Was Ozempic Right For Me?

August 8, 2024 8:04 AM

Autostraddle columnist Em Win chronicles her experience with Ozempic, the good and bad.
posted by Kitteh (24 comments total)

However, I was never in my life able to achieve even the tiniest bit of weight loss without medicine.

We really need to give people less crap for not being able to lose weight when their bodies literally fight against it in every possible way and they have "food noise" hunger going on constantly.

I feel so bad for the writer being utterly dumped from her good doctor and medication for no good reason and it can't be fixed. BLEAH.
posted by jenfullmoon at 8:18 AM on August 8 [28 favorites]

Right??? I was so sad she lost her compassionate doctor AND ended up not being able to afford the medicine that was working for her.
posted by Kitteh at 8:23 AM on August 8 [4 favorites]

I am not on one of these drugs, but have seen some weight loss due to my ADD/anti-anxiety meds (and some pretty minor addition of exercise), and it also feels weird to get complimented on that. Not to mention that I am also pre-diabetic still even with that change. And my previously low blood pressure has started to go up a bit, despite not making any lifestyle changes that would contribute to that.

My conclusion being, we actually don't understand very much at all about weight gain/loss, fat, diabetes, blood pressure, and so on. Or rather that we have made assumptions about initial causes (laziness, eating too much) when it's clear that the feedback loop of fat/inflammation/appetite/diabetes/blood pressure/heart disease is more complex.

(and that's not even trying to take any environmental factors or food supply factors into account)

These drugs interrupt that cycle in a way that seems to help a lot of people, and I can't be angry about that, or see it as a bad thing, so long as it's not creating other worse problems. But at the same time, I want us to completely drop our moralizing around fat bodies.

Bodies that look fat (like weight lifters) can be very healthy and strong. Bodies that look thin can be very sick. Bodies create and store fat in ways that vary a lot from person to person, and yes, often resist attempts to exercise or starve that fat away. In short, what a body looks like is not something that requires your approval or disapproval, or that should invite you to speculate on that person's health or most especially, their personal decisions.
posted by emjaybee at 8:39 AM on August 8 [27 favorites]

Maintenance Phase episode that is mentioned in the article. Kitteh, thanks for sharing - It's great to hear from a Type 2 diabetes patient around semiglutides (the Maintenance Phase Podcast really focuses around its weight-loss usage), so this article really broadened my perspective. I feel forr her, that does suck tremendously that Medicaid doesn't cover it.
posted by WedgedPiano at 8:59 AM on August 8 [3 favorites]

I use Ozempic. I've lost maybe 5-10 pounds on it? On the other hand, it cut my daily insulin use to less than half what it was before. The only side effect I've seen is my going hypoglycemic when I sleep. (I also use a CGM, which wakes me up when my blood glucose level goes under 70. I drink some orange juice, and can go back to bed.)
Unfortunately, I got a letter from my insurance saying that they need a letter from my physician to keep taking it, so who knows if I'll be taking it next month. (They needed a letter for the CGM, too. Regularly going hypoglycemic while unconscious wasn't a good reason. Taking fast insulin was, so who knows?)
posted by Spike Glee at 9:09 AM on August 8 [8 favorites]

Maintenance Phase episode that is mentioned in the article - was just on the way to post that. Fascinating and surprisingly positive given that they are extremly attuned to deflating medical hype.
posted by Artw at 9:18 AM on August 8

I’m a pretty athletic person who does 6-10 hours aerobic stuff a week (hiking and biking). I’m in year 2 of being on wegovy. I lost weight once before in my adult life, but it took feeling hungry a lot of the time and counting calories which I did for 2 years before it slowly fell apart and then I regained for 2 years.

Having my body/brain not fighting me has improved my life a huge amount. What people call food noise I think of, for me, like an obsession. With Wegovy the obsession is pretty much gone. I can just enjoy food without it being fraught.

At 18 I was 315lb computer nerd kid. At 35 I was an athletic person who was 250lbs. Now I’m just as athletic, but 190. So many things are nicer in my body.

For me it was a pain to get on the medicine, but now that I’m on it’s easy for me to live with. Hope these meds continue to be a huge net positive as they age and are studied more and hope they become cheap and widely available.
posted by creiszhanson at 9:30 AM on August 8 [11 favorites]

I'm in the process of appealing my insurance decision to deny this. My heart doctor, my pulmonologist, my rheumatologist, my PT, and my primary care physician are all in agreement that I should take this, at least in a three-month trial to see if I can get enough weight loss to indicate if this is right for me. I have comorbidities and a BMI such that their policy indicates that they should approve automatically. Their denial stated that I had to see a dietitian for three months before they would reconsider. I'm on the third month with no change in weight. I wonder how they're going to move the goalpost after I'm done with this.

Insurance companies are right bastards.
posted by BlueHorse at 9:35 AM on August 8 [28 favorites]

I have a friend with genuine good intention and spirit, who spent much of their career in healthcare administration and management, on the insurer side, trying to change the system from within.

When he quit the business altogether, it was with the unshakable realization that "I'm in the healthcare prevention business."
posted by atomo at 9:45 AM on August 8 [15 favorites]

oh my god do I see myself in this article. I've been trying for six months to get my MD to prescribe Wegovy, because she also "doesn't believe in it". She finally did, and after two insurance appeals I'm covered (ironically my insurance company said its "only for weightloss" so she had to rewrite the whole thing to omit things like my A1C, dunno what that's about), and now I'm struggling to find a pharmacy that can fill it.
posted by anastasiav at 10:01 AM on August 8 [1 favorite]

Insurance companies are right bastards. Agree, but if there are bigger bastards than insurance companies, it's the pharma companies charging the prices they are charging.
posted by latkes at 10:09 AM on August 8 [8 favorites]

I started insulin for my diabetes on May 1 of this year. My blood sugar before I started insulin was 170. During May, I had to do two rounds of high dose steroids, because I have chronically low platelets and they had gotten so low that I was starting to have spontaneous bleeding. The steroids didn’t Increase my platelets, but they did run my blood sugar up over 400. A couple of times, when I tested my blood sugar in in the morning, my little testing device just said that my blood sugar was too high to measure and I should call my doctor. That sucked. About six weeks ago, my endocrinologist suggested I go on Ozempic to see if we could bring my blood sugar down, and it was absolutely miraculous for that. My blood sugar has been totally normal ever since I started ozempic, and we’re currently seeing if I can taper down on my daily insulin.

I’ve been a lifelong fat person, and also a fat activist for like 40 years now. I’m not thrilled to be on a drug that causes weight loss. At the same time, several years ago I was on a medication that caused me to gain over 100 pounds, then two years ago I had a long illness during which I basically couldn’t eat for nine months, and I lost about 110 pounds in that nine months. My baseline adult weight has been about 270. Gaining 100 pounds from there was really hard on my body, and hard on my life. it was common for me to go to places and discover that there were no seats I fit into. My arms are only so long, and hygiene became challenging. I was very grateful for the bidet we installed on the toilet.

It feels good to be back to await at which I have been able in the past to be very active and fit. I have lost about 20 pounds since I started the Ozempic, and I don’t care so much about that, but I do feel reassured that I’m not going to regain that weight. It was a terrible experience, gaining so much weight so quickly when it was obvious it wasn’t being driven by my diet. That connection is never as direct as we’re told it is, but I felt like my body was just completely out of my control. I feel like Ozempic gives me a buffer against going through that again.

I appreciated the honesty of the Maintenance Phase episode on Ozempic. In general, I’ve tried not to pay too much attention to how it’s viewed in popular culture, or to any of the ways it can feed into fat phobia. I can’t believe how much better I’m feeling with my blood sugar in good control, and Ozempic has been a real driver of that, so I’m grateful for it.

I ended up doing four rounds of Rotuxin infusions in June, which brought my platelets up to the point where I’ve no longer developing spontaneous nosebleeds or bleeding in my mouth at night while I sleep. So that’s all good, too, though the infusions really took a toll out on me.
posted by Well I never at 10:10 AM on August 8 [9 favorites]

This is going to make me go down rabbit holes! And feel a lot of things. Thanks for posting it.

I just want to note that the assumption that insurance coverage brings the drug to around $5-$50 a month likely ignores the problems people have with high-deductible insurance plans. I just had COVID, and Paxlovid is recommended for me, to keep me out of the hospital and keep me alive. With my high deductible plan (I work for an academic health center, ffs) the cost of Paxlovid was $400, during a global pandemic. Make it $800 if your spouse gets it too. (He did.)

The doctor prescribing it did not let me know that ahead of time. And neither she nor the pharmacy I spoke with when they called to warn me that they were "filling a high cost prescription" told me that the pharmaceutical company has a plan to cover the cost (no income eligibility - this is for people with insurance). If you don't know about that program, and if you have a high deductible plan, you pay the full amount (that your insurance company has negotiated) until you reach the deductible - which is higher every year and usually in the thousands. I cried, asked the pharmacy to give me a day to think about it with my COVID brain (you have to be within the 5 day window since starting to have symptoms) and a friend, after offering to pay for it herself, found a link to the pharma webpage for getting a "coupon".

A family member takes Mounjaro and told me that she's glad her insurance covers it, because it'd be $5000 per month otherwise.
posted by vitabellosi at 10:59 AM on August 8 [7 favorites]

I am currently on a weight loss drug that is not Ozempic. It acts as a metabolism booster and as a way to curb eating cravings. This is because my weight gain has, as far as I can tell, two sources: at one time, I was prescribed medication that screwed my metabolism worse than it already was, and two, my body and brain were so traumatized by starvation diets that now it reacts to stress and hunger by extreme overeating.

To be very clear, again: it is largely trying to do things the way I was told was the “good” way to do them that traumatized my body enough that I now need medical intervention.

I initially lost about 1/5 of my body weight; I have put about 1/10 of that back on in part because of the difficulties I have had in maintaining regular access to the prescription. It is a controlled substance, which means I can’t just have it mailed to me anymore; now I need to sign for it, and my doctors wanted in person visits I couldn’t manage what with law school, so I have had some months I was taking it and some months I was not taking it.

It isn’t “magic”, but it lets me eat what other people consider to be “normal” portion sizes without feeling as though I am starving and dying. And it has gotten me down to a weight where my body and muscles can lift my frame without struggling too hard, which makes it more possible to exercise.

And yet I struggle, I struggle with people feeling like somehow my wanting this is fatphobic. And I feel like the framing of this is really all wrong - like, I wish there was space to say that we shouldn’t be awful to anyone in the world, but also that yes, too much weight on a body does have consequences and it is tiring and hard. It’s just not something everyone can do anything about without medical intervention, and not something everyone has the money to do anything about.

Our society doesn’t really give health insurance to women for things that are important because it considers it “cheating”; it’s “cheating” to want to look prettier or thinner or less hirsute than you were born into, you might “mislead” people. But just - let people be what they want to be, and let them be happy in it, and the world would be so much better.
posted by corb at 11:25 AM on August 8 [17 favorites]

To be very clear, again: it is largely trying to do things the way I was told was the “good” way to do them that traumatized my body enough that I now need medical intervention.

Similarly, I wish I could resurrect my deceased father and inform him that his obsession with my body not being fat and his restriction of food and constant fat-shaming and encouragement of significant disordered eating caused my body to become fatter than it otherwise would have been. And, y'know, punch him in the dead face a little bit for doing all of that to me and insisting the outcomes were entirely my fault.
posted by terretu at 12:00 PM on August 8 [13 favorites]

I am a diabetic. I was prescribed Farxiga when it first came out due to my diabetes. It did not seem to have much effect on my blood sugars, and was still considered a new drug, so my copay was the highest level. Thus, we shifted to another strategy. Then, a few years later, my heart doctors prescribed Farxiga to me, as a heart medication, irregardless of any diabetes impact, as studies had shown it had real benefits for heart surgery aftercare. (the price had gone down significantly in the meantime, as well).

Cut to a few years later, and my old GP retired, and a new, younger doctor came into the practice. He brought up Ozempic as an option based on my struggle to lower my A1C level. I told him that my experience with Farxiga had me skeptical of any big pharma, big cost solution to diabetes. And sure enough, after six months, little effect. But he had started me on the lower dosage - when we went to the higher dosage, we have seen a reduction in my A1C.

what we haven't seen is any weight loss. But you know what? IT WASN'T PRESCRIBED FOR WEIGHT LOSS in my case. I would like to say that the lesson here is that we need to stop prescribing drugs for side effects, rather than their purported main treatment, but my experience with Farxiga shows that sometimes the unintended side effect is the reason to use something.

But i still say that taking a semaglutide for weight loss is a misuse in general. I only skimmed the OP, but I don't think I saw any mention of whether their blood sugars were affected, only their weight.
posted by jkosmicki at 1:09 PM on August 8 [3 favorites]

BTW I’m in Boston area and went to Beth Israel’s Weight Loss Clinic and not my primary care doctor for the script. They are very supportive. I have 2 appointments a year and if I have questions they are quick in the portal.

And they handle my insurance folks well.
posted by creiszhanson at 1:12 PM on August 8

I'm on Ozempic AND Farxiga AND once-daily and mealtime insulin.

I'm honestly not sure how much effect the Farxiga has, but I know when I went to the 2mg Ozempic instead of 1mg my A1C came down almost a full point.

If it's had any effect on my weight it's been very minor, especially compared to my first few months on Byetta, which had the effect of making me feel full much more quickly (and the line from "pretty full" to "I think I may throw up" was about two bites). Unfortunately the Byetta stopped being effective after a while.

I've been kind of curious about asking my doctor about Wegovy, but haven't done it yet.
posted by Foosnark at 1:21 PM on August 8 [1 favorite]

Ditto, Ozempic 0.5/weel let me stop using twice-daily insulin. And drop about 2 stone.
posted by mdoar at 2:45 PM on August 8

But i still say that taking a semaglutide for weight loss is a misuse in general.

This is a misunderstanding that is creating serious obstacles to access for people who would clearly be helped by the drug. Wegovy is semaglutide and was initially approved solely for the purpose of weight loss. As of this spring, it has additionally been labeled for the reduction of risk of heart attack and stroke in obese/overweight people. I believe the study supporting that approval found that risk reduction kicks in immediately, regardless of weight lost. It is 100% identical to Ozempic and is made by the same manufacturer.

The inventor has spoken about how she was hoping to create a solution to obesity. The company chose to market it initially for diabetes, probably because Medicare and Medicaid are forbidden from paying for weight loss drugs and the US is the big profit center.

Because of the idea that prescribing this class of meds to non-diabetics is harmful and taking it away from the deserving, there are stories all over of people being denied by misinformed doctors and berated or completely denied fills by pharmacy staff. The situation is very similar for Mounjaro/Zepbound, which is tirzepatide approved for either diabetes or obesity, respectively. Removing A1C from insurance appeals is to remove mention of diabetes from a request for a weight loss drug. Pre-diabetics are also broadly denied coverage for Ozempic or Mounjaro, as they aren't yet diagnosed with the condition. Heaven forbid insurers pay to prevent illness, but at this time Zepbound and Wegovy are the appropriate drugs for obese individuals who are prediabetic. Again, they're the exact same things with different words on the box.

As an aside, I won't be surprised if this is approved for treatment of alcoholism relatively soon. Many people report reduction in all kinds of addictive behaviors, but significant loss of interest in drinking appears to be nearly universal. Zepbound/Wegovy could provide huge benefits to many who are obese and also struggling with drinking.

The current insurance and supply situation is disastrous for many reasons, but the evidence appears clear at this point that many more people could be helped and lives saved by increased access to this class of drug.
posted by pekala at 4:02 PM on August 8 [16 favorites]

I'm type 2, on Metformin for several years. My A1C has fluctuated between 6.7 and 7.2. I test blood glucose 1x a day (just after waking up) and it's often been in the 120s or 130s.

So my doctor prescribed Rybelsus. I sometimes think I'm the only person in the world taking it, because no one seems to talk about it. It's basically the pill form of Ozempic. It works; my daily blood glucose tests have been in the low teens down to as low as 90. (I haven't had an A1C lately, but it's coming up next week). I was also losing a bit of weight, because I didn't feel hungry as much.

But I quit taking it almost a month ago. The side effects were difficult. I had even more gas and rumbling stomach than when I was just on Metformin, and more than once I had to leave work because I was so nauseous I couldn't do my job.

When I informed my doctor through our patient portal, she immediately prescribed Mounjoro. I told her "no" because (a) she didn't discuss it with me, (b) it's an injection and I'm not sure I can do that, (c) it costs four times more a month than the Rybelsus (which costs four times more a month than any of my other meds, but is still affordable) and (d) it appears to have the same percentage of people who experience gastric side effects as Rybelsus.

Since I quit, my daily pokes still show me to be in the mid-110s, with occasional 1-day spikes into the 120s. This is better than I was before Rybelsus, but not as good as when I was. When I told my doctor I wasn't going to take the Mounjaro without talking about it first, she said fine...I have an appointment next week, we'll talk about it.

How is the injection experience? I hate needles...I can't watch when I get a shot or I get my blood taken (I've gotten used to lancet pokes, fortunately).
posted by lhauser at 9:07 PM on August 8

The injection I would say is very similar to lancet pokes (short needle, you don't have to look at the needle going in or anything like that). Much less painful as you're not putting it somewhere as sensitive as your fingertip. If you can get it, I would at least try it a few times.
posted by knobknosher at 12:13 AM on August 9

The Ozempic injection (I'm assuming Mounjaro is similar) is super super easy and much less painful to me than finger pokes. Seriously, the needle is teeny - I can hardly even feel it going in - and the injection lasts about two seconds and aches a little bit.
posted by Daily Alice at 4:14 AM on August 9

I need 4 injections per day plus Ozempic. The needles are super tiny. The process is usually [i]completely[/i] painless, and at their worst are still less painful than an average finger stick in my experience.

The first time I did it, it took almost a full minute to psych myself up. But then I laughed while the needle was in because I couldn't feel it at all.

It's worth getting better quality needles to make the whole experience as smooth as possible. BD Nano 2nd gen seem to be the best (though typically more expensive than others), and Owen-Mumford Unifine are pretty good.
posted by Foosnark at 5:08 AM on August 9