Ozempic: users face prejudice for using medicine – 06/15/2023 – Equilibrium

Eileen Isotalo, 66, has managed to lose weight all her life but has always gained it back. She went on her first Weight Watchers diet at age 14. She’s gone on to try one regimen after another and has bought so many books on weight loss that she thinks she has more such books than the public library.

Desperate, she finally went to a weight-management clinic at the University of Michigan. Isotalo had sleep apnea and pain in his knees, in addition to being unable to control his appetite.

“It’s just an eating urge,” says she, a retired interior decorator. “It’s almost a panicky feeling when you start to crave food.”

“My mental shame ran deep,” he says.

But now, since he’s started taking Wegovy, part of a new class of doctor-prescribed obesity drugs, those urges are gone. She lost 50 kg and abandoned the dark clothes she used to hide her body. Her obesity-related medical issues disappeared, along with much of the stigma that had driven her away from family and friends.

But like others at the clinic, she still struggles with the fear that people will judge her for getting shots to treat her obesity rather than finding the supposed willpower to lose weight and keep it off. However, the medicine “changed my life,” she says.

Wegovy and drugs like it make this “a very exciting time in this field,” says Susan Yanovski, co-director of the office of obesity research at the National Institute of Diabetes and Digestive and Kidney Diseases.

About 100 million Americans, or 42% of the adult population, are obese, according to the US Government Centers for Disease Control and Prevention (CDC). [No Brasil, segundo dados da PNS (Pesquisa Nacional em Saúde) de 2020, 60% dos adultos brasileiros vive com sobrepeso. Já a obesidade, atinge 26% desta população.]

For the first time, people with the condition, who faced a life of medical risk, can escape the relentless trap of junk diets and see their obesity-related health problems alleviated, along with weight loss.

But there is still a stain.

“There is a moral component to this,” says Yanovski. “People really believe that people with obesity just need to find willpower, and they think that taking medicine is the easy way out.”

Unlike other chronic diseases, obesity is clearly visible, says Yanovski. “Nobody looks at you and knows you have high cholesterol or high blood pressure,” he points out. Obesity, he adds, “is one of the most stigmatized health problems out there.”

Wegovy and a similar but less effective drug, Saxenda, are the only ones in their class so far approved for the treatment of obesity in Brazil and the US – others like Ozempic and Mounjaro (which is under review by Anvisa) are drugs for diabetes, but which also stimulate weight loss.

Novo Nordisk, the maker of Wegovy, reports that doctors in the United States have written about 110,000 prescriptions for the drug. Citing strong demand, the company recently suspended its advertising of the drug.

“We can’t produce enough,” says Ambre James-Brown, a spokeswoman for Novo Nordisk. Supplies are so limited that the company is only selling the drug in the US, Norway and Denmark, where the company is based. Its high list cost of US$1,349 per month (R$6,475) puts it out of reach for most people whose health insurance does not cover the drug.

The drugs came at a time when researchers were documenting the risks of obesity and the ineffectiveness of prescribing diet and exercise alone as a treatment. Decades of studies have consistently shown that very few people are able to lose excess weight and keep it off with lifestyle changes alone.

People with obesity are at risk for a number of serious medical conditions, including diabetes, high blood pressure, high cholesterol, sleep apnea, and non-alcoholic fatty liver disease. Weight loss can make some of these complications go away.

However, the belief persists – fueled by diet gurus, influencers and an industry that sells supplements and diet plans – that if people really tried, they could lose weight.

Therefore, those who take a drug like Wegovy often end up in uncomfortable situations, influenced by the common view that obesity is a lifestyle choice.

At the University of Michigan clinic, there are people like Isotalo, whose reluctance to admit to taking Wegovy stems from his conviction that people who take it are often thought of as cheaters.

Another patient, however, Katarra Ewing of Detroit, readily tells anyone who asks her that she takes the drug. After experimenting with diets, it was Wegovy that allowed him to lose 40 kg.

She headed to the weight-management clinic after her night shift at a Ford plant. She looked effervescent and vibrant wearing a bright green sweater. Ewing has more energy now that she’s lost weight. Her mood is also better and her high blood pressure is gone.

But she discovered an unforeseen social consequence of losing weight: many old friends drifted away. “There are only my real friends left, and it’s a very small number,” says Ewing.

Experts in obesity medicine say they aren’t surprised – they see the same thing after people lose weight with bariatric surgery.

Relationships change because obesity is a very defining condition. Normal-weight people can feel superior to an obese friend, and that helps define a relationship — until the friend loses weight. Other friends who also have obesity may use the condition as a bonding factor in the relationship. Now that might be going away.

Another issue is the drugs’ reputation as vanity drugs, which has been amplified by comedians’ jokes at the Oscars and in other high-profile settings.

Translated by Luiz Roberto M. Gonçalves