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
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
