What's the deal with Ozempic and Wegovy? 2 Minnesota doctors explain

CATHY WURZER: Did you know about 30% of the Minnesota population is considered obese? It's part of an ongoing public health issue both in the state and nationally. A new drug is changing the conversation, though, around obesity in this country. Back in 2021, the Food and Drug Administration approved a new weight loss medication, Wegovy.

It has the same active ingredient, semaglutide, as the diabetes drug Ozempic. The drugs have become so popular that their manufacturers could not keep up with demand, and some pharmacies are still seeing shortages. Some patients say they have-- these drugs have vastly improved their lives.

There are also critics who worry these drugs are being too widely used for cosmetic weight loss and feeding into an obsession with thinness. And then there's the question of price and access. So clearly, this is a complicated issue. Here to help explain are two doctors, one an obesity specialist, another focused on eating disorders.

First, Dr. Aaron Kelly is with us. Dr. Kelly has researched semaglutide in teens. He's the co-director of the Center for Pediatric Obesity Medicine at the University of Minnesota. Professor, welcome.

AARON KELLY: Hi, Cathy. Thanks for having me on.

CATHY WURZER: Thanks for being here. So for folks not familiar at all, can you explain in layman's terms what are Ozempic and Wegovy, and what do they do?

AARON KELLY: Yeah, there's been a lot of confusion about this. It's the same medication. It's just used for two different diseases. So Ozempic is used at a lower dose to treat Type 2 diabetes, and Wegovy is a higher dose used to treat obesity. And that's created a lot of confusion for people, but it's the same medication that we're talking about.

CATHY WURZER: And how does it work in folks who are obese?

AARON KELLY: Yeah, so with folks who have obesity, the mechanisms of action, so how the medication works, it's thought to reduce appetite by working in the brain. It notably enhances satiety. So people who use the medication report getting fuller faster while they're eating a meal, and they feel fuller for longer between meals. And then finally, there seems to be important ways that it works to manage cravings. So it helps push back against certain types of cravings that people may have.

CATHY WURZER: So it seems to work.

AARON KELLY: It works, and it works primarily through the brain. And people who use it often report that their relationship with food changes fundamentally. People have talked about it as sort of reducing food noise, so preoccupation with food, and it gives a lot of people a better sense of control over their relationship with food in a positive way.

CATHY WURZER: Now, we reached out to listeners for questions, and one that came up over and over had to do with people going off the drugs and then regaining the weight they lost. So will folks have to take this drug for the rest of their lives?

AARON KELLY: Yeah, so we need to think about this in the same way that we think about other chronic diseases. So let's think about blood pressure. So if a patient has high blood pressure, and their physician starts them on a medication for that, that person's going to probably stay on that medication indefinitely, right? If they were to come off that blood pressure medication, the blood pressure would come right back up.

Same with diabetes, same with mental health, and obesity is no different. And so we have a lot of work to do, I think, in educating not only the general public but even the medical community that obesity really is a chronic disease, and you have to keep your foot on the gas pedal long term.

CATHY WURZER: As someone who researches these drugs, trains pediatricians, what do you want docs to consider before prescribing these drugs?

AARON KELLY: Well, we have a lot of work to do. One is we need to do a better job of educating physicians about the disease of obesity, what causes it, and to have empathy and sensitivity when approaching the conversations about medications and other types of obesity treatments. A lot of people come in implicitly thinking that having obesity is their fault even though a lot of it is due to underlying genetics and biology and, of course, our environment. And so that's one big step is having physicians approach it the right way so that people don't feel threatened.

CATHY WURZER: I know there are shortages of the drug out there. Like Walgreens still hasn't recovered their supply. Do you know what's causing the shortages?

AARON KELLY: Yeah, so we don't know all the details of what's causing the shortage. One of the big ones, though, is thought to be just the demand. The demand has literally outstripped the supply of the medication. I think this is because we've now entered a new era of anti-obesity medications where we're getting average weight reduction that really matters to the people that want help for their treatment of obesity.

And of course, when they see this and they see the clinical trial evidence-- it's safe and effective-- people want access to it. So I think it's going to take some time for things to level set, for the production to catch up with people's demand for it.

CATHY WURZER: The expense has to be fairly significant, though.

AARON KELLY: It's expensive, and this is going to be interesting to see how it plays out over the coming years and the market forces around this. But yes, right now some of these newer medications are exceedingly expensive, and notably, a lot of insurance companies don't pay for it. So if you're talking about having to pay out of pocket, we're talking about for some of these medications more than $1,000 a month, putting it out of reach for people, particularly people that need it most. So this is something that we're going to have to really watch out for and advocate for in the future.

CATHY WURZER: Good background, Doctor. Thank you so much.

AARON KELLY: My pleasure. Thanks for having me on.

CATHY WURZER: We've been talking to Dr. Aaron Kelly who co-directs the Center for Pediatric Obesity Medicine at the U of M where he has researched semaglutide in adolescents. We're going to turn to another doctor right now who's looking at these drugs from a bit of a different perspective. Dr. Mary Bretzman specializes in eating disorders with Accanto Health. That's the parent company of the Emily Program. Doctor, I hope I pronounced your last name correctly. Did I?

MARY BRETZMAN: Close, it's Bretzman. But you--

CATHY WURZER: Bretzman.

MARY BRETZMAN: Almost nailed it, Cathy.

CATHY WURZER: Thank you. It's a pleasure having you here. Thank you so much. So--

MARY BRETZMAN: Thank you.

CATHY WURZER: What are you hearing from your patients about these drugs?

MARY BRETZMAN: Well, it's interesting. I've been in this world of eating disorders coming from primary care, but I've been working with patients with eating disorders for many years. And I have patients-- I don't have a lot of patients requesting Ozempic or Wegovy. I think partially because of the cost but also because of the active work that they're doing on their eating disorder.

What we understand with eating disorders-- particularly binge eating disorder or compulsive overeating, bulimia nervosa where there's been people live in larger bodies-- is that there's been so much emphasis on somebody's size, somebody's BMI that there's just a tremendous amount of shame, guilt, a variety of emotional layers that emerge over time as patients have constantly felt like they're not good enough. They're not thin enough.

Your previous speaker spoke to the fact that the medical community is only focused on weight and not actually taking a greater look at how wellness, their general wellness, affects the patient. So I do see patients coming in usually on Ozempic for the treatment of diabetes. Sometimes they experience weight loss. Sometimes they don't because the eating disorder has not been adequately treated.

CATHY WURZER: I'm wondering, I know you work with adults, but teens, what do we know about how it might affect adolescent brains to start on a drug like this?

MARY BRETZMAN: Well, we don't really know. That's the problem. And what we do know is that teens' brains are actively changing and evolving over time. And what I'm particularly concerned about is the emphasis that we're putting on someone's body shape and size at such a young age and only focusing on that and not focusing on all the other aspects of this young person's wellness.

Now, it's not to say that there are health issues that we are aware of that many of my patients come in extremely scared about a new diagnosis of diabetes or high blood pressure or whatever it is. And parents are worried as well. But if we don't really holistically look at our patients in the end, particularly these young patients, we're not doing them service. We have to really approach this whole situation very holistically.

CATHY WURZER: So as the other speaker mentioned, this is an expensive drug, right?

MARY BRETZMAN: Yes.

CATHY WURZER: And it's popular, but I'm wondering, for folks who can't afford to get this drug or can't get access to it, what does it mean for those individuals?

MARY BRETZMAN: Well, I think it puts them into a greater place of shame. Like it won't be unusual for people to say why aren't you on Ozempic? You're overweight. Why aren't you taking that? Why aren't you doing that? And all of a sudden-- there is no miracle drug in this world.

We've had weight loss medications for years, and they come and go. And I'm not saying that this is that. I mean, Wegovy and the semaglutide medications are excellent drugs for what they're designed to be. But there's no miracle drug, and if you're not addressing the underlying eating disorder thoughts and behaviors, you're not going to make good progress.

So I look at a lot of my patients, there's no way they could ever afford this. And I think it just reinforces kind of that whole sense of I'm wrong. Something's wrong with me, and I can't fix it.

CATHY WURZER: So final question here for you. What do you recommend to folks who are making-- trying to decide whether to get a prescription?

MARY BRETZMAN: I try to just inform my patients the best that I can about what I know about the medication but also what I know about eating disorders. And that no matter what you do in trying to affect weight change, if you don't address the underlying behaviors and thoughts, the different emotional components of their life, that the medication is not going to do any good.

Just because you lose weight does not necessarily make your life that much better. And so I just try to have as non-judgmental a call as I can with my patients, realizing that a lot of them come from very difficult situations.

CATHY WURZER: , Doctor I appreciate your time. Thank you, good information.

MARY BRETZMAN: Thank you.

CATHY WURZER: Dr. Mary Bretzman is a primary care doctor with Accanto Health specializing in eating disorders.