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Weight loss drug’s success leaves some Florida teens out of supply

Medications like Wegovy are changing the landscape when it comes to weight loss but access to the expensive drugs remains a concern.
 
Sara Karjoo, a pediatric gastroenterology and pediatric obesity specialist, has seen long-term obese patients achieve weight loss when taking weigh loss drug Wegovy. But a national shortage of lower doses of the medication has meant some patients having to stop treatment.
Sara Karjoo, a pediatric gastroenterology and pediatric obesity specialist, has seen long-term obese patients achieve weight loss when taking weigh loss drug Wegovy. But a national shortage of lower doses of the medication has meant some patients having to stop treatment. [ DIRK SHADD | Times ]
Published Aug. 14, 2023|Updated Aug. 22, 2023

Google drug names “Ozempic” or “Wegovy” and you’re as likely to end up on a celebrity gossip website as a medical one.

Comedian Amy Schumer, former basketball star Charles Barkley and reality TV star Sharon Osborne are among those who have publicly acknowledged trying the drug that has been hailed as a magic bullet for weight loss. Elon Musk, in a post on the X platform, formerly known as Twitter, said he had used Wegovy and fasted to look “ripped.”

Ozempic, which lowers blood sugar, was developed to treat diabetes. But the medication also causes significant weight loss, which led to the development of Wegovy, a drug approved to treat obesity and weight problems linked to health issues like high blood pressure and cholesterol.

The medication has produced much better results than previous weight loss drugs. One study published in the New England Journal of Medicine showed an average of a 15% drop in body weight. Tampa pediatric specialist Sara Karjoo has used the drug to treat obese teens, achieving positive results with patients who, even after years of counseling, diet and exercise, had struggled not to gain weight, she said.

But the drug’s success has created a demand that manufacturer Novo Nordisk has been unable to keep up with, leading to a national shortage. In Tampa Bay, some of Karjoo’s patients have reported not being able to find any pharmacies with lower doses of Wegovy, while others have driven long distances to pick up the medication, Karjoo said.

And there is no generic substitute. That’s a problem because the drug, which is prescription only, is administered through weekly injections while slowly increasing the dosage. Missing one shot can mean having to start the regimen from scratch.

Some of Karjoo’s patients have been forced to stop treatment, she said, resulting in some regaining weight. Karjoo has also paused prescribing it for new patients until at least September, when supply is expected to catch up with demand.

“Because so many people are interested in this drug, there’s a national shortage,” she said. “It’s created an unsafe situation that did affect patient care; it delayed everything.”

A Wegovy syringe. The obesity drug has become so popular that manufacturer Novo Nordisk cannot keep up with demand.
A Wegovy syringe. The obesity drug has become so popular that manufacturer Novo Nordisk cannot keep up with demand. [ Sara Karjoo ]

An expensive solution

Both Wegovy and Ozempic work by tricking the body into feeling that it’s full. That’s achieved through an ingredient known as a semaglutide, which mimics a hormone produced by the body when eating. The body responds by producing more insulin and lowering blood sugar.

Drugs that use semaglutide have been around since the early 2000s, said Shauna Levy, an assistant professor in the Division of Minimally Invasive Surgery/Bariatric Surgery at Tulane University School of Medicine. But the latest iteration has produced results that could completely change how obesity is treated.

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Roughly 90% of patients on Wegovy lost at least 5% of their body weight over the course of a year, she said. Newer versions of these drugs currently under medical trials are reporting results of near 25% body weight loss, almost equal to the results from bariatric surgeries like a gastric bypass.

“It’s disrupted the whole game when it comes to obesity medicine,” Levy said during a recent webinar about the drug.

But the cost, as much as $1,400 per month, has raised questions about who can get Wegovy. The drug is covered by some health insurance plans but not by Medicare, the government program that provides health care for seniors, a population with high rates of obesity and diabetes.

Citing the link between obesity and cancer, the Moffitt Cancer Center is among those advocating for the drug to be covered through Medicare.

“Since obesity is linked to increased risk of 13 types of cancer, Moffitt is supportive of policies that allow for widest possible patient access to strategies to treat and reduce obesity,” said John DeMuro, federal legislative affairs director for Moffitt. “This includes behavioral interventions, as well as anti-obesity medications prescribed by physicians.”

Levy is hopeful that more insurance companies will cover the cost of the drug once they realize that it will result in fewer expensive treatments for heart and liver issues and fewer cases of diabetes as patients age.

But for now, she grapples with a system that is still coming to terms with the drug. Her state’s Medicaid program covers bariatric surgery but not Wegovy. Even for those with private insurance, her staffers have to call insurance companies to get pre-authorization for virtually every patient she prescribes, she said.

“I can’t just give them what they want or what they need,” Levy said. “I have to give them what they have access to and that sucks.”

Tampa pediatric specialist Sara Karjoo has used Wegovy to treat obese teens, achieving positive results with patients who, even after years of counseling, diet and exercise, had struggled not to gain weight, she said.
Tampa pediatric specialist Sara Karjoo has used Wegovy to treat obese teens, achieving positive results with patients who, even after years of counseling, diet and exercise, had struggled not to gain weight, she said. [ DIRK SHADD | Times ]

“Consistent victories”

Despite its popularity among celebrities and influencers, Wegovy is not approved for cosmetic weight loss. To be prescribed, patients must meet medical criteria of either a body mass index, or BMI, of 30, or a BMI of 27 with accompanying weight-related health concerns. A 5-foot-9-inch person weighing more than 200 pounds averages a body mass index of about 30.

But that’s a broad swath of the U.S. population. Roughly 42% of Americans were obese in 2017, according to data from the Centers for Disease Control and Prevention. Their yearly medical costs are, on average, $1,861 higher than for those with healthy weights.

Karjoo, the Tampa pediatric specialist, has been treating children with obesity for two decades. As a specialist, she is often the last resort for parents whose children continue to gain weight even after seeing a doctor for several years.

She began prescribing Wegovy in February shortly after the Food and Drug Administration approved the drug for obese children as young as 12.

She is concerned that more pediatricians are not aware or not making use of it. Some 14.7 million children and adolescents — about 20% of that age group — were considered obese in a three-year period through 2020, CDC data shows.

Some of those weight problems are caused by factors like a sedentary lifestyle, stress, poor diet and an overuse of processed foods, she said. Others stem from medical issues. They put children on the path to medical problems like hypertension, prediabetes, Type II diabetes and leave them at risk for cardiac issues, among other concerns.

“So many kids are going to be sick adults and not be in the workforce,” she said. “A lot of people feel there isn’t good treatment for pediatric obesity.”

Karjoo stressed that the drug must be accompanied by healthier eating and exercise to start dropping pounds. Patients’ blood work is taken monthly to check insulin levels and other health measures. They are also monitored for side effects like nausea, diarrhea, vomiting, constipation, stomach pain and headaches, among others.

One 17-year-old boy from Tarpon Springs whom Karjoo treated with Wegovy had thyroid issues and had been referred after a pediatrician had told his mom that you “can’t outrun genetics” and that she should consider bariatric surgery.

He has since lost almost 20 pounds in three months, she said.

“We’re seeing kids whose doctors had given up,” she said. “With diet, lifestyle and the addition of this medication, we’re starting to see some positive outcomes.”

April, the boy’s mother, said the drug has completely changed her son’s life. Her son has dropped two pant sizes. More than that, it’s made it easier for him to stick to a regimen of healthy eating and exercising up to 200 minutes per week, she said. The Tampa Bay Times is not using her full name to keep her son’s medical condition confidential.

“Every time he got on a scale, he felt like he failed again,” April said. “Now, he’s seeing consistent victories, and I think that is empowering. It’s making him feel more in control of his choices.”

April said the shortage meant she had to call half a dozen pharmacies to find one that had the drug in stock. She’s hopeful that her son can eventually come off the drug once his weight has dropped further. But she’s also comfortable keeping him on the medication for the rest of his life if it keeps him healthy, the same attitude she has to the medication he takes for his thyroid condition.

“People who haven’t suffered with their weight think it’s a willpower issue,” she said.