Semaglutide is causing a social media frenzy. So what is it?
The latest craze on social media isn’t a dance challenge or a viral meme, but an injectable medication originally designed to treat diabetes.
Known as semaglutide and marketed under names such as Ozempic and WeGovy, the drug has recently gained popularity as a weight loss tool.
TikTok and Instagram videos theorize Kim Kardashian used the medication to lose weight for her outfit at the 2022 Met Gala.
Celebrity doctor and Republican candidate Dr. Oz has been injecting semaglutide on his television show, and billionaire Elon Musk has tweeted that the drug is in his own weight loss regimen.
Here’s how rising demand for the diabetes drug led to a global shortage, leaving Australians waiting months for their next dose.
What is semaglutide?
Semaglutide is a medication that works by mimicking hormones that control blood sugar levels in people with diabetes.
The medication has also been found to affect appetite, leading to fewer cravings, a change in preferences away from fatty foods and less overall energy intake.
In one study, participants lost an average of 15 percent of their body weight while taking the drug.
Danish pharmaceutical company Novo Nordisk markets semaglutide under the brand name Ozempic, which comes as a once-weekly injection.
Another dose specifically designed to tackle obesity – called WeGovy – is registered on the Australian Register of Therapeutic Goods but is not yet available in Australia.
Further studies on semaglutide have shown disadvantages to its use.
In clinical trials, 44 percent of WeGovy patients reported nausea compared to 16 percent treated with a placebo, while 30 percent of WeGovy users reported diarrhea compared to 16 percent of placebo patients.
Trials also found that patients taking semaglutide regained an average of two-thirds of their weight once they stopped taking the drug.
This means that using semaglutide is probably not a permanent solution.
Who uses semaglutide?
Ozempic brand semaglutide has been available in Australia since 2019 and is used by type 2 diabetics to manage blood sugar levels.
But in recent years the drug has become popular in Australia to treat obesity.
Melbourne resident Rachel* started using the drug out of a desire to lose weight.
“Even people who are part of the fat acceptance movement have reached that mental point, after years and years of dieting and then gaining that weight back, or dieting and losing a little bit, and then plateauing,” she said.
“Always struggling with this nagging hunger that you just can’t let go.”
Rachel discovered semaglutide through a New York Times article, one that reported measurable weight loss for those taking it in clinical trials.
Her GP had never even heard of the drug from the article when Rachel brought it up, and she had to be referred to a specialist to obtain it.
Rachel tried all the treatments available. Medications, such as the appetite suppressant phentermine, caused anxiety and insomnia, and bariatric surgery did not help her long-term.
Ozempic worked for Rachel where other treatments did not.
While Rachel eventually had access to treatment she found effective, its growing popularity coincided with dwindling supply in Australia.
Rachel found herself facing more questioning about her use.
“In certain [pharmacies] … they started asking me ‘do you have diabetes?'” she said.
After almost two years of using Ozempic, Rachel could no longer get the drug anywhere.
What caused the shortage?
The Therapeutic Goods Administration (TGA) has directly linked the flood of social media coverage to the semaglutide shortage in Australia.
“When social media posts increased about achieving rapid weight loss with Ozempic, it created a huge demand for the product that the manufacturer was not prepared for, and it quickly developed into a global shortage,” said a TGA spokesperson said.
The TGA does not expect Ozempic to be available in the country until at least March 2023, with other countries experiencing similar shortages.
Britain already restricts access to semaglutide to specialist weight loss clinics and has not made it available to GPs because of the cost.
With new supplies months away, the Royal College of General Practitioners (RACGP) advised GPs not to start Ozempic for new patients until the shortage eases.
Chair of the diabetes-specific network at the RACGP Gary Deed said the sophistication of the drug treatment made supply issues an “international problem”.
“They come in very sophisticated delivery devices, so it’s a combination of not only the difficulty of manufacturing the medication, but also the devices needed to administer it,” Dr Deed said.
He said no diabetic would be at risk if they stayed in touch with their GP and sought alternative treatments.
What impact does the shortage have?
Besides its popularity on social media and its effectiveness for some patients, another factor drew Australians to Ozempic: it was relatively affordable.
Despite the federal government estimating that obesity will cost Australia’s healthcare system $87.7 billion by 2032, there are currently no obesity treatments available through the PBS.
However, because of its diabetes treatment properties, Ozempic is subsidized on the Pharmaceutical Benefits Scheme (PBS).
This means increased competition between weight-loss patients and diabetics for remaining supplies of the drug.
Rachel was forced to switch to an alternative, more expensive drug because of the semaglutide shortage, which tripled the cost of her monthly prescription.
“That’s a lot of money. It’s a lot more than Ozempic,” she said.
The Pharmaceutical Benefits Advisory Committee has not recommended the listing of semaglutide (under its WeGovy brand) on the PBS for the treatment of obesity.
In making its decision, the body said the case for it, put forward by Danish pharmaceutical company Novo Nordisk, “poorly justified the population access it requested, the modeled benefits were highly uncertain, and the listing would not be cost-effective be at the asking price”.
It went on to say that listing the drug would require an “extremely high investment with very uncertain implications for the PBS and wider health budget”.
The TGA also urged doctors to consider alternatives to Ozempic for treatment and to prioritize type 2 diabetes sufferers for prescriptions, but admitted it could not control the decision-making of GPs.
“The TGA does not have the power to regulate the clinical decisions of healthcare professionals and is unable to prevent doctors from using their clinical judgment to prescribe Ozempic for other health conditions,” said the TGA spokesperson.
Anxious about her future, Rachel hopes that both diabetics and people living with obesity will be considered patients with a genuine need for semaglutide.
“No one gets semaglutide without a prescription. In every single case, a doctor looked at the patient and decided they had a good reason to take it,” she said.
“To say that fat people are [to blame] because they use up all the semaglutide is kind of unfair.”
What do health professionals say?
Melbourne GP Paul Nisselle said he continues to see a huge increase in patients asking about the drug.
“They come in and say I understand there’s this injection that can help you lose weight?” Dr. Nisselle said.
“And I say, well, there is, but you can’t get it now because it’s very scarce, it’s very expensive … and we’ve been asked very strictly by the government to limit it to diabetics who really need it.”
Dr Nisselle compared the drugs’ rise in popularity to the uptake in Viagra when it became available in Australia.
“It wasn’t prescribed on the Pharmaceutical Benefits scheme, and was expensive. But once people heard about it, they wanted it,” he said.
“There was a very good offer. So it became very widely prescribed.”
Dr Nisselle warned against long-term use of the drug, saying it would not ultimately solve the problem for many people struggling with obesity.
“I would not take a glucose-manipulating drug long-term by injection simply to lose weight when there are safer ways to do it,” he said.
But Dr Deed said the increased coverage and resulting demand for semaglutide treatments was not necessarily negative.
“Raising the profile of quality access to medication and disease conditions such as obesity and diabetes is a very good thing,” Dr Deed said.
He said that both diabetic and obese people deserved access to treatment, and any debate about who needed it more was unhelpful.
“Who should get it and who shouldn’t is an argument that’s really just based in speculation,” Dr Deed said.
“We really need to try to get delivery when the shortage is over so you can improve health outcomes for all people.”
*Rachel’s name has been changed to protect her identity.
