Kerry Toneguzzi has tried everything to lose weight.
From low-calorie and liquid diets to Weight Watchers, nothing worked. In 2007, she had bariatric surgery and lost 100 pounds – only to gain it all back.
When she was diagnosed with diabetes in the fall of 2020, her doctor suggested she try Ozempic – a drug approved in Canada to treat diabetes, with a frequent side effect of weight loss.
“In the beginning, I didn’t think it would ever work for me because nothing really had worked for me,” Toneguzzi, 55, said.
But it did. The Ottawa-area insurance underwriter lost 115 pounds over about two years. What she finds even more remarkable is that she hasn’t gained any of it back.
“For me to maintain my weight for a year, it’s a win,” she said. “This drug has given me a second chance at life.”
Like Toneguzzi, many Canadian obesity specialists and endocrinologists are welcoming Ozempic as a drug that actually works in treating what they say is a genetic, medical condition.
“We’ve failed to have success in pharmacotherapy until now,” said Dr. Sean Wharton, an internal medicine specialist who runs a weight and diabetes management clinic in Burlington, Ont.
With the advent of Ozempic, people living with obesity finally have a drug that can make a difference and can be an alternative to bariatric surgery, he said.
But Ozempic has gained notoriety in recent months, with celebrities singing the drug’s praises and many people posting success stories in weight loss they attribute to the drug.
Demand for Ozempic in Canada has risen steadily over the last year, according to the Neighbourhood Pharmacy Association of Canada, which represents most of the major pharmacy chains in Canada, as well as many community drugstores.
The problem with that, some doctors and pharmacists say, is that Ozempic isn’t intended for patients who want to drop a few pounds of “cosmetic weight.” Plus, people who need Ozempic likely need it for life – studies have shown that once they stop taking it, the weight often comes back.
“(There) should be no question about that. Nobody should think that they’re using this for short term and going to stop it,” Wharton said.
“This is a forever medication because (obesity is) a genetic disease.”
Ozempic costs between $200 and $300 per month in Canada. Its manufacturer, Novo Nordisk, also got Health Canada approval in 2021 for a drug called Wegovy. Ozempic and Wegovy have the identical active ingredient — semaglutide — but Wegovy is a higher dose to specifically treat obesity.
Health Canada has also approved Wegovy for people who are overweight and also suffering from a serious weight-related condition such as hypertension, diabetes or obstructive sleep apnea.
Semaglutide works by acting like a hormone called glucagon-like peptide-1 (GLP-1), which promotes insulin production and also stimulates part of the brain that controls appetite. Patients take it by injection once a week.
Because Wegovy is not yet available in Canada — and Novo Nordisk has not given a date when it will be — some doctors are prescribing Ozempic at higher doses for their patients suffering from obesity.
Dr. Ehud Ur, an endocrinologist at St. Paul’s Hospital and Vancouver General Hospital, said it’s important to look at Ozempic and Wegovy as a medical solution to treat a life-threatening medical condition, in conjunction with changes to diet, exercise and sleep habits.
“Most people don’t understand that obesity is not a cosmetic problem. It’s a significant disease. People with obesity will have a 10, 15, 20-year reduction in their life expectancy because of their weight problems,” said Ur.
But on the front lines of primary care, family doctors have been fielding a growing number of pleas from patients who want an Ozempic prescription, even though they’re not suffering from obesity, said Dr. Iris Gorfinkel, a family physician in Toronto.
“People who are coming to me as a family doctor … are people who, you know, they’re struggling with the belly fat, they’re not even diabetic, they’re not even pre-diabetic and they’re asking for the drug,” she said.
Shelita Dattani, vice-president of pharmacy affairs for the Neighbourhood Pharmacy Association of Canada, also practices on a family health team that is dealing with patients looking for Ozempic as a “quick fix” for weight loss.
“I’ve had people ask me, I’ve had friends ask me … ‘you know, I have a wedding coming up’ or ‘I need to be in a bikini’ or whatever it is,” Dattani said.
Gorfinkel and Dattani both say those requests require thoughtful conversations with patients about weight loss and other measures they can take.
“Obesity is a holistic problem. It is a biopsychosocial problem,” Gorfinkel said.
Those conversations take a lot longer than just saying yes and writing a prescription, she said.
Gorfinkel also worries about potential side effects.
According to Novo Nordisk’s Ozempic information website, the most common side effects include nausea, vomiting, diarrhea, constipation and abdominal pain.
Those symptoms go away after a few weeks, said Ur.
The website also lists more serious potential side effects including inflammation of the pancreas, gallbladder problems, kidney problems and low blood sugar.
It also notes that studies in rats showed thyroid tumours. Both Ur and Wharton said there’s no reason to believe that would happen in humans.
The health risks of living with obesity often outweigh the potential risks of taking the drug, they said.
“It’s important to understand who are the appropriate patients to treat because not everyone is a candidate for Ozempic,” Ur said.
“The simple point to make is that in any treatment in medicine you’re balancing risk against benefit.”
Gorfinkel said she would consider prescribing Ozempic along with lifestyle changes if the patient met the medical criteria for obesity.
But so far, that hasn’t happened.
“I have yet to prescribe it to any patients,” Gorfinkel said.
“I’m extremely skeptical. I worry tremendously that if I do prescribe it what may happen is that when they come off of it, they may experience significant weight gain.”
When asked if Ozempic and Wegovy are meant to be taken for the rest of patients’ lives, Novo Nordisk Canada said in an email, “Just like other chronic diseases, type 2 diabetes and obesity both require long-term management.”
“Decisions about the appropriateness and duration of any medication should be made on an individual basis in consultation with a health-care professional,” spokeswoman Amy Snow said.
Toneguzzi, who has started a Facebook group in Ottawa for others who are considering Ozempic, has no illusions that the drug is anything short of a lifelong commitment to help maintain her weight.
She also wants to help others be realistic in their expectations, noting that along with taking Ozempic, she worked hard on her weight loss, including a “very regimented” approach to her diet.
“It’s not a miracle,” she said.
“It wasn’t just the medication. I had to change my complete lifestyle.”
—Nicole Ireland, The Canadian Press