Jen* recalls her first time taking Ozempic. She says it was like flipping a switch on the food noise inside her head.
“I didn’t realise I was that obsessed with food, [with] eating and thinking about procuring food, and just how much of my waking life was an obsession with it,” she says.
The Sydneysider, who is morbidly obese and struggles with food addiction, has tried many weight loss strategies over the years.
But the treatment “totally revolutionised everything”.
“I was a little dubious and sceptical but then it was like night and day as soon as I had it, which was remarkable, and it spun me out a little bit,” she says.
The drug, which is part of a group known as glucagon-like peptide-1 receptor agonists (or GLP-1 RAs), mimics a naturally occurring hormone to let the brain know the stomach is full.
The Danish pharmaceutical company Novo Nordisk produces Ozempic and Wegovy. They contain the same active ingredient – semaglutide – but are marketed differently for type 2 diabetes treatment and weight loss, respectively.
Ozempic is approved on the Pharmaceutical Benefits Scheme (PBS) – meaning the government subsidises the cost – only for diabetes treatment.
It means even though Jen is on a healthcare card and all her other prescriptions are around $6.90, “Ozempic is $150 for me, because I’m not a diabetic”.
Each pen can deliver about a month’s worth of medication – meaning the treatment can cost nearly $2,000 a year.
“That reduces my ability to live, because I have to be so tight in every other aspect. Do I want to be crippled physically, or do I want to be crippled financially? Which one is going to be the lesser on my mental health?”
A peak medical body in Australia is now backing semaglutide-based obesity management medication to be subsidised on the PBS.
In its new position statement on obesity prevention and management released earlier this month, the Royal Australian College of General Practitioners (RACGP) recommends increased government support for clinical services and supplementary therapies – including PBS subsidised obesity management medication to address health inequity.
Thirty-two per cent of Australian adults live with obesity.
Dr Terri-Lynne South, the chair of RACGP’s specific interest group for obesity management, says the college’s change in position on weight loss medication comes as a growing body of research is showing semaglutide medicines not only cause weight loss but can also help overweight patients improve their health conditions.
South says among them are cardiovascular conditions, sleep apnea and knee osteoarthritis.
The college’s new position statement calls on the health and medical sector to reduce stigma and support patients to “gain health” rather than simply “lose weight”, as those living with obesity can experience limits on their access to effective treatment.
But South says semaglutides are “not a magic bullet” and the patients who benefit from them get the best results by also making lifestyle changes, including improving nutrition and increasing physical activity.
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“If we do get any sort of help from the government with regards to PBS subsidies, that is only one part of the expectation that all of that support from a lifestyle management is wrapped around that medication, before, during and after.”
Because social inequity affects health outcomes and contributes to obesity, South says “the people who need it most are the ones who can afford it least”.
“We do need to hold the drug companies accountable because they’re the ones that are deciding what price point they’re putting on their medication,” she says.
South says competition will eventually drive down the price of what is currently an “extremely expensive” drug, but that may be some years away.
In December, the Therapeutic Goods Administration (TGA) granted approval for Wegovy to be used as a complementary therapy for adults with both cardiovascular disease and high body mass index to reduce the related heart attack, stroke or death risks.
While the new “indication” for the drug means the TGA has satisfactory evidence of its benefits in regard to those particular conditions, it did not alter the cost of the drug.
For a drug to be placed on the PBS, a company needs to put in a submission to the independent expert body, the Pharmaceutical Benefits Advisory Committee. The committee has so far rejected two submissions from Novo Nordisk to place Wegovy on the scheme for Australians with severe obesity.
Dr Fiona Willer, the president of Dietitians Australia, the peak body for dietitians and nutrition professionals, says weight loss medication in Australia must be prescribed alongside a referral to an accredited practising dietitian to ensure nutrition needs are supported.
“These medications can have significant impacts on people’s appetite and nutrition status,” Willer said.
“We must remember both malnutrition and eating disorders can be life threatening, and this is why dietitians must be engaged to ensure people do not develop restrictive eating behaviours and become malnourished as a result of being on these medications.”
* Guardian Australia has agreed not to include Jen’s last name.