Ozempic is approved for use to treat Type 2 diabetes in Canada, but it is increasingly being used off-label to treat obesity.Hollie Adams/Reuters
Ask a Doctor is new series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Ozempic is the only medication my patients ask for by brand name. It joins an exclusive club of drugs that are widely known for what they treat. In the eighties, it was Prozac and in the nineties, Viagra. But unlike with mood disorders and erectile dysfunction – conditions I feel more than capable of discussing with patients – requests for Ozempic and similar meds to manage weight stop me in my tracks.
In Canada, Ozempic is approved to treat Type 2 diabetes but it is increasingly being used off-label to treat obesity. Wegovy, which is made by the same manufacturers, is approved for weight loss for patients with obesity. Both drugs contain semaglutide and are known as glucagon-like-inhibitor (GLP-1 inhibitors). Glucagon is a naturally occurring hormone that stimulates the release of glucose in the bloodstream. GLP-1 drugs act on the stomach to block glucagon, slowing digestion so less glucose is absorbed from food, and were developed to regulate blood sugars in people with Type 2 diabetes. A by-product is weight loss since they make you feel satiated earlier. But this weight loss is only sustained while remaining on the medication – stop taking it, and the weight returns.
Cheaper, generic versions of Ozempic could come to Canada as early as next year
Despite the growing popularity of GLP-1 drugs, when my patients request them, I become the medication police and question their intent. Lifelong medication treatment for certain conditions (such as underactive thyroid or seizure disorders) is simple when there are decades of safety data to guide our decisions as doctors. In contrast, Ozempic and its cousins have been on the market for less than a decade. Although the safety data is overwhelmingly positive for GLP-1 drugs, no medication comes without risks or side-effects. A study published in the journal Nature Medicine in January tracked people taking GLP-1 drugs for diabetes and found several potential health benefits beyond diabetes and obesity – but also potential risks, including nausea and vomiting. I never want to prescribe an unnecessary medication that could cause my patient harm.
Another reason I sometimes hesitate to prescribe these medications is their price. Wegovy can cost about $400 a month. As previously reported, public drug plans in Canada have so far limited coverage of Ozempic to people with diabetes and declined to cover Wegovy because it is marketed as a weight-loss drug.
But there was also something else behind my hesitation. “Obesity medications are the only ones that we make our patients audition for,” said Dr. Ali Zentner, an obesity specialist with the Vancouver-based Revolution Medical Clinic and thought leader in obesity care. “Ozempic is really illustrating the perfect clash between culture and medicine. It drives us to ask the question, ‘what is health?’”
I pride myself on bias awareness: I completed two online courses on weight bias. Posters in my clinic portray people of all sizes proclaiming that “this clinic is a no-bias zone” and that obesity is about science, not willpower. And yet, I’d still wonder if maybe the patient asking for medication for weight loss just needs to eat properly and exercise more. In reality, many people struggle with healthy weight despite doing all the right things. For some, years of tedious diets or compulsive exercise have led to a pathological relationship between their body image and self-esteem.
In addition, the line between “healthy weight” and “unhealthy weight” is one I still struggle with. The body mass index, or BMI, which measures weight relative to height and is used to screen for underweight, overweight or obesity, is an antiquated and misleading measure. But we still use it in medicine, despite other factors such as how the patient feels. When a patient asks for erectile dysfunction medicine, I trust their self-report that they really need better erections. Why shouldn’t I react the same way when they ask for GLP-1 drugs to help with weight loss?
Ultimately, these medications place physicians at the heart of the weight-health conversation, which until now has been relegated to a profit-driven, unregulated diet industry. This is a leap forward for patients but unchartered territory for many primary care physicians. The need many people have for medications to help with weight loss is real, and it highlights the opportunity for physicians to work through their individual weight biases.
So, what should you do if you want to ask your doctor about GLP-1 drugs? Here are five tips on how to approach the conversation:
1. Make the appointment just for this
Make sure there is adequate time to discuss your weight, health and the role of medications. Adding this to a laundry list of other things you want to discuss decreases the chances that you will leave with a game plan that’s right for you. Be honest with your physician about your intentions, struggles and goals.
2. Be realistic about the financial cost
Currently, provincial drug plans only provide limited coverage for patients with diabetes. Private insurers may require extra paperwork from your doctor, which can take time to complete.
3. Discuss side effects and lifestyle
These medications may come with side effects such as nausea or decreased muscle mass. Ask your doctor about lifestyle changes, which can help mitigate side effects.
4. Be honest with your doctor
If you don’t feel comfortable asking your primary care physician for the prescription and obtain it elsewhere, such as an online health platform, advise your regular doctor that you are on this medication. It is crucial they have this information so they can make sure there are no drug interactions with other medications, or to provide counselling on when to stop taking GLP-1 drugs (e.g. in advance of general anesthetic for surgery).
5. If you don’t have a family doctor, seek consistent in-person care
If you are one of the millions of Canadians without a family doctor, consider going to the same walk-in clinic consistently so they have your records over time. It would be preferable to visit a clinic in person, versus virtual providers, who will not be able to examine you and make sure there are no complicating factors before starting treatment.
Dr. Tahmeena Ali is a family physician, medical director and co-owner of Catalyst Kinetics Medical in Surrey, British Columbia. She is also a hospitalist at Peace Arch Hospital in White Rock, B.C., a child and youth mental health consultant and clinical lecturer in the Department of Family Medicine at the University of British Columbia.
