It’s known by many names: semaglutide, the skinny pen, Hollywood’s worst-kept secret. The injectable drug Ozempic has exploded in popularity in the 12 months, appearing frequently in news headlines and the TikTok feed.
Semaglutide (brand name Ozempic) is prescribed to people with type 2 diabetes to help control their blood sugar levels. However, semaglutide also leads to significant weight loss, leading to doctors prescribing the drug off-label to non-diabetic individuals. This practice has become more common recently, fuelled by celebrity and social media endorsements.
Due to increased demand for semaglutide, there is now a worldwide shortage of this medication. Semaglutide’s supplier, Novo Nordisk, has informed the Therapeutic Goods Administration (TGA) that Ozempic will not be available in Australia until the end of March 2023.
Australians people with type 2 diabetes who rely upon semaglutide are left searching for suitable alternatives.
“It’s a big issue,” said Dr Namson Lau, who is a Conjoint Senior Lecturer at UNSW Medicine & Health and a Consultant Endocrinologist with Liverpool and Royal Prince Alfred Hospitals.
“All of my colleagues are getting multiple calls from patients asking, what can we do about this shortage?”
Originally a diabetes medication
Semaglutide is a drug that targets areas in the body including the brain, pancreas and digestive system.
“It has at least four modes of action,” said Professor Jerry Greenfield from UNSW Medicine & Health and the Garvan Institute of Medical Research, who is also Head of the Department of Endocrinology and Director, Diabetes Services, at St Vincent’s Hospital.
“One is to reduce appetite centrally in the brain. The second is to slow down how quickly the stomach empties. The third action is to stimulate insulin secretion from the pancreas. The fourth is to suppress glucagon secretion.”
Due to these effects, semaglutide helps to regulate blood glucose levels, which is important for people with type 2 diabetes. A once weekly injection of semaglutide was first approved in 2017 under the brand name Ozempic by the US Food and Drug Administration (FDA), and in 2019 by the TGA.
Semaglutide’s weight loss effects
Because of semaglutide’s influence on appetite and digestion, it can lead to significant weight loss. This has been an additional benefit for obese people with type 2 diabetes who were prescribed semaglutide to manage their blood glucose levels.
However, non-diabetics have also been accessing semaglutide on a private prescription to lose weight. This includes overweight and obese individuals who need to lose weight for medical reasons, as well as ‘cosmetic’ users.
Concerns about advertising
Novo Nordisk’s cheerful advertisements for Ozempic in the US suggest that people who use it might lose weight, but also include a disclaimer: that it "is not a weight loss drug."
According to Professor Nitika Garg, who researches consumer behaviour at UNSW Business School, this could contribute to off-label use.
“What were they expecting? People will steal, people will beg, people will lie to get their hands on this drug. So, I think it is a bit irresponsible and regulatory bodies should have foreseen this,” Prof. Garg said.
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The weight loss effects of Ozempic have also been endorsed heavily by users of social media platforms. On TikTok, the hashtag #ozempicweightloss has racked up over 170 million views at the time of writing.
“What is happening is that social media influencer word-of-mouth (WOM) has exploded so fast that the regulatory bodies have not kept up with it,” Prof. Garg said. “We need to hold people accountable who are talking about these things online, without consideration of the consequences.”
In Australia, advertising a prescription-only drug to the public is illegal. The TGA says it is working with social media platforms to address allegedly unlawful advertising of Ozempic by users.
Prof. Garg said stronger, more proactive communication between industry and regulatory bodies is needed to prevent these types of issues.
“I think there needs to be a broader conversation among scientists, pharmaceutical companies, and regulators… There need to be ways for these parties to interact and come together about these issues before they become a problem.”
Not a ‘wonder drug’
Many of the social media endorsements of Ozempic gloss over its side effects. For example, the drug commonly causes unpleasant gastrointestinal symptoms including nausea and vomiting. Also, some users experience ‘Ozempic face’, appearing more gaunt and aged due to loss of fat from key areas of the face.
Importantly, the weight loss effects of semaglutide do not last when users stop taking the drug.
“One thing that is really important to remember is that once you stop taking the medication, the weight regains,” Dr Lau said.
“Once you lose the weight, if you want to maintain that even with the medication, you have to continue to embed in significant lifestyle changes.”
New weight-loss drugs are needed
The Ozempic shortage illustrates the immense unmet demand for medications to support weight loss. According to Prof. Greenfield, attitudes towards obesity throughout history have contributed to the current dearth of such medications.
“There are very few medications on the market for the treatment of obesity. It’s partly because obesity is not regarded as a disease by many people,” Prof. Greenfield said.
Over time, people are recognising that obesity is not caused by lifestyle and societal factors alone. A complex mix of biological factors which scientists are only beginning to understand contribute to weight gain. Some individuals could benefit from medications targeting these biological factors in addition to diet and exercise.
“One of the really important points that I would make is that obesity and the drive to eat has a very strong genetic component,” Prof. Greenfield said.
“As time goes on, more and more people will recognise obesity as a disease. There should be greater recognition of the important biological contributors to weight gain, as targeting these pathways may further drive drug development.”