Since the diabetes treatment Ozempic went viral on TikTok as a diet drug, hashtagged on the app some 350m times, the feverish popularity on social media has driven demand to the point where there are now worldwide shortages – and the social media platform has been forced to remove posts recommending the prescription drug to teenagers wanting to lose weight.
In recent times, reports The Independent, the diabetes treatment began to be prescribed “off-label” for weight loss.
Ozempic (the generic name is semaglutide) – works by mimicking a hormone that regulates appetite, by creating the feeling of fullness. The dose is administered via a weekly injection, shown to produce an average reduction of 6% to 15% of body weight over the course of a year (depending on strength).
The drug made manufacturers Novo Nordisk $3.4bn in 2020 alone, with analysts predicting sales to more than double to $7.8bn – particularly when Wegovy, a 2.4mg version of Ozempic approved for NHS use, reaches the UK in early 2023.
In the reams of online posts, users share how their appetites have dwindled, with the falling number on the scales flashing up in multi-coloured fonts. Quick waistline “fixes” have been around forever.
But the TikTok effect is expanding their reach further and faster than ever before: an investigation by The Pharmaceutical Journal earlier this year found that the site was the “worst culprit” for bombarding young people with medical misinformation online.
For obese patients, Ozempic “works well”, says GP Dr Simon Gordon, who has seen many of his own “lose lots of weight and (be) able to stop medicines for blood pressure… At the moment it’s helping”.
Although it has been effective thus far, there’s reason for caution when it comes to declaring the drug a weight loss panacea, particularly given others’ tumultuous past. At least 25 have been approved by medical authorities in the past six decades, only to be banned once their side effects – from heart valve damage to strokes and primary pulmonary hypertension, a potentially fatal lung condition – became clear. It is partly this chequered history that has left pharmaceutical companies side-stepping an easy goldmine.
With 3.5bn obese adults globally – rates that have trebled since 1975 – that only one drug could be prescribed in the UK between 2010 until last year speaks to those lingering fears.
Between the 1930s and 1960s, it was a different story. Vast sums were being pumped into developing amphetamine-based weight-loss drugs, with Tenuate Dospan, one such pill known to cause side effects such as “confusions and hallucinations”, prescribed to a certain Donald Trump in the early 80s. Psychosis was believed to be among its longer-term issues; shorter-term ones included “anxiety, insomnia and delusions of grandeur”.
But the race for medically-induced shedding reached a nadir the next decade with Fen-Phen, a pill combining fenfluramine, an appetite suppressant, and phentermine (an amphetamine akin to speed). A single study of 121 patients reported a 14.2kg average weight loss over 34 weeks, compared with 4.9kg in the placebo control group; its popularity soared to such a degree that weight loss clinics were set up just to capitalise on demand.
Two years, 6m patients and 18m prescriptions later, it had become “a morality tale for our times”, according to medical experts, with 30% of its users experiencing heart valve issues (as well as others reporting primary pulmonary hypertension, or PPH), leading to its licence being revoked.
Tens of thousands of legal claims were filed against Wyeth, the drug’s manufacturer, with $21bn set aside for payouts – a fallout so great that the US Food and Drug Administration approved no new diet pills for the following decade.
Neither Fen-Phen, nor Phentermine – another amphetamine-based weight-loss drug still used in the US – were approved in the UK. But the legalities of weight loss pills aren’t always a barrier to entry for those seeking quick results.
Since 2013, the UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA) has seized more than £4m of illegal diet pills in Britain, including Dinitrophenol or DNP, used to treat obesity in 1933 but later classed as a “toxic chemical”.
Available for purchase online, the compound has in recent years been linked to a string of deaths.
A 2019 study for Scotland’s Food Standards Agency found that, though they knew it could kill them, 5% of respondents would still take DNP to slim; a government survey of dieters in 2017 found that more than 40% of people used diet pills knowing there were associated health risks.
A total of 60% reported their motivation as being “desperate to lose weight”, with the same number experiencing bleeding, heart problems and blurred vision due to taking weight-loss drugs.
Ozempic has thus far proved itself as both safe and effective, so much so that when Gordon recently suggested that one of his patients, who is currently awaiting bariatric surgery, begin taking it, the surgeon refused; the drug will probably “hurt the careers of surgeons who specialise in obesity”, he thinks.
Dr Alex Miras, a consultant endocrinologist and clinical professor of medicine at Ulster University, is equally supportive of its use among patients dealing with health issues as a result of excess weight. But he is “not surprised it is popular” in both Hollywood and across social media, noting that “in the UK, the biggest prescribers of Saxenda (the other legal weight loss drug, approved last year) are cosmetic salons”.
Once a slimming aid gets green-lit, demand among the body-conscious can often outweigh that of those in genuine need, which, without the input of a medical professional, can significantly up the potential risks. The medication is intended for use alongside a healthy eating plan and exercise regime, but when taken solo – and then stopped – any benefits are reversed; medically suppressing appetite alone cannot fix the global obesity crisis.
And there is the matter of what happens after taking the drug, too. An April paper published in Diabetes, Obesity and Metabolism found that those on a 2.4mg dose of semaglutide regained two-thirds of the weight they had lost in the first year after stopping the medication, with those who had lost the most weight putting the most back on. Research has repeatedly shown the perils of yo-yo dieting, with gaining more weight than was originally lost and metabolic damage common outcomes.
- On 22 September, The Pharmaceutical Journal said TikTok had removed the posts after the publication’s investigation revealed that prescription drugs were being recommended to teenagers wanting to lose weight.
Study details
Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension
John Wilding,Rachel Batterham, Melanie Davies, Luc Van Gaal, Kristian Kandler, Katerina Konakli, Ildiko Lingvay, Barbara McGowan, Tugce Kalayci Oral ,Julio Rosenstock,Thomas Wadden, Sean Wharton, Koutaro Yokote, Robert Kushner STEP 1 Study Group
Published in Diabetes, Obesity and Metabolism on 19 April 2022
Abstract
Aim
To explore changes in body weight and cardiometabolic risk factors after treatment withdrawal in the STEP 1 trial extension.
Materials and Methods
STEP 1 (NCT03548935) randomised 1961 adults with a body mass index ≥ 30 kg/m2 (or ≥ 27 kg/m2 with ≥ 1 weight-related co-morbidity) without diabetes to 68 weeks of once-weekly subcutaneous semaglutide 2.4 mg (including 16 weeks of dose escalation) or placebo, as an adjunct to lifestyle intervention. At week 68, treatments (including lifestyle intervention) were discontinued. An off-treatment extension assessed for a further year a representative subset of participants who had completed 68 weeks of treatment. This subset comprised all eligible participants from any site in Canada, Germany and the UK, and sites in the United States and Japan with the highest main phase recruitment. All analyses in the extension were exploratory.
Results
Extension analyses included 327 participants. From week 0 to week 68, mean weight loss was 17.3% (SD: 9.3%) with semaglutide and 2.0% (SD: 6.1%) with placebo. Following treatment withdrawal, semaglutide and placebo participants regained 11.6 (SD: 7.7) and 1.9 (SD: 4.8) percentage points of lost weight, respectively, by week 120, resulting in net losses of 5.6% (SD: 8.9%) and 0.1% (SD: 5.8%), respectively, from week 0 to week 120. Cardiometabolic improvements seen from week 0 to week 68 with semaglutide reverted towards baseline at week 120 for most variables.
Conclusions
One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables. Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.
The Independent article – How TikTok turned the diabetes drug Ozempic into a diet pill (Open access)
See more from MedicalBrief archives:
Maintenance semaglutide injections led to continued weight loss — STEP 4
STEP 2 trial: Semaglutide hope for patients with type 2 diabetes
Weight loss jab slices type 2 diabetes risk by 60% in obese people