It goes by many names: semaglutide, thin pen, Hollywood's best kept secret. The injectable drug Ozempic has skyrocketed in popularity over the past 12 months, regularly appearing in news headlines and TikTok feeds.
Semaglutide (brand name Ozempic) is used in people with type 2 diabetes to help control their blood sugar levels. However, semaglutide also causes significant weight loss, leading doctors to prescribe the drug off-label to non-diabetic patients. The practice has become more common recently, driven by celebrity and social media endorsements.
Due to the increased demand for semaglutide, there is now a worldwide shortage of this drug. Semaglutide supplier Novo Nordisk has notified the Therapeutic Goods Administration (TGA) that Ozempic will be available in Australia by the end of March 2023.
Australian type 2 diabetics who are dependent on semaglutide will have to look for suitable alternatives.
“It's a big problem,” said Dr Namson Lau, joint senior lecturer at UNSW Medicine & Health and consultant endocrinologist at Liverpool and the Royal Prince Alfred Hospital.
“All my colleagues have had multiple calls from patients asking what can we do about this shortage?”
originally a diabetes drug
Semaglutide is a drug that targets areas of the body, including the brain, pancreas, and digestive system.
“It works in at least four ways,” said Professor Jerry Greenfield, from UNSW's Faculty of Medicine and Health and the Garvan Institute of Medical Research, who is also Head of Endocrinology and Director of the Diabetes Service at St Vincent's Hospital.
“One is to reduce appetite in the brain. The second is to slow down the rate at which the stomach empties. The third is to stimulate the pancreas to secrete insulin. The fourth is to inhibit glucagon secretion.”
Because of these actions, semaglutide helps regulate blood sugar levels, which is important for people with type 2 diabetes. Semaglutide, a once-weekly injection, was first approved by the US Food and Drug Administration (FDA) in 2017 under the brand name Ozempic and was approved by the TGA in 2019.
Semaglutide for weight loss
Due to semaglutide's effects on appetite and digestion, it can lead to significant weight loss. This is an added benefit for obese type 2 diabetic patients who take semaglutide to control blood sugar levels.
However, non-diabetics have also been using semaglutide by private prescription to lose weight. This includes overweight and obese individuals who need to lose weight for medical reasons, as well as “beauty” users.
concerns about advertising
Novo Nordisk's cheerful US ad for Ozempic suggests that people using it may lose weight, but also includes a disclaimer: It is “not a diet pill”.
According to Professor Nitika Garg, who studies consumer behavior at UNSW Business School, this could lead to off-label use.
“What are they expecting? People are going to steal, people are going to beg, people are going to lie to get this drug. So, I think it's a little bit irresponsible, and regulators should have anticipated that,” Prof Garg said.
Read more: What is Melanotan-II – the drug TGA urges consumers to avoid?
Ozempic's weight loss effects have also been strongly endorsed by users of social media platforms. At the time of writing, the hashtag #ozempicweightloss has more than 170 million views on TikTok.
“What's happening is word-of-mouth (WOM) from social media influencers is exploding to the point that regulators aren't keeping pace with it,” Professor Garg said. “We need to hold accountable those who talk about these things online without thinking about the consequences.”
In Australia, it is illegal to advertise prescription drugs to the public. The TGA said it was working with the social media platform to address users who allegedly placed Ozempic ads illegally.
Professor Garg said stronger and more proactive communication between industry and regulators was needed to prevent problems like this from happening.
“I think there needs to be a broader dialogue between scientists, pharmaceutical companies, and regulators … There needs to be a way for these parties to interact and come together on these issues before they become an issue.”
Not a “panacea”
Ozempic's many social media endorsements masked its side effects. For example, the drug often causes unpleasant gastrointestinal symptoms, including nausea and vomiting. Additionally, some users experience an “Ozempic face,” appearing more gaunt and aged due to fat loss in key areas of the face.
Importantly, the weight loss effects of semaglutide did not last when users stopped taking the drug.
“One very important thing to remember is that once you stop taking the medication, the weight will come back,” Dr. Liu said.
“Once you lose weight, you have to go on to make major lifestyle changes if you want to maintain the weight with medication.”
New Weight Loss Pills Needed
Ozone shortages illustrate the huge unmet need for drugs that support weight loss. According to Professor Greenfield, historical attitudes towards obesity have contributed to the current lack of such drugs.
“There are very few drugs on the market for treating obesity. This is partly because many people don't think of obesity as a disease,” says Professor Greenfield.
Read more: It's time to stop the moral panic about obesity
Over time, it has been recognized that obesity is not solely caused by lifestyle and social factors. Scientists are only just beginning to understand the complex combination of biological factors that lead to weight gain. Some people may benefit from medications that target these biological factors in addition to diet and exercise.
“A really important point I want to make is that there is a strong genetic component to obesity and the desire to eat,” Professor Greenfield said.
“As time goes on, more and more people will recognize obesity as a disease. There should be more recognition of important biological factors in weight gain, as targeting these pathways may further drive drug development.”
