In my role as the senior pharmacist here at IsraelPharm, I ensure that we always provide information and respond to questions with evidence-based answers, backed by personal experience and knowledge. Unfortunately, when the internet (namely social media) is our main source of input, we are often confronted with opinions and feedback that contradict medical facts. Nonetheless, it has captured the imagination of readers and run through the media like wildfire. This has especially been the case regarding medications for weight loss.
So, when I read an article by a leading US physician that debunks negative myths and legends about medications for type 2 diabetes like Ozempic and Mounjaro, and weight loss medications like Saxenda and Wegovy, I was keen to share it with you. This article sets out in a much clearer form than I could ever hope to exactly why you should be talking to your healthcare professional if obesity is a health issue for you.
Introducing Dr. Caroline Messer – a graduate of Yale University and the Mount Sinai School of Medicine, a board-certified expert in Internal Medicine, Endocrinology, Diabetes, and Metabolism. Endocrinologist at Well by Messer and at Fifth Avenue Endocrinology. In the past, she served as a clinical assistant professor at the Mount Sinai School of Medicine and an assistant professor at the Hofstra School of Medicine.
The following is a full reproduction of her article titled “It’s Not ‘Reckless’ to Consider Ozempic”, published on the website Medscape.com on August 24 2023. The only changes I have made have been to switch the brand name Ozempic over to Wegovy, because the FDA has now approved Wegovy for weight loss. Wegovy is simply a stronger version of semaglutide, the same compound found in Ozempic. From now on, doctors can only prescribe Ozempic for type 2 diabetes and will prescribe Wegovy for weight loss.
| A stylish 40-something-year-old walks into my office looking mildly sheepish. She is a well-known actress who was recently panned by the paparazzi for having “too much cellulite” after they illegally photographed her playing with her child on a private beach.
Without a doubt, she will request semaglutide (Wegovy) before long, but first we will need to wade through the morass of social condemnation out there about Wegovyto assure her that she is being neither immoral nor reckless for considering it. After nearly 20 years of practicing medicine with a focus on weight loss and preventive care, here is how I see the situation: Ozempic is nothing new, people! Endocrinologists have been using this class of medication since Byetta hit the market in 2005. We have had 18 years to make informed risk-benefit analyses. People are obsessed with the risk for pancreatitis. Any type of weight loss can cause gallstones, and this is what can trigger pancreatitis. Unless you’re the type of person who worries that your balanced Weight Watchers diet is going to cause pancreatitis, you should probably remove this risk from your calculations. Glucagon-like peptide 1 (GLP-1) receptor agonists are naturally occurring gut hormones that reduce inflammatory cascades and clotting risk. We are not giving a dangerous treatment (eg, fen-phen) that increases cardiovascular risk – quite the contrary, in fact. Just because influencers are promoting a product doesn’t mean the product is inherently worthless. One of my patients accused me of prescribing a medication which is the “laughingstock of America.” Try telling that to the scores of cardiologists who send patients to my colleagues and me to start Ozempic to help lower their patients’ risk for stroke and heart attack. Or tell this to my patient who survived an episode of rapid atrial fibrillation and was told by his cardiologist that he definitely would have died if he had not lost 30 pounds from Ozempic in the preceding year. Sometimes it seems like society has become more judgmental about Wegovy than about plastic surgery for weight loss. If we have to choose between liposuction (which doesn’t reduce visceral fat – the dangerous type of fat) or Wegovy, the latter clearly wins because of its real health benefits. How does it make any sense to say that this medication should be reserved for patients who already have obesity and type 2 diabetes? Why should we penalize patients who have not yet reached those thresholds by denying access to preventive care? Don’t we constantly hear about how our healthcare system would be much more efficient if we focused on preventive care and not just treatment? Some people claim that we have to limit access to this medication because of drug shortages. Thankfully, the United States responds to supply and demand economics and will quickly adjust. I’ve had more patients than I can possibly number with severe binge eating disorders (resistant to years of therapy and medication) who finally developed healthy relationships with food while taking these types of medications. Mounjaro, I’m talking about you… I always hear the argument that it is immoral to give these medications to patients with a history of restrictive eating patterns. Although every patient needs to be carefully evaluated, often these medications remove food as both the enemy and primary focus of every waking thought. They allow patients to refocus on other aspects of their lives — such as family, friends, hobbies, work – and regain a sense of purpose. If anyone wants to run a trial on this little hypothesis of mine, please reach out to me. Okay, I agree you might get a little constipated (most often described by patients as the “rabbit pellet phenomenon”), but it’s small price to pay, no? I’ll throw in a few prunes with the prescription. Suffice it to say, I did give my 40-something-year-old patient the medication she desired, and she has a new lease on life (as well as better blood pressure and cholesterol). |
The whole topic of the new generation of medications for type 2 diabetes (T2D) has been a central focus of both my own research and of what I have been trying to pass on to my customers and viewers here and on TikTok. More recently, the subject skipped over onto the high-speed track when it became clear that not only do these new meds give substantial benefits for people suffering from T2D, but they also offer an amazing path to address the even wider problem of chronic obesity. I’m talking of course about the hot subject of GLP-1 receptor agonists, mainly Ozempic/Wegovy and Mounjaro.
Unfortunately, there has been a trend of uninformed comments mainly on the social media platforms that are dissing what these kinds of meds can do for people who have been battling to get control of their body weight for most of their lives. These sorts of negative feedbacks fall into a few main categories, like:
- Semaglutide comes with side effects.
- You should never use drugs to improve how you look!
- Wegovy is so expensive – it can’t be worth it!
- I can never get hold of Ozempic – it’s out of stock all the time!
Questions we have answered
Q2. Semaglutide gives adverse side effects. Isn’t it too dangerous?
Start at the beginning, and maybe read a bit more here. Almost without exception, drugs come with side effects. The question is whether the benefits outweigh the risks. In the case of Ozempic, Wegovy, Mounjaro and other GLP-1 receptor agonists, the benefits for diabetics outstrip the positive elements of the older alternatives. On the risk side, semaglutide brings a degree of risk that is not substantially higher than other treatments for T2D. So on balance, there is normally a strong case to be made for Ozempic and Wegovy for almost every patient, based on the prescribing physician’s evaluation of the specifics relating to this person.
Q3. Should you ever use medications for weight loss to improve how you look?
This is the hardest question for a pharmacist like me to answer. If the only requirement is to improve the image in a mirror and in other people’s eyes, then this in fact is a valid question. Does a person gain anything when their waistline has shrunk six inches and they can fit back into the clothes they had stuck away several years ago?
It can be said that in such a case, the person can gain self-respect, an improved sense of self-worth and more self confidence. It’s all about “self” and only the people themselves can judge this.
On the other hand, doesn’t a person face risks when their own self esteem and sense of self worth is diminished by that unwanted image? It could severely affect their mental and emotional wellbeing and lead to unwanted behavior and poor decisions.
I have learned to leave it to each customer to make this decision, but I think it can only be made objectively if they understand the full benefits (and risks) that come with the medicine. That’s why I spend a lot of time and effort making these facts available both in person and on our website.
Q4. Wegovy is so expensive – can it be worth it?
We are often asked why is Wegovy so expensive. There are three ways to answer this question. Firstly, Wegovy is a long way down on the list of costly medicines. It doesn’t come anywhere on the list of the top twenty in monthly costs, coming in at barely one-tenth of the lowest priced drug on that table!
Secondly, it’s important to realize that it is priced differently depending on the purpose. Prescriptions for Ozempic to treat T2D should be covered by health insurance or a government health plan. In such a case, the out-of-pocket cost can be quite reasonable – sometimes as low as $25 per month, rarely exceeding $300 per month for people with low levels of insurance coverage. Given the great benefits, this is hardly an excessive cost.
However, when medications for weight loss are prescribed for weight loss, not for diabetes, then most health plans don’t cover it. That’s when a consumer will pay the full retail price of about $1000-$1200 per month in local US pharmacies.
But, US retail pharmacy prices are by far the highest in the world. So the question is not whether you can afford to buy medications for weight loss, but whether you should buy it at a US retail pharmacy, or from us here at IsraelPharm, where we can charge less than one-half of the average US retail price for Wegovy .
Q5. I can never get hold of Ozempic or Wegovy – why are they out of stock all the time?
Shortages of Ozempic persisted all through 2022 and the first half of 2023. This wasn’t unique to Ozempic. The US Government Department of Health and Human Services reported to Congress that “drug shortages are an ongoing concern in the United States…and impact consumer costs in various ways.” In fact, many diabetic patients who had been treated successfully with Ozempic were switched by their doctors to other older medications because of the risks they faced from being unable to get reliable supplies.
Here at IsraelPharm, we have secured much more reliable sources of supply of both Wegovy and Ozempic, and have also negotiated a way that other scarce drugs like compounded version of Mounjaro can be supplied without delay. Although right now we are restricting orders of all medications for weight loss to a single monthly dose, this will continue to ease over the next few months, so stay tuned.
