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Obesity as a Disease - Medication

LastApacheInjun

TL;DR - Anyone on Ozempic/Wegovy or Mounjaro? Is it worth it?

Hi everyone

I'm going anonymous for this one as I have not totally made up my mind about what I am going to do here.

I am 47, and have been putting on weight since I was 25. I am now in the obese category on BMI.

Like many women of my age, I have also dieted on and off for the entirety of those 22 years. I have lost a stone, sometimes two, though healthy eating and exercise, but it never lasts for more than three months (mostly less). I find that - in comparison to my teenage years and my twenties, I am hungry all day long. I'm just exhausted of not only feeling like less of a person, I am exhausted by how much space food takes up in my mind, and how I have such low self esteem and self worth every time I think about my failed attempts to lose weight. I think I am a very capable person - I have a well paid career, H have raised three kids, I have done a lot of hard things. Why can't I control the amount of food I'm eating?

I had this conversation with a family member a while back, just when I was at the start of another healthy eating campaign that I was convinced was going to work this time. Her husband is an obesity and diabetes specialist, and she mentioned that - more than likely - I had an imbalance of the hunger/full hormones, would probably really benefit from medication, and it was unlikely any healthy eating program was going to work for me long term. At Sthe time I was pretty offended, like she didn't believe I had the focus or willpower to lose the weight, and I thought that would spur me on to prove her wrong. It did, for a while, until it didn't. I remember her saying "when you're ready, come and talk to me".

So I'm ready, and I have an appointment next week with another doctor in her husband's clinic. I've done loads of research on the medication available here, including reading about the trials. I have tried to listen to podcasts both advocating for, and against, these medications. I have followed threads on UK forums of the experiences of those taking the medication, but I can't see anything online here that sets out the Irish experience. So I have a number of questions:

Are you currently being prescribed Wegovy (i.e. Ozempic but for weight loss)? What has been your experience? Any side effects? Any shortages?
I'm particularly nervous of needles. I don't know how I'll get over the idea of injecting myself. How painful is it?
Does anyone know if Mounjaro is available to be prescribed in Ireland for weight loss, rather than just for diabetes? I know it was recently approved in the UK, and it seems to have less side effects and be more effective then Wegovy. I can see that it's approved on the Irishmedicines.ie website, but not what it has been approved for.
Can anyone confirm the cost of Wegovy (and Mounjaro if available) here? What is the cost when it moves up to the theraputic dose? Presumably that's a good bit more since it's 10 times the starting dose (Wegovy) or four times the starting dose (Mounjaro).
I understand that it is likely I will have to take this medicine for the rest of my life. I listened to a UK podcast, and they mentioned that semaglutide is coming off patent in two years. I know that Novo Nordisk are - unsurprisingly - trying to extend the patents in various jurisdictions, but I doubt they'll be successful. Can anyone shed more light on the patent situation? If there's generic manufacturers lining up then the price surely will come way down?

I'm going to ask all these questions of my doctor next week. I just really want to be fully informed before I make a final decision.

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[Deleted User]

https://www.boards.ie/discussion/comment/122271109#Comment_122271109

Still shortages of the 0.25mg and 0.5mg Ozempic pens.

https://www.hpra.ie/docs/default-source/clinical-trial---hpra-pilot-project/ie_shortage-comms_hcp_ozempic-0-25-mg---0-5-mg_june-2024_final.pdf?sfvrsn=2

There is no blanket blanket "ban" on weight loss prescriptions and there never was. Doctors were still prescribing it, even when there were limited supplies available.

Also Ozempic is not typically the first port of call for the treatment of diabetes. You may be knowledgeable about weight loss drugs, but not so much about the treatment (and complications) of diabetes, especially uncontrolled diabetes. It is an extremely complex condition which takes daily management and sometimes a cocktail of drugs to get, and keep it under control.

I wonder if it was a cardiac or cancer treatment drug, and not just a diabetes one, would the attitude be the same.

LastApacheInjun

Look, I’m not saying pharmacists can’t prioritise limited supplies. I’m just saying that a blanket ban on weight loss prescriptions is inherently unfair. People with a bmi of 40+, or those with a bmi of 35+ and a heart condition may well be at a higher risk of serious complications than a diabetic who has been prescribed ozempic as their first port of call.

It shouldn’t be an outright no without asking the patient further questions. Even where they present a prescription for two pens, rather then to be told to “feck off”.

This is all rather moot though. 1mg ozempic has been taken off the IMB shortages list.

[Deleted User]

https://www.boards.ie/discussion/comment/122270937#Comment_122270937

You've tried to make this argument before, that pharmacists were making some kind of moral judgement on obese patients. That's in your head.

And I'll say to you again, that is a very unfair accusation to make. Pharmacists are not in the business of making any moral judgements, (as you say, if they were they could refuse to dispense the pill or emergency contraception).

What they are doing is prioritising limited supplies based on medical need. And they are qualified to make that judgement, even if there are some who think otherwise.

I've often found the advice of an experienced pharmacist more helpful and knowledgeable than that of a GP.

ohnonotgmail

https://www.boards.ie/discussion/comment/122270937#Comment_122270937

they are not obliged to fulfill any prescription. i'm sure there are some that wont fill a prescription for the pill. as for somebody coming in with a prescription for multiple ozempic pens, if they have to decide between filling that prescription or filling ozempic prescriptions for diabetic patients then I hope they would decide on the latter.

LastApacheInjun

https://www.boards.ie/discussion/comment/122270875#Comment_122270875

Pharmacists should only refuse to fill a prescription where there is a medical reason that the medication is unsuitable or unsafe for the patient. They should not be making moral judgements on who should or shouldn't get medication. If that was the case, every pharmacist in the country could refuse to fill prescriptions for the pill.

ohnonotgmail

https://www.boards.ie/discussion/comment/122270649#Comment_122270649

A pharmacist is more than qualified to make that decision. that IS their qualification.

LastApacheInjun

https://www.boards.ie/discussion/comment/122270668#Comment_122270668

Of Wegovy, yes.

[Deleted User]

https://www.boards.ie/discussion/comment/122270649#Comment_122270649

So a supply issue does still exist.

LastApacheInjun

https://www.boards.ie/discussion/comment/122270514#Comment_122270514

That's really interesting Ezeoul. Have they done trials on the higher doses with diabetics? I hadn't read anything and I've been keeping a really close eye.

By the way @taxAHcruel thank you for the heads up on the podcast. I'll start it on the way home. You are a mine of information!!

LastApacheInjun

https://www.boards.ie/discussion/comment/122270575#Comment_122270575

But it isn't the only dose that is beneficial for weight loss, as explained above.

It isn't sold here because Novo Nordisk have decided not to launch the 1.7mg and 2.4mg pens (branded as Wegovy) in smaller countries until they can guarantee supply. The 2.4mg dose is in fact licensed and approved here by the Irish Medicines Board. We are just waiting for NN to launch it.

if somebody brings in a prescription for multiple ozempic pens to a pharmacy the pharmacist should tell them to feck off.

What you should mean is doctors should not be prescribing it. A pharmacist should never have the power to decide what medication or what dosage is right for a stranger presenting themselves in their pharmacy, in circumstances where the person has attended a GP, who is qualified to make that decision.

ohnonotgmail

https://www.boards.ie/discussion/comment/122270211#Comment_122270211

2.4mg is the dose used for weight loss. it isnt sold her because the drug is not approved for weight loss here. and if somebody brings in a prescription for multiple ozempic pens to a pharmacy the pharmacist should tell them to feck off.

[Deleted User]

https://www.boards.ie/discussion/comment/122270211#Comment_122270211

According to my endocrinologist 1mg is not the optimum dose for diabetics, and has told me the max dosage they can prescribe will be increased, they're just waiting on whatever permissions are required.

LastApacheInjun

https://www.boards.ie/discussion/comment/122270078#Comment_122270078

I'm afraid I have to pull you up on this one too. The diabetic trials showed that a 1mg dose was the optimum dose to obtain blood sugar control benefits. The obesity trials showed that 2.4mg was the optimum dose for weight loss, where participants lost approx 15% of their body weight. However, weight loss also occurred at the 1mg dose, where participants lost approximately 10% of their body weight. At the moment, in Ireland, weight loss patients are restricted to taking a maximum of 1mg because the highest dose of Ozempic is 1mg. Of course you could buy two pens, or even three, in order to get up to the 2.4mg dose, and some GPs do prescribe that. But that makes the medication prohibitively expensive, apart from exacerbating the shortages of the 1mg pen, so most weight loss patients don't do that.

The main point is, there is no downside for weight loss patients taking the 1mg dose (which they have to titrate upwards through anyway, in order to get to the 2.4mg dose) and staying on it for a length of time. In fact, losing 10% of your body weight has massive benefits for your health, including reducing the chances of developing Type 2 diabetes by over 80% and the chances of developing all types of cancer by 33%.

It'd be different if it was the other way around - e.g. weight loss patients were only meant to take a 1mg dose and were taking the 2.4mg dose instead.

ohnonotgmail

https://www.boards.ie/discussion/comment/122269686#Comment_122269686

not just a brand name. a very different dose as well. Ozempic is only licenced for diabetes treatment in ireland.

[Deleted User]

https://www.boards.ie/discussion/comment/122269686#Comment_122269686

Wegovy is not available in Ireland at the moment.

Mellor

https://www.boards.ie/discussion/comment/122268610#Comment_122268610

Hilarious that you say I should educate myself, and then follow up with that ignorant nonsense.

Semaglutide was designed as a longer acting GLP-1 receptor agonist. That's exactly the pathway that aids weight loss, there were existing GLP-1 weight loss drugs at the time. This is not some shocking side effect, where people taking risks with unknown consequences. It's was literally be designed, tested and approved as both an anti-diabetic and an anti-obesity medication used.

Phase 3 testing for weight loss took place in 2021. https://www.nejm.org/doi/10.1056/NEJMoa2032183

Taking a medicine that is tested and licensed for weight loss, prescribed by a medical professional is not being a test dummy. It's literally taking tested and approved medicine, that due to the brand name is considered off label.

Mellor

https://www.boards.ie/discussion/comment/122268488#Comment_122268488

That's not really accurate though. Ozempic is a brand name. The actually drug is called Semaglutide. Semaglutide is licensed for weight loss in Ireland, and across Europe, under the label Wegovy (same manufacturer too).

The brand name is irrelevant medical speaking. I find it kinda strange that we license the brand and not the drug. In the future there will be generic semaglutide (like neurofen vrs ibuprofen). But a GP, not being total misinformed like some here, is aware of that, so he safely prescribes Semaglutide for a usage that it is approved for.

A pharmacist has no business interfering with peoples private prescriptions imo.

taxAHcruel

https://www.boards.ie/discussion/comment/122084689#Comment_122084689

Just for info - since you enjoyed the previous podcast - another informative and relatively deep discussion about the drug came out today on the Andrew Hubermann podcast. The discussion is with one Dr. Zachary Knight under the title "The science of hunger".

LastApacheInjun

In general, I agree with this. However, there are some people with morbid obesity who would have more immediate complications from obesity than someone who is Type 2 diabetic and may be able to control their condition through other available medications. It shouldn't just be a blanket ban. But I don't think that someone like me, who is only tipping into the obese category, should get priority over someone who is diabetic and can only control their condition with Ozempic.

[Deleted User]

I personally have no issue with non-diabetics being prescribed or using a drug licensed for diabetes off label, when supplies are plentiful. Have at it.

But when supply is very limited (as it has been), then I do think that pharmacies are correct to prioritise supplies for patients with a condition the drug is actually licensed for.

LastApacheInjun

https://www.boards.ie/discussion/comment/122268610#Comment_122268610

I am not sure that is quite right. Yes, Ozempic was originally designed for diabetics, and it is a very useful medication for them. But lots of medications end up showing other benefits that were not originally anticipated. Viagra was originally a blood pressure medication. Prednisone was originally developed for inflammatory diseases and is now used to treat Parkinsons. Ozempic itself has been shown to have benefits for those with heart conditions, and it is likely in the future that it will also be prescribed for people with heart issues, whether or not they are diabetic or overweight. They're called "repurposable" drugs in the pharmaceutical industry and it's a massive thing at the moment. AI can trawl through masses of data to see what drugs might also have a benefit on another disease, and it means that you don't have to go through years of safety trials as that data is already known.

Semaglutide, the active ingredient in Ozempic, has been prescribed for nearly twenty years. If there were shocking unknown side effects to it, at least in the short to medium term, we'd already know about them. As Johann Hari put it, if Ozempic caused you to grow horns, the diabetics would have horns already.

As to prescribing it off label, essentially you are correct, but it's a weak argument for preventing obese people from accessing the medicine. Irish GPs have no choice but to prescribe it off label. Wegovy, the drug approved in Ireland for weight loss, has yet to be launched here by Novo Nordisk. Wegovy is the EXACT same drug as Ozempic. It's like Opal Fruits and Starburst. Only the label on the pen is different. So GPs are essentially prescribing a drug that is approved and licensed for weight loss, with 20 years of safety information behind it, but the brand name is temporarily different. Wegovy is due to be launched at Halloween.

Jim2007

https://www.boards.ie/discussion/comment/122268306#Comment_122268306

You might want to educate yourself on how medicines are approved before talking about silly attitudes….

Taking medicines that were designed, tested and approved for a specific purpose in order to benefit from a side effect is an incredibly stupid idea. Because you have no idea of the consequences of taking the drug long term will have - you are basically the test dummy.

[Deleted User]

My maternal grandmother, mother and I all developed diabetes in our late 40s and 50s without obesity as a factor. My daughter is pre-diabetes without obesity as a factor. We must be a very unfortunate family.

ohnonotgmail

https://www.boards.ie/discussion/comment/122268306#Comment_122268306

Because it is only approved for the treatment of diabetes

ohnonotgmail

https://www.boards.ie/discussion/comment/122268060#Comment_122268060

They are not meant to, it isn't approved for weight loss only diabetes.

LastApacheInjun

https://www.boards.ie/discussion/comment/122268118#Comment_122268118

I do understand that Ezeoul. If someone develops Type 2 diabetes at a normal weight they are very unfortunate. But it is a fact that 90% of Type 2 diabetics are overweight or obese and the condition has developed because of their body weight.

I have definitely changed habits. Ozempic isn’t some magic pill that allows me to continue to eat the way I did before and still lose weight. But the point is, I have been able to change my habits because of Ozempic. I no longer think about food all day. I can eat one biscuit and stop. This is a revelation to me. Even as a tiny child I was obsessed with cakes and sweets, more than the average child would. My mum did everything right - breastfed, cooked from scratch, limited treats. I was never overweight until my thirties so I had no hangups or anything, and no trauma to hang this food obsession on. I was born like this, I’m convinced of it.

Mellor

https://www.boards.ie/discussion/comment/122268118#Comment_122268118

The shortage was a thing of the past afaik If doctors want to be selective with prescriptions, that's their choice. But I don't agree with pharmacists dictating who they dispense to. That sounds questionable, legally.

Mellor

https://www.boards.ie/discussion/comment/122267234#Comment_122267234

Why should it only be prescribed to diabetics? Silly attitude imo.

If OP has paid for the medication, it is there property and they are entitled to use it.

Who would be prescribing it if not their doctor.

[Deleted User]

https://www.boards.ie/discussion/comment/122268060#Comment_122268060

Ozempic can be prescribed "off label" for non-diabetics, though its primary use is still for the treatment of diabetes. As I posted earlier, due to shortages pharmacies have been prioritising their diabetic clients for the available supplies.

https://www.boards.ie/discussion/comment/122268044#Comment_122268044

Not all diabetics are obese.

Congrats on your progress. However, having read the thread, I do wonder how much of your progress is due to your changed habits, and how much is down to the medication.

JP Liz V1

https://www.boards.ie/discussion/comment/122268044#Comment_122268044

I'm glad you are doing good, I didn't realise it was prescribed by GPs to non diabetics, public or privately o