Ozempic, a Bitter Pill to Swallow. Knowledgeable folks and users of Ozempic will know right off the bat that Ozempic is a weekly injection and not a pill. So why the title, “Ozempic, a Bitter Pill to Swallow?” because there is no equivalent in modern parlance for the idiom that refers to a bitter injection.
But this is a play on words because a bitter pill to swallow is an expression from the 1600s that refers to something unpleasant or hurtful that is hard to accept. A bitter pill to swallow is the naked truth that people do not want to face but one that cannot be avoided.
Like a pill, it must be swallowed, these unpleasant facts must be taken in. And Ozempic is indeed a bitter pill to swallow, as will be explained later, this idiom is not meant to be taken literally and in fact, its use is both unpleasant and hurtful because of the profound side effects.
Obesity is a Bitter Pill to Swallow
The truth of the matter is that we have an obesity epidemic in this country and most folks become obese because of lifestyle choices. It is these destructive lifestyle choices that lead to packing on the pounds and until recently there were no effective long-term sustainable treatments other than radical disfiguring surgery for obesity.
Short of surgery, the only thing that has had success is lifestyle changes, moderate exercise, good eating habits, and avoiding high-calorie processed foods that are loaded up with salt, sugar, and fat.
Type 2 diabetes and obesity are metabolic syndromes that have bordered on becoming epidemics in the United States. There are about 30.6 million people living with Type 2 diabetes, and about 36% of people in the United States are considered obese.
Obesity is a major risk factor for developing Type 2 diabetes and other metabolic syndromes, but until recently, the treatments for this disease were limited. Habits are very difficult to change, in order to effectuate the necessary changes often requires significant effort on the part of the person, which most people cannot sustain.
Therefore pretty much all the diets for tackling obesity tend to fail because the underlying causes of obesity in the first place are not addressed.
Ozempic the Magic Bullet for Obesity
Out of the blue, in 2017, a type 2 diabetes drug Ozempic was released, and medical researchers noted in clinical trials that had an interesting side effect, that the use of the drug led to significant weight loss.
Once that weight loss side effect was discovered and found to be reproducible in large-scale trials, the popularity of Ozempic exploded as manifested by record drug sales.
All of a sudden the use of Ozempic skyrocketed and led to the development and approval of its sister drug, Wegovy which has the same active ingredient (semaglutide) as Ozempic but at a much higher dosage. Ozempic was only approved for use to treat type 2 diabetes, but its major use now is via off-label prescriptions to treat obesity. Wegovy is formally approved to treat obesity.
Ozempic copies the biological action of the naturally occurring hormone GLP-1, which helps the pancreas release insulin. GLP-1 acts on the pancreas beta cells that produce insulin and helps the pancreas make and release insulin. So when glucose levels rise after meals, the body needs more insulin to process sugar from the meals, and GLP-1 or in this case Ozempic helps the pancreas release insulin.
How does Ozempic work for Weight Loss?
Ozempic acts on the brain’s appetite center and the gut. The gut is where the majority of the naturally occurring hormone GLP-1 is manufactured and released in response to meals. Semaglutide-containing drugs Ozempic or Wegovy which copy the actions of GLP-1 act on the appetite center in the brain to reduce hunger and increase fullness this helps you feel full with smaller meals and decreases the need for snacks and decreases the desire for alcohol. High-calorie snacks and alcohol are major contributors to weight gain.
So less appetite and a feeling of fullness leads to reduced calorie intake which in turn leads to weight loss.
A Tale of Two Cities
According to a recent study, healthcare researchers have noted a disparity between the use of Ozempic and folks who have type 2 diabetes.
The data shows significant geographic variation in Ozempic prescriptions among 15 major metropolitan areas during the first year after Wegovy’s approval. Prescriptions skyrocketed by 481% in Cleveland and 351% in Seattle, but just 48% in Minneapolis and 79% in Boston.
The data shows that the use of these medications is not related to rates of diabetes, obesity, or heart disease in those cities. Philadelphia, where rates of all three conditions are extremely high, saw an 80% increase, while Seattle, which has relatively low levels of these diseases, saw a massive increase in prescriptions.
Most of the increase in Ozempic use is a result of off-label use, in other words, use that may not be indicated to treat a disease for which it was approved. The abundance of weight loss clinics, and the ability to get prescriptions via telemedicine, or even just by going online and ordering the drug, has led to the popularity of these drugs. And that explains the high use of these drugs in areas of the country that are not plagued by diabetes, obesity, or heart disease.
Ozempic is an Expensive Drug if not approved by Insurance
Ozempic retails for about $900 a month, while Wegovy, sells for more than $1,300. These drugs are meant to be taken forever like a cholesterol-lowering drug or blood pressure medication would be taken for life.
About half the prescriptions for Ozempic went to people whose medical records do not indicate a diabetes diagnosis.
Upper East Side New York
Prime example, the Upper East Side of New York is where the affluent tend to live and the abundance of social x-rays tend to gather, as made famous in the novel Bonfire of the Vanities.
In New York City, more than half, 56.2% of patients prescribed a GLP-1 have a documented type 2 diabetes diagnosis. Among these patients who both take a GLP-1 and have diabetes, the average age is 59.2, and 73.5% are commercially insured.
Patients prescribed this medication without a type 2 diabetes diagnosis are younger, average age of 47.5, and more likely to be commercially insured, 90.6%, and mostly female, 74.7% of the users.
At the neighborhood level, the highest rate of GLP-1 utilization was in Upper East Side/Gramercy with 231.3 patients per 10K individuals. Within that population, 67.8% were female, the average patient age was 49.6 and 26.6% had type 2 diabetes.
The East New York/New Lots neighborhood had the lowest GLP-1 utilization rate of 121.3 per 10K individuals. Within that population, the average patient age was 53.5, and a higher proportion 74.2% had diabetes.
Putting it all together
The Upper East Side neighborhood has one of the highest life expectancies and the lowest rates of diabetes and obesity in New York City, but prescriptions for GLP-1s are maximized in that neighborhood. Basically, the prescriptions are going to women who are younger, have insurance, and don’t have diabetes.
Conversely, in East New York, which has one of the highest obesity rates in New York City, GLP-1 prescribing rates are lower than in more affluent neighborhoods and are more concentrated among patients with a type 2 diabetes diagnosis.
All of these patients’ use mismatches have been attributed to off-label use and the availability of obtaining the medications easily and not having to rely on insurance to cover the cost.
Ozempic Serious Side Effects
Shortly after hundreds of thousands of patients used semaglutide for weight loss, many adverse reports surfaced about critical gastrointestinal (GI) side effects from Ozempic and similar drugs. These include severe nausea, vomiting, and a severe medical condition called gastroparesis or stomach paralysis.
Patients suffering from gastroparesis may not have normal stomach content emptying leading to vomiting of undigested food and malnutrition. Undigested food can actually remain in the stomach for some time leading to the development of balls of undigested food known as bezoars.
Ozempic, a Bitter Pill to Swallow
As a result of these serious side effects, Ozempic and similar drugs that cause gastroparesis and vomiting are indeed a tough pill to swallow, literally. Not only are these folks taking the medicine for obesity, but now are facing the increased risk of side effects.
Injured or have questions about Ozempic, or Wegovy?
Did you or a loved one experience gastrointestinal or gastroparesis injuries after taking Ozempic, or Wegovy? Dr. Shezad Malik law firm based in Dallas, Texas is now reviewing injuries after taking Ozempic, Wegovy, or other GLP-1 agonists cases nationwide. Please call 214-390-3189 or email us for further information.