In the online world, Wegovy and Ozempic are tied to extreme weight loss – particularly among newly gaunt celebrities. So how are they being prescribed and used in New Zealand?
Injection pens of Wegovy are now available at pharmacies to those with weight loss prescriptions and deep pockets. Medsafe made the decision to approve the medication for weight loss in April, barely three months ago. Smaller doses of the same drug under a different name (Ozempic) were approved to treat type 2 diabetes in 2023.
Both Wegovy and Ozempic are semaglutide – a drug that first entered the US market in 2017 as a diabetes medication. It was quickly hyped online as the secret to celebrities achieving extreme thinness. In 2021 the drug was re-marketed as a weight loss solution and global shortages have ensued.
On Monday, associate health minister David Seymour couched the announcement of Wegovy’s arrival as a way to “save [the] country billions”. He said health problems like type 2 diabetes, heart disease and liver disease that are linked to obesity put a “major strain” on the health system, with reports estimating the cost of excess weight at $4-9 billion a year. “We’re giving Kiwis access to another tool to deal with this problem,” said Seymour.
How does the medication work?
Wegovy and Ozempic are doses of semaglutide, a GLP-1 agonist. It is self-injected as a clear fluid once a week and mimics a naturally occurring hormone. It binds to and activates GLP-1 receptors that are responsible for insulin production, regulating blood sugar levels, appetite and gastric emptying. Essentially, taking semaglutide makes people eat less as they feel more full or satiated, don’t feel as hungry and food cravings are reduced.
When are people prescribed these medications?
In New Zealand, Wegovy can be prescribed for weight loss or weight maintenance in adults with a BMI of 30 or more, or a BMI of 27 with at least one weight-related comorbidity. In adolescents (12-18 years old) it can be prescribed when BMI indicates the person is obese and they weigh more than 60kg. The medication is intended to be used alongside a reduced-calorie diet and increased physical activity.
New Zealand has the third highest adult obesity rate in the OECD, and it continues to increase. One in three adults (over 15 years) and one in 10 children are classified as obese.
Ozempic has been approved by Medsafe for the treatment of type 2 diabetes, but is not available to buy here due to a worldwide shortage. A similar, but less effective, drug called Saxenda is available for treating diabetes and weight loss. Many patents will now be transitioning from Saxenda to Wegovy.
Do they work?
Wegovy and Ozempic have helped millions of people lose weight – in 2021 the participants of a landmark clinical trial lost on average 15% of their body weight over the course of 68 weeks. For type 2 diabetics, semaglutide helps to lower blood sugar levels. A trial from 2023 showed that semaglutide cut the risk of heart attacks and strokes by a fifth in patients with a history of cardiovascular disease.
How long do they have to be taken for?
Semaglutide is not a one-and-done permanent cure for obesity. While it has transformed the weight loss field, it is not like a round of antibiotics nor does it have lasting effects like gastric sleeve surgery. Obesity is a chronic disease and medications for it should be viewed much like medications used to reduce blood pressure – they must be ongoing in order to continue working. When people stop taking semaglutide, they tend to regain most of the weight they lost. Novo Nordisk, the manufacturer of Ozempic and Wegovy, said in a statement to the BBC that “these findings also confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.”
The leading theory is that this is because semaglutide only masks dysregulation in the brain relating to appetite so once a person comes off it their food cravings return. There’s also concerns that people are left with GLP-1 deficits. Some practitioners in the medical weight loss field provide dieticians and psychologists alongside medication to increase the possibility that people may not need weight loss medication forever. Clinical trials to see if following higher doses of semaglutide in an acute phase with lower maintenance doses on a long-term basis could be effective are under way. In any case it seems that many people will have to rely on medication permanently to avoid relapses.
Sounds expensive. Who is paying for all this?
Yeah, Wegovy is likely to cost people $450 to $600 a month. It is not currently funded by Pharmac so patients will have to pay for the treatment themselves. The same is true for Saxenda. Future decisions around funding are up to Pharmac and the supplier and would need to be prioritised against all other medicines.
The cost is likely to put Wegovy out of reach for many people. “When I look at the health statistics, a lot of body size runs hand in hand in parallel with lower incomes,” said associate professor Lesley Grey, from the department of primary health care and general practice at the University of Otago. “The very people who may be able to benefit most are going to be the least likely to be able to take it now.”
Already debate as to whether it should be funded or not has begun. Some experts like professor Boyd Swinburn from Auckland University’s school of population health say that unjustified prejudice – “the view that people’s excess weight is their own silly fault” – may cause hurdles. He thinks that without funding, Wegovy won’t make much of an impact, but over time as other drug manufacturers make similar drugs and generic alternatives, the price will drop.
What are the risks and side effects?
Common side effects include headaches, dizziness, nausea, vomiting, diarrhoea, constipation, abdominal pain, fatigue, Gastritis, Gastrooesophageal reflux disease, Dysgeusia (taste disorder), Dysaesthesia (sensation of burning skin), gas, abdominal distension (swelling), dry mouth, gallstones, hair loss and injection site reactions.
Uncommon side effects include increased heart rate, acute pancreatitis, delayed gastric emptying, impaired renal function, acute kidney injury, worsening chronic renal failure and acute pancreatitis (fatal and non-fatal).
Using semaglutide is not recommended when people are pregnant, breastfeeding, over 84 years old, have inflammatory bowel disease, diabetic gastroparesis or end-stage renal disease. Much is unknown – the drug hasn’t been tested in under-12s and its effect on fertility in humans is unknown.
Are we fueling a culture that prizes thinness above all else?
In a statement to media, Eve Hermansson-Webb, a clinical psychologist at the Eating Disorders Association of New Zealand says that “while weight loss may be framed as a health pursuit, the reality is that it often stems from internalised appearance ideals, societal pressure, and stigma – not genuine medical need.” She says there’s concerns that the increasing visibility of weight loss medication may further normalise the use of prescription medication as a means to pursue appearance-based goals.
Hermansson-Webb also says that the medication focuses on a narrow approach to health that may not represent true wellbeing. “Tools like these reinforce the societal message that thinner is better, whatever the cost, even if that’s not achievable, appropriate, or healthy for many people.”
