GLP-1s have been in development for some time but have only recently come to the forefront of American medicine for weight loss use. Since its FDA approval in 2017, Ozempic use has exploded by a factor of 40 and continues to increase. This increased use highlights ongoing concerns, such as known adverse effects like hypoglycemia and malnutrition, the unknown long-term health consequences, and newly developed problems, such as accessibility and economic challenges.
According to CNN, 1.7% of all Americans used GLP-1 drugs, which include Ozempic, Mounjaro, and Wegovy in 2023. The 40-fold increase of Americans suddenly taking these drugs came after both industry and consumers realized its potential use for weight management. In 2018, more than 90% of Ozempic was prescribed for type 2 diabetics, now only 58% in 2023. The consumer demand for the drugs’ weight loss applications has created supply issues for this drug. This particularly affects diabetics seeking access to this treatment, causing some to pay as much as $1600 out of pocket per month if their insurance doesn’t cover it.
In 38 of 50 U.S. markets, the rates of generic/off-label prescriptions of Ozempic have more than doubled over the past two years, which carries greater potential for adverse effects. Furthermore, the authorization rate of insurance coverage has decreased from 60% in 2022 to as low as 25%, which is predominately due to people taking the drug for weight loss. This is the first ethical concern that must be addressed regarding GLP-1 distribution. With the finite supply of the drug(s), we must determine if diabetics should be prioritized or if the market should self-regulate.
Due to increased demand, Ozempic shortages are expected through 2024. Until the supply/demand discrepancy is solved, those with chronic diseases such as moderate to severe obesity, type 2 diabetes, or hyperglycemia should be prioritized in receiving Ozempic. For some diabetics, Ozempic is more effective in managing their A1C, as well as lowering their risk of heart attack or stroke. While Ozempic has potential advantages over other standards of care for diabetic interventions, it does not appear to have advantages over other standard-of-care interventions for weight management.
This is because of the uncertain efficacy of chronic weight management. Like treatments like bariatric surgery, GLP-1 agonists may suffer from issues of weight regain and lifelong implementation. This raises a second issue of medical weight management and cosmetic weight management, and weight management for medical purposes should be prioritized. With what is currently presented to us, the short-term risks associated with obesity far outweigh the short-term risks of Ozempic. However, in cases where it is not a treatment for chronic conditions, it is uncertain whether this will do more harm than good, especially when sustaining use over a long period of time.
The long-term health impacts of Ozempic are still being studied with no definitive results yet published. When patients stop taking Ozempic, evidence suggests that 2/3 of the weight lost is regained within one year. Ongoing treatment is suggested, but Ozempic use is only recommended in other countries for a maximum of 2 years by the National Institute for Health Care Excellence (NICE). Furthermore, this extends the potential for adverse side effects that are already present in short-term use, such as gallstones, kidney disease, loss of appetite, and thyroid complications. Given this uncertainty, it is not ideal to accept Ozempic’s glorification with the new rise in demand.
In turn, the decrease in access has raised counterfeit concerns, even for pharmacies. This is due to the demand driving pharmacies to distributors that they might otherwise not be familiar with, where counterfeiters have been able to sneak past the authorized supply chain. An even bigger problem lies in the “gray market”, where unlicensed distributors can often sell counterfeits without encountering an authorized supply chain. The FDA has issued an official warning after the rise in reports of adverse effects, that would otherwise not be found in original versions.
Proponents of Ozempic might argue that it nonetheless serves its intended purpose: to manage blood glucose levels and to reduce weight loss. With this, they assume that people know the short-term risks and that the free-market approach already in place could make Ozempic access more feasible to solve the supply/demand discrepancy. Essentially, this would not make prioritization and use less of a problem, namely for medical interventions. However, accepting the short-term risks for cosmetic purposes dismisses the fact that it is not necessary for these individuals and that prioritization is something that needs to be addressed. Accepting this view also requires holding the uncertainty of long-term risks as insignificant, and this is simply not the case when discussing ethical concerns. Moreover, this view fails to consider alternatives such as lifestyle interventions for weight loss use (i.e. diet and exercise), and other FDA-approved medical interventions that have been deemed effective and safe for long-term use, such as liraglutide, phentermine, and several others.
GLP1s could be a practical treatment for obesity if its incidental benefits outweigh the risks, which have yet to be seen. Even if this was the case, prioritization is needed for medical intervention over cosmetic purposes. What we do know is that one must permanently stay on Ozempic or risk regaining the weight, there is no information on the long-term health impacts since no one has used it that long, and these statistics surrounding supply, demand, and access are nevertheless concerning. Access issues have also caused a considerable increase in counterfeit concerns. With what is currently presented to us, we should be having second thoughts on whether Ozempic is really the answer for cosmetic, non-chronic weight management use.
