Spokane — The popularity of weight loss drugs has soared during the past few years as new injectable medications have appeared as an effective and safe solution to obesity.
But while these drugs may be one of the most successful treatments ever offered for weight loss, their ubiquity in Spokane and across the globe has raised concerns regarding who is right for these treatments. And now that the drugs are in short supply, a cottage industry of lightly regulated online retailers and clinics with questionable expertise have filled the vacuum with impure and possibly dangerous medication.
Best known among this new class of drugs is Ozempic, which was first approved to treat diabetes in 2017. But the medication treated diabetes in part by assisting diabetic or prediabetic patients in losing weight. Ozempic was often prescribed for weight loss alone, and in 2021 the FDA approved the underlying drug for weight loss. When prescribed for this purpose, the drug is marketed under the name Wegovy, even though it is the same drug as Ozempic.
Erik Nelson, owner of Sixth Avenue Pharmacy, said his pharmacy fills prescriptions of Ozempic and Wegovy when they “can get them.”
They are in short supply, and demand has been “tremendous,” he said. Since the first release of these drugs, demand has grown by 75 percent, he said.
At MultiCare’s weight management and wellness program in Spokane, the drug is often prescribed as one way patients can work toward weight-loss goals. Nurse practitioner Megan Vulcan said Wegovy and similar medications have “high outcomes” for her patients.
“That is why they’re so popular and in high demand. They have the highest efficacy of any medication that’s been previously available,” she said.
According to Vulcan, previously prescribed oral medications produced a 5 percent to 7 percent weight loss on average. Newer injectable medication creates a 10 percent to 20 percent weight loss.
Semaglutide, the underlying drug marketed as Ozempic and Wegovy, works by mimicking a hormone that triggers the body to feel full. When the drug interacts with a receptor in the stomach, patients feel full sooner and for a longer period of time after eating. The drug does not cause weight loss directly — instead, it makes you want to eat less.
Side effects of the medication most commonly include nausea, heartburn and constipation. Some patients report increased anxiety. The medication is also a drug that needs to be consistently used. Once on a semaglutide drug, patients need to stay on it or they may regain weight.
When properly prescribed and monitored, Vulcan does not see a lot of downsides for many patients interested in losing weight.
“It definitely has a high outcome for many people. And so I think its popularity would be the case for any medication. If it is more effective, people want it,” she said.
She did note that patients are screened for eating disorders, and that any treatment plan will also include nutrition and exercise education to ensure “changes are sustainable and safe.”
Cost and availability
Semaglutide-based drugs prescribed for weight loss can be expensive and often are not covered by insurance.
According to Vulcan, the retail cost of these drugs ranges from $1,000 to $1,500 each month. Commercial insurance only covers the drug approximately 30 percent of the time when prescribed for weight loss. But when prescribed for diabetes, it is covered upwards of 90 percent of the time.
Wegovy and Ozempic have also been on the FDA shortage list for the past several years — making prescriptions difficult to fill as their use has skyrocketed.
Due to these factors, online sellers and some less regulated med spas have started to offer Ozempic knock-offs at cheaper prices, often without the medical care one should receive. Vulcan said patients should not use any weight loss drugs from an establishment or provider that does not require an initial exam and monitoring.
“These online programs have a great deal of risk because they’re not always doing the work-up, the exam and the blood work and the physical to make sure that the person’s a good candidate for the medication,” she said. “We make sure that people are losing weight safely, and those online programs generally aren’t doing that.”
Because these drugs are on the FDA shortage list, pharmacies are allowed to create their own versions. If improperly compounded or stored, the drug can be diluted or even become dangerous.
“They might not add the preservatives in the same way that a retail manufacturer would. There have been some incidents of pharmacies that aren’t following protocols, and the drug is less effective as a result,” Vulcan said.
MultiCare does some compounding of these drugs but only at FDA-approved pharmacies. Sixth Avenue Pharmacy does not compound these medications. Nelson sources their chemicals from a supplier that conducts a third-party test of every batch that they sell, and the pharmacy also does a third-party test when it is received. According to Nelson, most compounding pharmacies do not take these precautions.
“If people are getting these drugs from a compounding pharmacy, they should do their homework and make sure that the pharmacy is licensed in the state, and that they are accredited,” he said. “This is something that you’re injecting in your body. Once it’s in there, you’re not, you’re not going to take it back out.”
Obese patients can often be afraid of going to their legitimate medical provider for help because of stigma. Vulcan encourages those considering these drugs to go to their provider and ensure any medication they take is safe.
“A big part of the journey is helping them to see that we can help with this,” she said. “It’s not entirely personal choices that affect how well somebody does with managing the disease of obesity.”
Eating disorders
Eating Recovery Center medical director and psychiatrist Dr. Elizabeth Wassenaar is skeptical of the drugs and their effect on her patients who struggle with eating disorders. Those with these mental health conditions have a delusion that their body is larger than it is.
The Colorado-based Eating Recovery Center provides high-level care for patients recovering from disordered eating, including anorexia or bulimia. According to Wassenaar, patients with these eating disorders can be prescribed Wegovy and its counterparts — causing them to relapse into their mental illness.
“In real life, in real time, I am seeing patients who are coming into treatment who are being prescribed these medications for the purpose of weight loss by practitioners who may or may not know that their patient has a history of an eating disorder. And it is precipitating a relapse of their eating disorder or an exacerbation of their eating disorder,” she said.
According to Wassenaar, the widespread use of these medications “reinforces the idea that people should be thinner.” That belief that smaller bodies are better can trigger or exacerbate an eating disorder.
“It is hard-fought to get through and into recovery. And I think if people knew this medication could put them at risk of a relapse, they would be very cautious about taking it,” she said. “Patients with eating disorders very often experience eating as being deadly. I have people that sit in my office all day long and talk to me about the fact that if they take one more bite, they feel like they will die. And I worry how these drugs could exacerbate those beliefs.”
Wassenaar also fears how the drug might be prescribed and marketed to children and adolescents, who are at higher risk of developing an eating disorder.
“These drugs are marketed as harmless and easy; especially in social media, there is a tendency for these messages to get to adolescents and kids,” she said.
The youngest age at which these medications can be prescribed is 12.
