Imagine a world where there are no fat people. A world where people lose their urge to snack on cookies and potato crisps, where T-shirt makers stop turning out extra-large sizes.
Welcome to the world of Ozempic!
Badri Raghavan, who lives in California and suffers from Type 2 diabetes, has been taking Wegovy, which is similar to Ozempic, for a year and is ecstatic about its impact.
His diabetes is well under control, and he has lost an enormous 14kg. Most crucially, he never overeats at mealtimes and has stopped extra trips to the fridge or the cookie jar.
Says Raghavan: “I feel great. I have not been in better health. All my vital signs are significantly better. My diabetes is well under control, my blood pressure is well under control."
Dr Jothydev Kesavadev, founder and CEO of Jothydev’s Diabetes Research Centre in Thiruvananthapuram, showers praise on Ozempic. “This is a big breakthrough, a landmark molecule. It’s a milestone in the treatment of diabetes and obesity," says Kesavadev.
Ozempic is described by many of its fans as a wonder drug – and that may turn out to be true.
The drug, based on a molecule called semaglutide, has been proven to improve heart health and reduce abdominal fat. Clinical trials have also demonstrated it can be useful for preventing kidney disease.
More recently, studies have shown semaglutide’s potential to reduce liver fat, which could make it a candidate for treating non-alcoholic fatty liver disease.
Clinical trials are also taking place on whether semaglutide could have an impact on early-stage Alzheimer’s patients. Ozempic is thought to help with Alzheimer's by protecting brain cells and possibly reducing harmful proteins in the brain. This may help slow down the disease or improve memory.
If all this isn't enough, there are indications it could also be used to prevent or treat various types of cancer. Some early research suggesting that Ozempic and other GLP-1 receptor agonists may have a role in prevention of certain types of cancer like pancreatic or colon cancer or slowing cancer growth.
As well, studies show that the severity of sleep-apnea is reduced, making it easier to breathe.
For Indians, there are some sizeable catches in this picture of a miracle drug. So far, only Rybelsus, an oral tablet, has been okayed in India.
The government is stalling on giving the green signal for injectable Ozempic, the most popular form of delivery, which is said to offer maximum efficacy.
While government regulators have promised to clear all approvals in the next three months, similar timelines have been given and missed before. The injectable formulation has been available in the US since 2017.
But there's a much greater hurdle for anyone who wants to be treated with semaglutide-based drugs: the wonder drug comes with a hefty price tag that puts it far out of reach for most Indians.
At Christian Medical College, Vellore, Dr Nihal Thomas reckons he can only prescribe it for 10 per cent — the most affluent of his patients. Rybelsus sells at about Rs 9,000 a month.
If all that isn’t enough, there’s one other giant-sized reason why Ozempic won’t be coming to India in large quantities in the near future – global demand for the drug has soared through the roof, and it is in short supply.
“We still don’t have access to it in India. One reason is the high global demand, which has made it difficult to produce enough for India," says Kesavadev.
Novo Nordisk, which makes Ozempic and a similar semaglutide drug, Wegovy, is putting up a new $4.1-billion manufacturing facility in Clayton, North Carolina – but that’s only scheduled to be ready by 2027.
In addition, it’s racing ahead to construct a $220 million plant in Koge, Denmark, that will manufacture the ingredients for both Ozempic and Wegovy. Wegovy comes in higher dosages and is more effective for weight loss.
Novo Nordisk has stated that the global shortage is not expected to ease significantly until at least late 2024. Raghavan says he frequently has to hunt for supplies even in the US.
Obviously, the world’s pharma giants are racing to get a share of the diabetes and weight-loss goldmine.
Eli Lilly received the thumbs up from the US FDA (Federal Drug Administration) a year ago for Mounjaro (based on a molecule called tirzepatide), which it says is even more effective than semaglutide.
Importantly, it also says it's cheaper than the semaglutide family of drugs – and its results are as good or better.
Both semaglutide and tirzepatide belong to a class of drugs called GLP-1 receptor agonists. Studies show that initial use of semaglutide can cause a 15 to 16 per cent weight loss, and Mounjaro can result in 14 to 18 per cent loss.
Jothydev says that Mounjaro can cause an even greater weight loss. Ozempic works on one hormone (GLP-1) to lower blood sugar and control appetite. Mounjaro works on two hormones (GLP-1 and GIP), making it better at both blood sugar control and weight loss for most people. Doctors say to think of the drugs in this way: Ozempic is a single-tool kit, while Mounjaro is a two-tool kit, so it can do more.
A Morgan Stanley study reckoned that people on weight-loss drugs might cut their calorie intake by almost 30 percent.
Eli Lilly has developed a second drug, Retatrutide, which is said to have even greater weight-loss properties but it it is not yet available commercially.
Retratrutide affects GLP-1, GIP, and another hormone called glucagon. By affecting three hormones, it can work more strongly to reduce hunger, burn fat, and help with weight loss. So, while Ozempic and Mounjaro mainly focus on two hormones, Retatrutide works on three, which may make it more powerful for weight loss.
Says Dr V. Mohan, chairman of Dr Mohan’s Diabetes Specialities Centre in Chennai: “With Retatrutide, a person could get up to 20 to 25 per cent weight loss. This means a 100-kg person can expect almost 25 kg weight loss, which is almost equal to that achieved by bariatric surgery."
About 10 other global giants are also working on equivalent drugs.
India now has over 200 million people suffering from diabetes or pre-diabetes. Even when they come on the domestic market, the vast majority of Indians will be unable to afford Ozempic or other such drugs, though that could change when generic versions start being sold.
But the booming demand for these drugs globally has been boosted sharply by people who are eager to shed weight fast.
Though these drugs aren’t available legally yet in India, everyone who wants the medication and can afford it is getting regular consignments from abroad.
It’s also said to be easily available in Mumbai and Delhi. The other option is to ask friends to bring the injectables from abroad – if they have a prescription. But there’s a hefty price tag for grey market buyers in India. A month’s supply could cost at least Rs 40,000 to Rs 50,000, doctors say.
Is it possible that a drug can trigger such huge weight losses with only minimal side effects? The doctors insist that it is indeed possible. Ozempic has been on the market globally for about seven years.
Says Kesavadev: “We know that nobody's going to die with this medicine, and these side effects of nausea or vomiting or diarrhoea are very, very mild, and the moment you stop the medicine, it disappears. It doesn't kill. It doesn't damage the liver and it doesn't damage the kidney. There’s only some sort of discomfort for the patient."
Dr Nihal Thomas emphasises that patients to whom these drugs are given should be chosen carefully. Because of the weight-loss angle, he says that they should only be given to patients with a higher body mass index of over 35 and do not have eating disorders.
Mohan stresses that the drugs have only been on the market for a few years, and caution must be the key watchword. Says Mohan: “We will have to wait and see how they pan out in the long run."
For patients who’ve started GLP-1 receptor agonist drugs, the long-run may indeed be a key word. Most doctors say they have to be taken for life. Says Thomas: “It has been shown that if you withdraw the medication, in a proportion of patients, a rebound in weight will occur."
In many ways, weight-loss drugs could alter the world as we know it in countless ways. The Morgan Stanley study reckoned that by 2035 in the US, 24 million people, or 7 per cent of the population, will be taking these drugs. It reckoned that people on weight-loss drugs might cut their calorie intake by almost 30 percent.
Says the study: “This may be welcome news for the biopharma industry, but the drugs’ prevalence could have long-term implications for food-related sectors as consumers eat less and make more nutritious choices."
Raghavan notes that he eats “significantly less than I used to. You have a few bites or something, and you feel satisfied."
One example of the share price hit that food companies could take was fast-food chain McDonald’s, which saw its share price fall almost 17 per cent in 2023 because of fears it would be affected by weight-loss drugs.
Similarly, companies like Hershey’s and Mondelez (which makes Oreo cookies) have reported a decline in sales. Hershey’s admitted a “mild year-on-year impact" on its business from GLP-1 drugs. The sugar industry is also alarmed by the possibility that weight-loss drugs could have an impact on its long-term sales.
However, there are still complications. Raghavan says that US insurance companies will not cover the drug costs for people who are taking it only for weight loss. Raghavan due to his diabetes has his weight-loss drug covered by insurance but he notes it’s $3,000 for a two-month supply.
The “miracle" weight-loss drug was the butt of jokes this week when the Hollywood awards season kicked off with the Golden Globes. Host Nikki Glaser didn't waste a moment addressing the elephant in the room, starting with her opening monologue that began with, "Good evening to the 82nd Golden Globes – Ozempic’s biggest night."
It was a cheeky jab at the A-list celebrities to shed weight rapidly before big roles or red carpet appearances. Of course this isn't what these meds were intended for but that hasn't stopped the entertainment industry from using them for cosmetic reasons. Eli Lilly even sponsored the Golden Globes broadcast.
However, when generic versions of these weight-loss drugs come on the market, and prices fall, we could start seeing a much slimmer society.
In India, where obesity and diabetes rates are increasing rapidly – India has over 77 million people living with diabetes and is seeing a sharp rise in pre-diabetes – it’s not difficult to see why drugs that tackle both problems will be a huge hit.