Ozempic vs Wegovy: How can semaglutide be off-label?

When I get asked to give an interview about the new weight loss drugs it is always the same questions. "What are the risks of taking Ozempic if you don't have diabetes?" Answer: "NONE."

What is the difference between Ozempic and Wegovy? Money. If you ask pharma or the FDA, their answer would be indication. Ozempic is FDA approved for Type 2 diabetes and Wegovy is FDA approved for obesity. But it's exactly the same drug. Both are the incretin mimetic called semaglutide, also known as a GLP1 receptor agonist. This gut hormone does lots of cool things in the body but the magical effect that has everyone buzzing is it's ability to turn down the volume on hunger, and more specifically, food noise. Patients are more easily able to make a calorie deficit to drop pounds. It does this by acting on receptors in the brain and also in the digestive tract including the stomach, small bowel, and pancreas which improves glucose levels in patients with type 2 diabetes.

Modern Day Miracle

Think of the potential this has to impact chronic disease in modern times. Throughout history we fought against famine and plagues. In modern day, we are fighting against chronic disease. Obesity has the potential to shorten our average life expectancy. That's a big deal.

And this makes perfect sense. Rates of obesity have been climbing for decades now with no end in sight. Rates of childhood obesity are rising even fasting including childhood diabetes. We know that these diseases shorten the lifespan of the individuals who suffer with them so it is logical that developing these diseases earlier in life will portend a worse outcome. In my mind, I picture a runaway train. Now imagine that we can do something to stop it, or at least slow down that train. When people say these are game changers, that's what they are talking about. Obesity and its related chronic diseases are catastrophic in how they impact our health, quality of life, and cost of healthcare. We have had bariatric surgery for a long time but it is under-utilized likely due to lack of coverage and it does carry greater risk than medications.

What's In a Name?

But if they have different names (and indications) then the manufacturer can charge more money. Unfortunately, this also creates another barrier to access for patients. And it highlights another way in which we stigmatize those with obesity. We have assigned a value to each of these two diseases: obesity and diabetes. And we see how insurance companies rank them. You can often get coverage for Ozempic for diabetes. But there is very little coverage right now for Wegovy for obesity. If you ask decision makers about coverage, the answer is usually that they feel that treating the disease of obesity is important but it will cost too much money. Of course there is some overlap in these two diseases but they don't always go hand-in-hand. Two thirds of the US population meet the criteria for a diagnosis of overweight or obesity (https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity)

but only ten percent of people in the US have type 2 diabetes (https://www.cdc.gov/diabetes/basics/type2.html#:~:text=More%20than%2037%20million%20Americans,adults%20are%20also%20developing%20it.).

It doesn't really matter what we call it. The incretin mimetics including liraglutide, semaglutide, and now tirzepatide are game changers. And there are more in the pipelines. We need coverage for effective treatments for both obesity and diabetes including bariatric surgery and anti-obesity medications. There is no substitute for lifestyle modifications but we know that lifestyle modifications alone are usually not enough to result in significant, sustained weight loss in patients with obesity. Obesity is a disease that can lead to serious health consequences and it requires treatment.