There isn't enough Ozempic for everyone who wants it. People with health conditions like type 2 diabetes and severe obesity should get it before people who hope to lose a few pounds. As the new ‘miracle drug’ for weight loss, Ozempic is one of the most popular new drugs in America. This has come mostly from the media, celebrities, and TikTok influencers praising it for its short-term effects, but not from experts.
The FDA approved the top-selling GLP-1 agonist in 2017 to treat diabetes. One in eight American adults has taken a GLP-1 drug like Ozempic, and more than 15 million are currently taking one. Due to increased demand, Ozempic shortages are expected through 2024. With a large portion of Ozempic’s market consumed by people without diabetes, those seeking the drug for diabetes treatment face a new array of ethical challenges. This rise in Ozempic for weight loss highlights ongoing concerns, such as known adverse effects like low blood sugar and malnutrition, the unknown long-term health consequences, and newly developed problems, such as accessibility and economic challenges. Until the supply/demand discrepancy is solved, those with chronic diseases such as type 2 diabetes, hyperglycemia, and moderate to severe obesity, should be prioritized in receiving Ozempic.
Prescriptions
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 their potential use for weight management.
In 2018, more than 90% of Ozempic was prescribed for type 2 diabetes, down to only 58% in 2023. The increased demand from those diagnosed with obesity, and those who desire the drug for weight loss without a diagnosis has created supply issues for this drug. This particularly affects people with diabetes 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 — which is often not covered. With the finite supply of these drugs, we must prioritize people with diabetes and other serious health conditions. It’s unreasonable to expect the market to self-regulate at this rate; correcting supply and demand differences without government intervention.
Weight Loss and Cosmetics
For some people with diabetes, Ozempic is more effective than other medications in managing their A1C (a marker of glucose control over time) and lowering their risk of heart attack or stroke. While Ozempic has potential advantages over other standard-of-care diabetes interventions, it does not have an advantage over other standard-of-care interventions for long-term weight management. Wegovy and Zepbound are shown to have a higher weight loss percentage and are also FDA-approved for long-term use, unlike Ozempic. It is still uncertain which is most effective at preventing weight regain once people stop taking them, since none of these medications have been studied that long.
The uncertain efficacy of long-term use is often overlooked in the rapidly expanding market. Like other treatments for obesity, such as bariatric surgery, GLP-1 agonists may suffer from issues of weight regain and lifelong implementation. This raises a secondary issue of weight management for medical purposes and weight management for cosmetic purposes, or those who seek treatment without an underlying medical condition. Those seeking treatment for diabetes and/or obesity should be prioritized not only until the supply and demand issue is solved, but until the effects of cosmetic use are further studied. The short-term risks associated with obesity far outweigh the short-term risks of Ozempic. However, in cases where it is not a treatment nor preventative measure for chronic conditions (i.e. cosmetic purposes), it is uncertain whether this will do more harm than good, especially when sustaining use over a long period of time.
Long-Term Health Impacts
The health impacts of Ozempic beyond a few years are still under investigation, with no definitive results yet published. The first clinical trial studying the effects of semaglutides on obesity was in 2021, and no studies have yet been published on the effects of semaglutides on mental health or cosmetic weight loss. When patients stop taking Ozempic, evidence suggests that two-thirds of the weight lost is regained within one year. Ongoing treatment is suggested, but no one seems certain how long is too long. In the United Kingdom, Ozempic is only recommended for a maximum of 2 years “as an adjunct to a reduced calorie diet and increased physical activity.” The National Institute for Health and Care Excellence (NICE) claims this combination is the most sustainable long-term. Furthermore, long-term use of the drug 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, continuing to glorify Ozempic in the United States as a quick and easy weight loss solution is not ideal.
Counterfeiting
The supply/demand discrepancy drives even those with a medical need for Ozempic to get it from unfamiliar sources. High demand and low supply fuel counterfeit operations, with semaglutides produced from unreliable, unregulated sources and marketed through unauthorized distributors. Using techniques like fake batch numbers and relabeling insulin as Ozempic, counterfeits contain harmful ingredients, causing adverse effects not found in the real medication. The FDA has issued an official warning after the rise in reports of life-threatening adverse effects, such as hypoglycemic shock, nausea, comas, seizures, and infections. The World Health Organization (WHO) also issued an official warning of falsified Ozempic citing the risks of “incorrect dosage, contamination with harmful substances, or use of unknown or substituted ingredients.”
Consumers trust pharmacies to provide safe and effective medication. However, even legitimate pharmacies are at risk as they turn to unfamiliar distributors to meet demand. Convincing counterfeiters can sneak Ozempic replicas past the authorized supply chain. An even bigger problem lies in the “gray market”, where products are bought and sold without government oversight. Unlicensed distributors often sell counterfeit Ozempic to consumers or other distributors in this market without ever even encountering an authorized supply chain.
Counterarguments
Proponents of Ozempic argue that it nonetheless serves its intended purpose: to manage blood glucose levels and to achieve weight loss, regardless of supply/demand issues. With this, they assume that people know the short-term risks and that the existing free-market approach could make Ozempic access more feasible by increasing production to solve the supply/demand discrepancy. The production increase would make prioritization less of a problem and could at least prioritize medical interventions. However, this has yet to be seen, and the supply/demand issue still exists. How long are we going to give the market time to self-regulate? How long are we willing to let those with a need go without?
Other proponents might accept the short-term risks for cosmetic purposes and dismiss the fact that there is much unknown, including whether it is sustainable long-term. Accepting this view would also require holding the uncertainty of long-term risks as insignificant, and this is simply not the case when there is potential for harm. Moreover, this view fails to consider the effects of taking Ozempic alone without other lifestyle interventions for weight loss (i.e. diet and exercise), which would make it less of a ‘miracle drug’ than it may seem. Especially when other FDA-approved medical interventions have been deemed effective and safe for long-term use, such as liraglutide, phentermine, and several others; meanwhile, Ozempic has not. Therefore, it is not reasonable to listen to the media that is giving praise to it.
Conclusion
We must prioritize patients with clear, beneficial reasons to take GLP1s, like Ozempic. While GLP1s may become a practical treatment for obesity, clear evidence that the benefits outweigh the risks has yet to be seen. Prioritization is needed for medical intervention over cosmetic purposes. We know that one must permanently stay on Ozempic or risk regaining weight. As a new drug, we lack information on long-term health impacts, and the statistics surrounding supply, demand, and access remain concerning. That means the risk/benefit assessment is different for people with significant medical needs compared to people hoping to lose weight for its own sake. Access issues have also caused a considerable increase in counterfeit drugs, causing problems for pharmacies trying to meet the inflated demand. With what is currently known, we should ensure Ozempic is available for people who need it before access for cosmetic, non-chronic weight management use.
Morgan Rich is a graduate assistant for the Indiana University Center for Bioethics.
