When supplies resume, should governments subsidise drugs like Ozempic for weight loss? We asked 5 experts
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.
Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.
Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).
Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?
Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.
In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?
Four out of five said yes
This is the last article in The Conversation’s Ozempic series. Read the other articles here.
Disclosure statements: Clare Collins is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Medical Research Future Fund (MRFF), the Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, the Western Australian Department of Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk (for weight management resources and an obesity advisory group), Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update, the Heart Foundation evidence reviews on meat and dietary patterns and current co-chair of the Guidelines Development Advisory Committee for Clinical Practice Guidelines for Treatment of Obesity; Emma Beckett has received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg and the University of Newcastle. She works for FOODiQ Global and is a fat woman. She is/has been a member of committees/working groups related to nutrition or food, including for the Australian Academy of Science, the NHMRC and the Nutrition Society of Australia; Jonathan Karnon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment; Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd (a medical device company) and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design and testing; Priya Sumithran has received grant funding from external organisations, including the NHMRC and MRFF. She is in the leadership group of the Obesity Collective and co-authored manuscripts with a medical writer provided by Novo Nordisk and Eli Lilly.
Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Distracted Mind – by Dr. Adam Gazzaley and Dr. Larry Rosen
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Yes, yes, we know, unplug once in a while. But what else do this highly-qualified pair of neuroscientists have to offer?
Rather than being a book for the sake of being a book, with lots of fluff and the usual advice about single-tasking, the authors start with a reframe:
Neurologically speaking, the hit of dopamine we get when looking for information is the exact same as the hit of dopamine that we, a couple of hundred thousand years ago, got when looking for nuts and berries.
- When we don’t find them, we become stressed, and search more.
- When we do find them, we are encouraged and search more nearby, and to the other side of nearby, and near around, to find more.
But in the case of information (be it useful information or celebrity gossip or anything in between), the Internet means that’s always available now.
So, we jitter around like squirrels, hopping from one to the next to the next.
A strength of this book is where it goes from there. Specifically, what evidence-based practices will actually keep our squirrel-brain focused… and which are wishful thinking for anyone who lives in this century.
Bringing original research from their own labs, as well as studies taken from elsewhere, the authors present a science-based toolkit of genuinely useful resources for actual focus.
Bottom line: if you think you could really optimize your life if you could just get on track and stay on track, this is the book for you.
Click here to check out The Distracted Mind, and get yours to focus!
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Loaded Mocha Chocolate Parfait
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Packed with nutrients, including a healthy dose of protein and fiber, these parfait pots can be a healthy dessert, snack, or even breakfast!
You will need (for 4 servings)
For the mocha cream:
- ½ cup almond milk
- ½ cup raw cashews
- ⅓ cup espresso
- 2 tbsp maple syrup
- 1 tsp vanilla extract
For the chocolate sauce:
- 4 tbsp coconut oil, melted
- 2 tbsp unsweetened cocoa powder
- 1 tbsp maple syrup
- 1 tsp vanilla extract
For the other layers:
- 1 banana, sliced
- 1 cup granola, no added sugar
Garnish (optional): 3 coffee beans per serving
Note about the maple syrup: since its viscosity is similar to the overall viscosity of the mocha cream and chocolate sauce, you can adjust this per your tastes, without affecting the composition of the dish much besides sweetness (and sugar content). If you don’t like sweetness, the maple syrup be reduced or even omitted entirely (your writer here is known for her enjoyment of very strong bitter flavors and rarely wants anything sweeter than a banana); if you prefer more sweetness than the recipe called for, that’s your choice too.
Method
(we suggest you read everything at least once before doing anything)
1) Blend all the mocha cream ingredients. If you have time, doing this in advance and keeping it in the fridge for a few hours (or even up to a week) will make the flavor richer. But if you don’t have time, that’s fine too.
2) Stir all the chocolate sauce ingredients together in a small bowl, and set it aside. This one should definitely not be refrigerated, or else the coconut oil will solidify and separate itself.
3) Gently swirl the the mocha cream and chocolate sauce together. You want a marble effect, not a full mixing. Omit this step if you want clearer layers.
4) Assemble in dessert glasses, alternating layers of banana, mocha chocolate marble mixture (or the two parts, if you didn’t swirl them together), and granola.
5) Add the coffee-bean garnish, if using, and serve!
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Enjoy Bitter Foods For Your Heart & Brain
- The Bitter Truth About Coffee (Or Is It?)
- Which Sugars Are Healthier, And Which Are Just The Same?
- Cashew Nuts vs Coconut – Which is Healthier?
Take care!
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How To Out-Cheat “Cheat Days”
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Out-Cheating “Cheat Days” (Or Even Just “Cheat Meals”)
If you are in the habit of eating healthily, the idea of a “cheat day” probably isn’t appealing—because you simply don’t crave junk food; it’s not what your gut is used to.
Nevertheless, sometimes cheat days, or at least cheat meals, choose us rather than the other way around. If your social group is having a pizza night or meeting up at the burger bar, probably you’re going to be having a meal that’s not ideal.
So, what to do about it?
Well, first of all, relax. If it really is an exception and not a regular occurrence, it’s not going to have a big health impact. Assuming that your basic dietary requirements are taken care of (e.g. free from allergens as necessary, vegan/vegetarian if that’s appropriate for you, adhering to any religious restrictions that are important to you, etc), then you’re going to have a good time, which is what scientists call a “pro-social activity” and is not a terrible thing.
See also: Is Fast Food Really All That Bad? ← answer: yes it is, but the harm is cumulative and won’t all happen the instant you take a bite of a chicken nugget
Think positive
No, not in the “think positive thoughts” sense (though feel free, if that’s your thing), but rather: focus on adding things rather than subtracting things.
It’s said:
❝It’s not the calories in your food that make the biggest impact on your health; it’s the food in your calories❞e
…and that’s generally true. The same goes for “bad things” in the food, e.g. added sugar, salt, seed oils, etc. They really are bad! But, in this case you’re going to be eating them and they’re going to be nearly impossible to avoid in the social scenarios we described. So, forget that sunk treasure, and instead, add nutrients.
10almonds tip: added nutrients remain added nutrients, even if the sources were not glowing with health-appeal and/or you ate them alongside something unhealthy:
- Those breaded garlic mushrooms are still full of magnesium and fiber and ergothioneine.
- The chili-and-mint peas that came as an overpriced optional side-dish with your burger are still full of protein, fiber, and a stack of polyphenols.
…and so on. And, the more time you spend eating those things, the less time you spend eating the real empty-calorie foods.
Fix the flaw
We set out to offer this guide without arguing for abstemiousness or making healthy substitutions, because we assume you knew already that you can not eat things, and as for substitutions, often they are not practical, especially if dining out or ordering in.
Also, sometimes even when home-cooking something unhealthy, taking the bad ingredient out takes some of the joy out with it.
Writers example: I once incorrectly tried to solve the fat conundrum of my favorite shchi (recipe here) by trying purely steaming the vegetables instead of my usual frying/sautéing them, and let’s just say, that errant-and-swiftly-abandoned version got recorded in my nutrition-tracker app as “sad shchi”.
So instead, fix the flaw by countering it if possible:
- The meal is devoid of fiber? Preload with some dried figs (you can never have too many dried figs in your pantry)
- The meal is high in saturated fat? Enjoy fiber before/during/after, per what’s convenient for you. Fiber helps clear out excess cholesterol, which is usually the main issue with saturated fat.
- The meal is salty? Double down on your hydration before, during, and after. If that sounds like a chore, then remember, it’s more fun than getting bloated (which results, counterintuitively, from dehydration—because your body detects the salt, and panics and tries to retain as much water as possible to restore homeostasis, resulting in bloating) and hypertensive (which results from the combination of the blood having too much salt and too little water, and cells retaining too much water and pressing inwards because it is the cells themselves that are bloated). So, tending to your hydration can help mitigate all of the above.
- The meal is full of high-GI carbs? Preload with fiber, enjoy the carbs together with fats, and have something acidic (e.g. some kind of vinegar, or citrus fruit) with it if that’s a reasonable option. Yes, this does mean that a Whiskey Sour is better for your blood sugars than an Old Fashioned, by the way, and/but no, it doesn’t make either of them healthy.
- The meal is inflammatory? Doing all of the above things will help, as will eating it slowly/mindfully, which latter makes it less of a shock to your system.
See also: How To Get More Nutrition From The Same Food
Enjoy!
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Semaglutide’s Surprisingly Unexamined Effects
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Semaglutide’s Surprisingly Big Research Gap
GLP-1 receptor agonists like Ozempic, Wegovy, and other semaglutide drugs. are fast becoming a health industry standard go-to tool in the weight loss toolbox. When it comes to recommending that patients lose weight, “Have you considered Ozempic?” is the common refrain.
Sometimes, this may be a mere case of kicking the can down the road with regard to some other treatment that it can be argued (sometimes even truthfully) would go better after some weight loss:
How weight bias in health care can harm patients with obesity: Research
…which we also covered in fewer words in the second-to-last item here:
But GLP-1 agonists work, right?
Yes, albeit there’s a litany of caveats, top of which are usually:
- there are often adverse gastrointestinal side effects
- if you stop taking them, weight regain generally ensues promptly
For more details on these and more, see:
…but now there’s another thing that’s come to light:
The dark side of semaglutide’s weight loss
In academia, “dark” is often used to describe “stuff we don’t have much (or in some cases, any) direct empirical evidence of, but for reasons of surrounding things, we know it’s there”.
Well-known examples include “dark matter” in physics and the Dark Ages in (European) history.
In the case of semaglutide and weight loss, a review by a team of researchers (Drs. Sandra Christenen, Katie Robinson, Sara Thomas, and Dominique Williams) has discovered how little research has been done into a certain aspect of GLP-1 agonist’s weight loss effects, namely…
Dietary changes!
There’s been a lot of popular talk about “people taking semaglutide eat less”, but it’s mostly anecdotal and/or presumed based on parts of the mechanism of action (increasing insulin production, reducing glucagon secretions, modulating dietary cravings).
Where studies have looked at dietary changes, it’s almost exclusively been a matter of looking at caloric intake (which has been found to be a 16–39% reduction), and observations-in-passing that patients reported reduction in cravings for fatty and sweet foods.
This reduction in caloric intake, by the way, is not significantly different to the reduction brought about by counselling alone (head-to-head studies have been done; these are also discussed in the research review).
However! It gets worse. Very few studies of good quality have been done, even fewer (two studies) actually had a registered dietitian nutritionist on the team, and only one of them used the “gold standard” of nutritional research, the 24-hour dietary recall test. Which, in case you’re curious, you can read about what that is here:
Dietary Assessment Methods: What Is A 24-Hour Recall?
Of the four studies that actually looked at the macros (unlike most studies), they found that on average, protein intake decreased by 17.1%. Which is a big deal!
It’s an especially big deal, because while protein’s obviously important for everyone, it’s especially important for anyone trying to lose weight, because muscle mass is a major factor in metabolic base rate—which in turn is much important for fat loss/maintenance than exercise, when it comes to how many calories we burn by simply existing.
A reasonable hypothesis, therefore, is that one of the numerous reasons people who quit GLP-1 agonists immediately put fat back on, is because they probably lost muscle mass in amongst their weight loss, meaning that their metabolic base rate will have decreased, meaning that they end up more disposed to put on fat than before.
And, that’s just a hypothesis and it’s a hypothesis based on very few studies, so it’s not something to necessarily take as any kind of definitive proof of anything, but it to say—as the researchers of this review do loudly say—more research needs to be done into this, because this has been a major gap in research so far!
Any other bad news?
While we’re talking research gaps, guess how many studies looked into micronutrient intake changes in people taking GLP-1 agonists?
If you guessed zero, you guessed correctly.
You can find the paper itself here:
What’s the main take-away here?
On a broad, scoping level: we need more research!
On a “what this means for individuals who want to lose weight” level: maybe we should be more wary of this still relatively new (less than 10 years old) “wonder drug”. And for most of those 10 years it’s only been for diabetics, with weight loss use really being in just the past few years (2021 onwards).
In other words: not necessarily any need to panic, but caution is probably not a bad idea, and natural weight loss methods remain very reasonable options for most people.
See also: How To Lose Weight (Healthily!)
Take care!
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5 Things To Know About Passive Suicidal Ideation
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If you’ve ever wanted to go to sleep and never wake up, or have some accident/incident/illness take you with no action on your part, or a loved one has ever expressed such thoughts/feelings to you… Then this video is for you. Dr. Scott Eilers explains:
Tired of living
We’ll not keep them a mystery; here are the five things that Dr. Eilers wants us to know about passive suicidal ideation:
- What it is: a desire for something to end your life without taking active steps. While it may seem all too common, it’s not necessarily inevitable or unchangeable.
- What it means in terms of severity: it isn’t a clear indicator of how severe someone’s depression is. It doesn’t necessarily mean that the person’s depression is mild; it can be severe even without active suicidal thoughts, or indeed, suicidality at all.
- What it threatens: although passive suicidal ideation doesn’t usually involve active planning, it can still be dangerous. Over time, it can evolve into active suicidal ideation or lead to risky behaviors.
- What it isn’t: passive suicidal ideation is different from intrusive thoughts, which are unwanted, distressing thoughts about death. The former involves a desire for death, while the latter does not.
- What it doesn’t have to be: passive suicidal ideation is often a symptom of underlying depression or a mood disorder, which can be treated through therapy, medication, or a combination of both. Seeking treatment is crucial and can be life-changing.
For more on all of the above, here’s Dr. Eilers with his own words:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- The Mental Health First Aid You’ll Hopefully Never Need ← about depression generally
- How To Stay Alive (When You Really Don’t Want To) ← about suicidality specifically
Take care!
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Addiction Myths That Are Hard To Quit
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Which Addiction-Quitting Methods Work Best?
In Tuesday’s newsletter we asked you what, in your opinion, is the best way to cure an addiction. We got the above-depicted, below-described, interesting distribution of responses:
- About 29% said: “Addiction cannot be cured; once an addict, always an addict”
- About 26% said “Cold turkey (stop 100% and don’t look back)”
- About 17% said “Gradually reduce usage over an extended period of time”
- About 11% said “A healthier, but somewhat like-for-like, substitution”
- About 9% said “Therapy (whether mainstream, like CBT, or alternative, like hypnosis)”
- About 6% said “Peer support programs and/or community efforts (e.g. church etc)”
- About 3% said “Another method (mention it in the comment field)” and then did not mention it in the comment field
So what does the science say?
Addiction cannot be cured; once an addict, always an addict: True or False?
False, which some of the people who voted for it seemed to know, as some went on to add in the comment field what they thought was the best way to overcome the addiction.
The widespread belief that “once an addict, always an addict” is a “popular truism” in the same sense as “once a cheater, always a cheater”. It’s an observation of behavioral probability phrased as a strong generalization, but it’s not actually any kind of special unbreakable law of the universe.
And, certainly the notion that one cannot be cured keeps membership in many 12-step programs and similar going—because if you’re never cured, then you need to stick around.
However…
❝What is the definition of addiction?
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.❞
~ American Society of Addiction Medicine
Or if we want peer-reviewed source science, rather than appeal to mere authority as above, then:
❝What is drug addiction?
Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control. Those changes may last a long time after a person has stopped taking drugs.
Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of an organ in the body, both have serious harmful effects, and both are, in many cases, preventable and treatable.❞
~ Nora D. Volkow (Director, National Institute of Drug Abuse)
Read more: Drugs, Brains, and Behavior: The Science of Addiction
In short: part of the definition of addiction is the continued use; if the effects of the substance are no longer active in your physiology, and you are no longer using, then you are not addicted.
Just because you would probably become addicted again if you used again does not make you addicted when neither the substance nor its after-effects are remaining in your body. Otherwise, we could define all people as addicted to all things based on “well if they use in the future they will probably become addicted”.
This means: the effects of addiction can and often will last for long after cessation of use, but ultimately, addiction can be treated and cured.
(yes, you should still abstain from the thing to which you were formerly addicted though, or you indeed most probably will become addicted again)
Cold turkey is best: True or False?
True if and only if certain conditions are met, and then only for certain addictions. For all other situations… False.
To decide whether cold turkey is a safe approach (before even considering “effective”), the first thing to check is how dangerous the withdrawal symptoms are. In some cases (e.g. alcohol, cocaine, heroin, and others), the withdrawal symptoms can kill.
That doesn’t mean they will kill, so knowing (or being!) someone who quit this way does not refute this science by counterexample. The mortality rates that we saw while researching varied from 8% to 37%, so most people did not die, but do you really want (yourself or a loved one) to play those odds unnecessarily?
See also: Detoxification and Substance Abuse Treatment
Even in those cases where it is considered completely safe for most people to quit cold turkey, such as smoking, it is only effective when the quitter has appropriate reliable medical support, e.g.
- Without support: 3–5% success rate
- With support: 22% success rate
And yes, that 22% was for the “abrupt cessation” group; the “gradual cessation” group had a success rate of 15.5%. On which note…
Gradual reduction is the best approach: True or False?
False based on the above data, in the case of addictions where abrupt cessation is safe. True in other cases where abrupt cessation is not safe.
Because if you quit abruptly and then die from the withdrawal symptoms, then well, technically you did stay off the substance for the rest of your life, but we can’t really claim that as a success!
A healthier, but somewhat like-for-like substitution is best: True or False?
True where such is possible!
This is why, for example, medical institutions recommend the use of buprenorphine (e.g. Naloxone) in the case of opioid addiction. It’s a partial opioid receptor agonist, meaning it does some of the job of opioids, while being less dangerous:
It’s also why vaping—despite itself being a health hazard—is recommended as a method of quitting smoking:
Similarly, “zero alcohol drinks that seem like alcohol” are a popular way to stop drinking alcohol, alongside other methods:
This is also why it’s recommended that if you have multiple addictions, to quit one thing at a time, unless for example multiple doctors are telling you otherwise for some specific-to-your-situation reason.
Take care!
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