The controversy around Hollywood’s latest diet drug

Sam Hawley: Hi, I’m Sam Hawley, coming to you from Gadigal Land. This is ABC News Daily. It shot to fame in Hollywood and is so popular in Australia we ran out of stock. The diabetes drug Ozempic is now being used for weight loss and it helps to shed kilos fast. Today a GP on how it works and the ethical decisions for doctors as demand for the drug exceeds all expectations.

Natasha Yates: My name is Natasha Yates. I’m a frontline GP and have also been working in academia for a number of years as well. I’m definitely not an obesity expert, but I definitely know what’s going on at the frontline when it comes to weight loss questions and weight loss drugs.

Sam Hawley: And Ozempic, which is the word of the day by the sounds of it. A lot of people, Natasha, seem to be talking about this drug Ozempic from celebrities like Chelsea Handler….

Chelsea Handler: It’s too good to be true. She goes, if you ever want to drop 5 pounds, this is good.

Sam Hawley: …to business people like Elon Musk. So what exactly is it and where has it come from?

Natasha Yates: So it is a medication that’s been around for a few years, but mainly in managing type two diabetes.

Advertisement: So people with type two diabetes are excited about the potential of once weekly Ozempic. In a study with Ozempic…

Natasha Yates: What happened about 12 to 18 months ago is people started to realise that it’s also very good for helping with weight loss.

Advertisement: …And you may lose weight: in the same one-year study, adults lost on average up to 12 pounds….

Natasha Yates: Now we did notice it helping our diabetic patients lose weight, but it hadn’t really been used as a just weight loss drug for people up until more recent times. I think what really happened was there was a lot of social media buzz around it and all of a sudden it was discovered as being an effective weight loss option.

Reporter: Google searches for Ozempic have been skyrocketing, now that the diabetes drug is trending on TikTok.

Tiktok user: My goal weight is 135 pounds.

Tiktok user: Baby, the hype is real.

Natasha Yates: It essentially sold out internationally and supply couldn’t keep up with demand. And so we’ve had several months now where not even our diabetic patients have been able to obtain it.

Sam Hawley: Yeah, that’s a real worry. I mean, it even got a mention at the Oscars when comedian Jimmy Kimmel insinuated that everyone there looked so great, they must all be taking it. But as you say, it’s got a big name through people like him and on social media. But that’s a concern, right? If diabetics can’t actually get the drug that they need, that that must be really worrying.

Natasha Yates: It is and I have a lot of patients who’ve been quite frustrated. For them it was the best medication for their diabetes control, they tried all kinds of other things and they really felt that they were being betrayed, I guess, by people who were using it for weight loss. Now, I should say obesity itself is definitely a health issue and I’m not against people using it to treat obesity either, but I think the problem is that we don’t have enough of it around. So, really we need to prioritise who gets it when it does start to trickle back onto the market.

Sam Hawley: Tell me, how does this drug work when it comes to weight loss? What does it do?

Natasha Yates: So it works in a couple of different ways. It mimics a hormone called GLP-1 which means that when you take it, it makes you not as hungry, it makes you feel fuller with less food. But it’s more than just that, because it doesn’t just decrease people’s intake of food, it also acts at a hormonal level, which is why it’s very effective with diabetes. It’s acting on the insulin and glucagon and the balance there. And so essentially is changing the function of people’s metabolism.

Sam Hawley: Yeah, okay. So it makes you feel like you’ve already had a full meal, so you don’t eat as much, basically?

Natasha Yates: Correct, but it also seems to be, I guess, supercharging people’s metabolism so that the exercise that they’re doing and the lifestyle, particularly if they have already got a healthy lifestyle, seems to be helping them lose weight. So I’ve had patients who’ve struggled with obesity for years, who’ve been doing all the things they can as far as diet and exercise goes and seem to have just hit a kind of set point that their body won’t budge from. And once they start taking Ozempic, it gives them a bit of a metabolic boost to start burning fat again. Part of what we’re trying to navigate is, well, when it is available, how do we prioritise? Of course diabetics will get first priority, but then how do we then prioritise those people who are living with obesity to be able to access it as well?

Sam Hawley: But Natasha, why can’t we just make more of it? I mean, obviously it’s very, very popular, everyone wants some of it around the world, so why don’t we just make more of it?

Natasha Yates: Well, we are. The company that produces it has actually built a massive new facility to be able to manufacture it. And we know that they were giving us the end of March as a deadline. so we’re there. We’re hoping that they will be able to now produce huge amounts more than they were this time last year. So I also think that there are other companies that are trying to produce a similar medication so other drug companies know how to make it. And I think there will be such a market for it that we will start to see a range of options rolling out for people over time.

Sam Hawley: Okay, but even when you have masses of it, as you say, you have to prioritise. But going from that Oscars joke, there is concern, isn’t there, that people who are not obese and potentially not even overweight will want to get access to this drug?

Natasha Yates: Absolutely, and I think that’s something that very much worries me as a GP. We’ve got so much weight stigma in our community, there’s a lot of blame and shame of people who live with obesity and for even people who are not clinically obese or even clinically overweight, we are just constantly bombarded with images of unrealistic body images, you know, an unrealistic thinness. And I very much worry about the way that this could and probably is already being used inappropriately by people who just want to lose a few kilos. But it’s not really a health issue for them. It’s more a body image issue.

Comedian: According to The New Daily, very, very thin is in again. This resurgence of thinness has been put down to the emergence of the drug Ozempic.

TikTok user: If you’ve noticed, a lot of celebrities have lost a lot of weight recently.

Instagram user: Just to elaborate a little bit further on this ‘heroin chic’, so disingenuous! Just call it hungry chic. They want you to look hungry. They’re not even interested in you looking like natural….

Sam Hawley: I guess that leads to the question of whether or not this ends up on the black market, because how do they get it if it’s not prescribed?

Natasha Yates: Yes, so the prescription around this is interesting. At the moment in Australia, we can prescribe it on the Pharmaceutical Benefits Scheme for people with diabetes, only type two diabetes. And if someone wants it for obesity, we can prescribe it on a private script. Now, as I said, towards the end of last year, GPS were asked not to do that anymore. But when there is more of it available, I can guarantee that GPs will be prescribing it, I certainly will be for some of my patients who do struggle with obesity, and it’s a health issue for them. But then the question comes who actually can get those non PBS prescriptions? And as you say, there’s a very real risk of a black market. So even if I prescribe it for a patient who genuinely would benefit from it, what if they go and sell it on to someone else who doesn’t? I think we need to realise that it does get metabolised through the liver and there is a risk of things like pancreatitis. So if someone is taking it, they should really be taking it under medical supervision. It’s not something that people should just be injecting on the side.

Sam Hawley: And you have to take it. How often I mean, how does this work?

Natasha Yates: It’s an injection once a week and you tend to buy it in a one month supply. So four injections. One of the downsides of the medication, it’s not actually curing obesity. It’s simply treating it and so once you stop taking the drug, the weight does creep back on.

Sam Hawley: How much does it cost? Is it is it very costly?

Natasha Yates: So if someone’s getting it on the Pharmaceutical Benefits Scheme, it personally to them just costs the same as a normal script. To us as tax payers, it did cost last year around 130 to $150. As there is such a market for it now we suspect that the cost of producing it in mass will mean that that cost flows on to the consumers. So, at the moment we don’t really know. In America they have been selling it for around 1,000 USD a month, which is really quite expensive and probably out of reach then for many, many people.

Sam Hawley: And feeling full all the time, that mustn’t be that fun.

Natasha Yates: Actually, you’re right. And something patients have actually said to me is that they have noticed quite an impact on their social life. So they’ll go out with friends and they’ll order a meal and they’ll take a couple of bites and then not be able to finish it. So it really can put a dampener on on a social life. And especially if you come from a culture and a community that loves eating food, it can be almost insulting to your family and your friends if you’re not eating their food.

Sam Hawley: Okay, so it’s a drug that’s being now promoted by influencers around the world, in America and elsewhere, rather than being promoted by doctors.

TikTok user: And welcome to my weekly Ozempic check in, officially one month on Ozempic. Um, yeah, I just start dropping pounds left and right.

TikTok user: And the result of it is, you know, I’ve got a completely brand new body.

Sam Hawley: Do you think doctors are or there is that risk that they’ll prescribe it too much? It sounds like there’s a moral decision that doctors have to make when prescribing this drug.

Natasha Yates: So part of the challenge to us on the frontline is how do we make that decision? The guidelines for treating obesity don’t actually include Semaglutide or Ozempic, which is its trade name. And part of that is because it’s fairly new on the market, but partly because the current guidelines were actually rescinded back in 2018 and the new ones haven’t actually been released. So, for the last five years we’ve been flying a little bit blind as to what we are meant to do. And you’re right, we’re sitting there trying to make moral judgements with the patients in front of us, really with no clear guidance. Every time we write a prescription that is off the PBS or off label because we’re writing it for something that it hasn’t been kind of labelled for, we are putting ourselves at risk as GPs. If something went wrong, the patient would be able to turn around and, you know, take us to court and ask why we prescribed them something off label. So it does make us nervous as GPs. We do want to help our patients, but we don’t have a lot of guidance and particularly not legal coverage either.

Sam Hawley: Yeah, that’s a worry. So what should happen, do you think, now then, because we’ve had a shortage of this drug, I assume there’s some lessons to be learnt in that regard.But then also in this regard of regulation and this rather new drug that, you know, we don’t really know how to deal with particularly.

Natasha Yates: Yes, so I think the first thing is that we do need to be aware that this is a medication that works. And for some people, it’s going to be really helpful and in fact, life changing. But we need to work out what kind of boundaries should be put on it so that the people who will be helped by it are helped. But then the people who could be harmed by it are protected. And that’s the same with what we do with all kind of medications. That’s not my role as a frontline GP, that’s definitely is a role that should be filled by the people who make guidelines and who regulate these kind of medications. And so far I haven’t really seen any of that come across my path, but I’m hoping that they’re working on that really hard at the moment.

Sam Hawley: Natasha Yates is a GP on the Gold Coast. The Therapeutic Goods Administration has warned consumers to only obtain Ozempic from pharmacies with a doctor’s prescription, saying due to the shortage, there have been several scams relating to the sale of the drug. This episode was produced by Flint Duxfield, Veronica Apap, Chris Dengate and Sam Dunn, who also did the mix. Our supervising producer is Stephen Smiley. I’m Sam Hawley. You can find all our episodes of the podcast on the ABC Listen app. Thanks for listening.