through January.
“In Hollywood, people lose 10 pounds, get it for $1,500 a month, and sell out stores for people who are so badly obese they have congestive heart failure and diabetes,” says Apovian. “These are people who are going to die, and you just take them off for cosmetic weight loss. It’s deplorable.
In addition to huge demand, Wegovy has also experienced a disruption in its supply chain. At present, it is not available at all at lower doses, which contributes to increasing off-label demand for Ozempic. Novo Nordisk expects these issues to be ironed out by the end of the year, with distribution following soon after.
The price of access
With a list price of $1,350 per month, Wegovy costs as much as many mortgages. And Medicaid, Medicare, and many insurance companies don’t cover it. Although obesity is a disease, the insurance industry sees weight loss as a vanity issue – so even if you could find the drug, you might not be able to afford it.
“We find that about half of the prescriptions we write aren’t covered,” Apovian says. “And for the half that is covered, you have to do a prior authorization, which takes days, and it’s laborious.” In some cases, she says, insurance companies withdraw their authorization after 3 months if they do not see sufficient weight loss.
It’s not like you can take Wegovy for 3 months, lose weight and expect it to stay either. Medication requires a real commitment, potentially for life. This is because once semaglutide leaves your system, your appetite returns. In one study, people regained two-thirds of the weight they had lost within a year of quitting.
Many see a double standard in insurance companies’ refusal to cover a drug that could prevent serious illness or death.
“They say it’s not cost effective to give the 42% of Americans who have a BMI over 30 Wegovy. Did they say that when statins came out? said Apovian. “Why are they doing this with anti-obesity agents? It’s culture. The culture is not ready to embrace obesity as the disease it is.
Unpleasant side effects
Suppose you are one of the lucky ones – your insurance covers Wegovy, and you can find some. You may find that using it is no picnic. Common side effects include gastrointestinal issues like nausea, vomiting, and diarrhea.
“The way we counter that is to start very slowly on a low dose of these drugs,” says Apovian. “We only go up when the patient is not nauseous or is feeling better.”
Elise Davenport was thrilled to try Wegovy. “I did my research online. I’m the type who’s interested in early adoption, tech gadgets, etc. says the 40-year-old technical writer. “I wanted to try it because I had tried so many other things that failed or didn’t work long term.”
With a BMI over 30, Davenport qualified for the drug. She signed up for an online program that guaranteed insurance coverage and started taking it in October 2021. At first the side effects were mild, just a touch of nausea and diarrhea. And the results have been impressive. She found it easy to feel satisfied with small portions and lost her cravings for sugar and highly processed foods. Weight dropped, about 5 pounds per week.
Turns out it’s too much, too fast. Apovian and Velazquez say their patients lose more than 2 pounds each week, with careful monitoring.
By early December, Davenport’s side effects were increasing. Due to shortages of lower doses, the online program was unable to adjust its own right away. She felt nauseous all the time, bad enough that brushing her teeth made her vomit and she had to force herself to eat. Some weeks she was managing less than 500 calories a day. Her sleep patterns became irregular. And then her depression, which the drugs had controlled for years, escalated.
“I remember sitting on my bathroom floor crying, thinking I’d rather carry the extra weight,” she says. “Before, I used to enjoy eating a lot, and I didn’t have any of that anymore. It was such a joyless experience at that time.
Eventually, her dosage was reduced and the symptoms subsided, but her GP encouraged her to stop. By the time she did, in March, she had lost 55 pounds. So far, she has collected about 10.
More than just weight loss
Although Davenport’s experience was not good, with better supervision, she would be willing to try again. On the one hand, seeing how easy it was to eat less with medical help helped undo years of shame.
“Our culture treats obesity as a moral flaw. I realized that the doctors and the programs made me feel like that — that I wasn’t doing enough,” she says. “This drug made me realize that there are legitimate physiological things going on in my body, things that are often left out of the conversation.”
Apovian and Velazquez say their patients regularly discover similar things.
“Obesity is not a disease of the will. Medication is not the easy way out,” says Velazquez. “It’s a chronic, recurring disease, and because of that, we should treat it like we treat diabetes, high blood pressure, all these other conditions. high blood pressure, let’s tell them to work on their willpower and withhold any medications they may be entitled to.