Ozempic, which was designed for Type 2 diabetes but is prescribed off-label in Canada for obesity, works by reducing cravings and making people feel full more rapidly.David J. Phillip/The Associated Press
Ozempic is part of a new class of drugs that many doctors and advocates believe represents the future of obesity treatment. The medication, which was designed for Type 2 diabetes but is prescribed off-label for obesity, works by reducing cravings and making people feel full more rapidly. Although semaglutide – Ozempic’s active ingredient – is not the first drug of its kind to hit the market, scientists believe it appears to work better for weight loss than previous iterations.
In the past year, Ozempic and other semaglutide medications have exploded in popularity, driven by social media and celebrity endorsements. As a result, the drug is in short supply in Canada, with manufacturer Novo Nordisk expecting the shortage to last until March.
Here is an overview of how Ozempic works, other semaglutide medications and what insurance coverage looks like in Canada.
What is Ozempic and how does it work?
First off, Ozempic is the brand name of a Type 2 diabetes medication manufactured by Novo Nordisk. The pharmaceutical company also makes the drug Wegovy, which is specifically designed to treat obesity.
Both Ozempic and Wegovy have the active ingredient semaglutide, which mimics the body’s own GLP-1 hormone that’s produced when there’s food in the intestines. In people with diabetes, this hormone helps the body produce insulin more efficiently. For weight management, it helps people feel a sense of fullness.
“In a nutshell, Ozempic works not by boosting metabolism or melting fat. It works by decreasing caloric intake because people have decreased hunger, decreased cravings and feel full more rapidly,” says Dr. Yoni Freedhoff, a physician and the medical director of the Bariatric Medical Institute in Ottawa.
In an Ozempic clinical trial, people taking the drug lost an average of 15 per cent of their body weight over a 68-week period – when combined with therapy, calorie reductions and other lifestyle interventions. Participants who took a placebo and received the same lifestyle interventions lost only 3 per cent of their body weight. Another study found that people taking Wegovy lost a similar amount of weight over a 68-week period, results that surpass any previous obesity drugs.
Both drugs are administered through weekly injections.
Ozempic and Wegovy are designed to treat chronic health conditions – Type 2 diabetes and obesity – which means the medication needs to be used long term, explains Dr. Freedhoff. In fact, a 2022 study found that most people taking semaglutide gained much of the weight back within a year of stopping the medication.
Who qualifies for Ozempic in Canada?
Health Canada approved Ozempic in 2018 and Wegovy in 2021, but the latter is not yet available here due to overwhelming demand in the United States and other countries. As a result, some doctors prescribe Ozempic “off-label” to treat obesity.
Ozempic must be prescribed by a licensed healthcare professional, such as a family doctor or physician, nurse practitioner or through telemedicine. To qualify for Ozempic, patients generally need to have a body mass index of 30 or above, or a BMI of 27 to 30 with a weight-related medical condition, such as high blood pressure or Type 2 diabetes.
What are the side effects of Ozempic?
Common side effects of Ozempic include nausea, vomiting, diarrhea, stomach pain and constipation. More serious but rare side effects include changes in vision, kidney problems, severely low blood pressure, pancreatitis or severe allergic reactions.
In a study from the University of British Columbia, researchers found that people using Ozempic for weight loss are at a higher risk of gastrointestinal conditions, such as pancreatitis, bowel obstruction and stomach paralysis, compared to those who use bupropion-naltrexone, another medication approved specifically for obesity management. Compared to that other weight-loss pill, which is sold under the brand name Contrave, semaglutide was linked to more than four times the risk of bowel obstruction, which prevents food from passing through the small or large intestine, resulting in symptoms such as nausea and vomiting, the study found.
In September, 2023, the U.S. Food and Drug Administration announced Ozempic’s warning label would be updated to say it may be linked to a life-threatening intestinal blockage. The condition, called ileus, can lead to reduced blood flow to organs. There is no warning about ileus on the Canadian boxes.
Dr. Freedhoff says Ozempic is a very well-tolerated medication. “Having prescribed this medication at least 1,000 times, I’ve probably had to stop it in 2 per cent of patients for side effects. And the only side effects I’ve ever had to stop it for is nausea that’s persistent,” he says. “But if you start the drug at a low dose and you advance it slowly, the vast majority of people see the nausea disappear.”
What are some other concerns about Ozempic?
Some eating disorder specialists believe that Ozempic is contributing to harmful diet culture and weight shaming. The widespread promotion of the drug, including on TV ads, streetcar wraps, sports games and social media, reinforces the idea that weight loss should always be the end goal.
Ozempic promotion is “just another example of how diet culture is telling us that we should lose weight if we can because living in a larger body is a bad thing. And that’s what keeps us in a cycle of diet culture,” said Debra Wells-Hopey, a program manager for Eating Disorders Nova Scotia, in an interview with the Canadian Press.
What other weight loss medications are available in Canada?
Since Ozempic came onto the market, other semaglutide medications have also become available.
Rybelsus
Novo Nordisk, the manufacturer of Ozempic and Wegovy, also produces Rybelsus, which is the pill form of semaglutide. Rybelsus is currently approved by Health Canada for Type 2 diabetes, but is prescribed off-label for obesity.
Tirzepatide
Sold under the brand name Mounjaro, Health Canada approved the Type 2 diabetes medication tirzepatide in November, 2022. Like Ozempic and Wegovy, tirzepatide imitates the GLP-1 hormone, but it also targets a second hormone, called glucose-dependent insulinotropic polypeptide, or GIP. Manufacturer Eli Lilly also sells the drug specifically for weight management under the name Zepbound, but that has not yet been approved in Canada. As a result, some doctors prescribe Mounjaro off-label for obesity.
According to the U.S. Food and Drug Administration, patients who used tirzepatide lost an average of 18 per cent of their body weight when it was taken at its highest dose in a drug trial. In comparison, Wegovy produced an average of 15 per cent weight loss.
As a result, Health Canada said that Ozempic and Mounjaro should be conserved for people who have no other treatment options and advised pharmacists to not start new patients on these drugs.
In Europe, lawmakers have set harder restrictions. Belgium issued a new law in November banning doctors from prescribing Ozempic and other GLP-1 drugs for weight loss unless a patient’s BMI is 35 or above and has one underlying health condition. Last summer, in July, Britain called for physicians to only prescribe Ozempic and other GLP-1 drugs for Type 2 diabetes, not for weight loss. Germany is debating banning the export of the medication.
Last April, British Columbia began restricting the sale of Ozempic to people who live in Canada after a huge surge in individuals outside the country filling prescriptions. From Jan. 1 to April 10, around 30,700 Ozempic prescriptions were dispensed from B.C. pharmacies to people with U.S. addresses. (Price was the driving factor behind Americans purchasing Ozempic online in B.C.: a month’s supply of Ozempic in B.C. costs roughly $300. The price in the U.S. can be three times higher.)
The shortage has prompted some medical groups and professionals to call for a moratorium on prescribing the drug for obesity, suggesting that people with Type 2 diabetes get priority access.
But according to physicians who treat obesity, the implied suggestion here is that people with diabetes are more deserving of priority access to semaglutide while it’s in shortage, demonstrating another example of weight bias.
Dr. Freedhoff says that obesity needs to be seen as a chronic health condition, like high blood pressure, and treated accordingly. “The only reason we seem to be upset as a society about the long term use of these medications is weight bias. If this was simply a choice that people could make, people would have made them,” he says.
“There are lifestyle levers that can help some people with high blood pressure – people can exercise more, eat differently, lower their sodium content, sleep and meditate. But we don’t moralize about the people who either don’t want to do those things or don’t see success with those things. We put people on medications to treat high blood pressure because we know that high blood pressure carries with it long term risks.”
How much does Ozempic cost? Is it covered by insurance?
Out of pocket, Ozempic costs around $300 a month in Canada, depending on the pharmacy. If you’re taking the medication for Type 2 diabetes, typically private insurance will cover the costs, as will some provincial/territorial plans if you meet certain criteria.
If you’re planning to use Ozempic for weight loss, it’s best to speak with your provider, since some companies like Manulife do not cover the drug for obesity.
Dr. Freedhoff says, however,that he believes in the future Ozempic and similar drugs will be covered more broadly for weight loss as the benefits of these drugs become clear.
“The benefits are not just risk reduction for common comorbid conditions, like diabetes and high blood pressure, but also likely the most common human cancers,” he says. “Those risk reductions and improved quality of life would affect things like presenteeism, absenteeism and use of the health care system. I think over time, we will without a shadow of doubt recognize that there are real cost benefits to the coverage of these medications.”
With reports from Carly Weeks, The Canadian Press and Reuters
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
