Weight loss drugs are no quick fix – here’s what you need to know

In recent months, A-list celebrities have openly shared that they have taken drugs like Ozempic and Wegovy to lose weight.

This has prompted a huge demand for these sorts of medicines from the broader public and created supply chain shortages for drugs like Ozempic, significantly impacting the management of patients living with diabetes (for whom this drug is intended).

What’s the hype about?

“To really understand this new weight loss drug landscape, it’s important that we take a closer look at Ozempic and related medicines,” says Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health. “Ozempic falls under a class of medicines called the GLP-1 receptor agonists as they mimic a hormone in the body called glucagon-like peptide-1 (GLP-1).”

“These medicines target areas of the brain that regulate appetite and food intake. They also help people to manage their blood sugar by slowing the release of food from the stomach, so controlling blood sugar spikes after a meal and making us feel full for longer. They also help the body to make more insulin - a hormone released after a meal to regulate blood sugar levels – and they prevent the liver from releasing extra sugar into the blood stream.”

GLP-1 RA medicines registered for the treatment of:

1. Type 2 Diabetes Mellitus include:

• Semaglutide branded as ‘Ozempic®’ and Rybelsus®
• Liraglutide branded ‘Victoza®’
• Dulaglutide, branded ‘Trulicity®’ and Exenatide, branded ‘Byetta®’

All are available in South Africa except for Rybelsus®

2. Weight loss management (for adults and children 12 years and older from BMI ≥27 kg/m2):

The GLP-1 RA class of medicines is one of 4 medicine classes currently registered by the American Food and Drug Administration (FDA) for weight loss management.

• Liraglutide, branded as Saxenda^®
• Semaglutide as Wegovy® (only registered abroad)

“Registered Liraglutide and Semaglutide doses for weight loss management are higher than those registered for their use in the management of diabetes,” explains Dr Nematswerani.

“These medicines are mainly given through injections under the skin, except for Rybelsus® which is taken orally. While Liraglutide needs to be injected daily, Semaglutide is injected weekly adding to its appeal.”

Like all medicines, these have associated side effects which include the following commonly reported ones: nausea, vomiting, diarrhoea, headache, stomach pain and fatigue.

They should be prescribed by a doctor as they may not be appropriate for all patients.

Obesity is a complex, chronic disease: Supportive programmes key to achieving lasting results

Obesity is a major risk factor for diabetes, high cholesterol, high blood pressure, heart disease, and various cancers and other serious conditions.

“Being a multifactorial condition, healthy eating and exercise habits remain the foundation for weight loss management but for some people this may be sufficient to achieve a healthy weight which is where these medicines may play an exciting, supportive role alongside a healthy lifestyle programme that promotes the right behaviours,” adds Dr Nematswerani.

Vitality offers its members a personalised digital weight-management programme, the Vitality HealthyWeight Programme. The programme’s primary goal is to support members facing greater health risks from being overweight or obese and gives them access to their own dietitian at affordable rates. Through the programme, members get encouragement and personalised support for five days a week to help them achieve their weight goals.

These medicines are not a weight-loss quick fix

Clinical studies show that patients treated with Semaglutide (Wegovy®) lost 6% to 15% of their body weight in a period of 12 to 68 weeks (three to one year and four months) while those treated with Liraglutide (Saxenda®) lost up to 8% of their body weight.[1]

“Losing anywhere from 6% to 15% of body weight has a magnitude of health benefits which include lowering the risk of diabetes and heart disease.

People are however drawn to these medicines thinking that they bring about weight loss without the need for healthy lifestyle changes, which is not the case as they should be carefully prescribed in combination with a healthy diet and exercise.” Dr Nematswerani further explains.

“It’s important to note that patients regain all or some of the weight, within a few months of going off the medicine hence the need to be used long-term,” adds Dr Nematswerani.

Discovery Health Medical Scheme claims experience shows spike in demand

Discovery Health Medical Scheme (DHMS) claims data for Q4 2021 and Q1 2022 show a 77% increase in Ozempic claims from the Scheme’s Chronic Illness benefit for diabetes mellitus and a 224% increase for claims paid from day-to-day benefits (where people pay from their medical savings accounts, most likely for use of Ozempic for weight loss management which is not the intended use).During the same period, Liraglutide claims (include Saxenda®and Victoza®) decreased by 16% from CIB and but showed an increased utilisation of 70% from day-to-day benefits.

Weight loss management drugs can be exorbitant

While these drugs show great promise, they do come at a price tag that raises affordability concerns as they need to be used long-term.

Locally, the cost of Saxenda is about R4,184 and the cost of Wegovy, which is not available locally, costs US$1,400 per month in the United States.

Globally, diabetes and obesity are at epidemic proportions

Worldwide, 537 million adults live with diabetes. According to the International Diabetes Federation (IDF), diabetes affects one in nine people in South Africa[2] (4.2 million people[3]) with the highest diabetes prevalence (11.3%) in Africa. “Around half the number of people living with diabetes in South Africa are undiagnosed, so the prevalence of this illness will increase in time,” adds Dr Nematswerani.

The World Health Organization[4] shares that obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese.

“Considering these trends, I expect that the popularity and relevance of diabetes and weight-control medicines will continue to increase,” adds Dr Nematswerani. “Patients will however derive the greatest benefit when they are treated by doctors who are fully equipped to offer a comprehensive individualised weight loss programme with careful section of the most appropriate clinical intervention (such as lifestyle, medication or surgical) for each patient.”