Christopher Labos: Why Ozempic should be covered by medicare for weight loss

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The Quebec Liberals want semaglutide — also known as Ozempic — to be covered by medicare for weight loss. You may object and say it would cost too much and that people should be responsible for their own lifestyle choices. But the point of paying for semaglutide is not to lose weight. The point of paying for semaglutide is to prevent the complications of obesity like heart disease, liver disease and arthritis. We shouldn’t cover the costs of semaglutide because we want people to be thin. We should cover the costs of semaglutide because we want people to be healthy. 

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Semaglutide was initially developed as a diabetes drug and the SUSTAIN trials demonstrated its efficacy in lowering blood sugar. The sixth trial in that series, the SUSTAIN-6 trial, also showed that semaglutide reduced the risk of cardiovascular disease. But the truly interesting finding was the impressive degree of weight loss that far surpassed anything that came before. Buoyed by this success, the STEP trials were launched to see if the results could be replicated in patients with obesity but without diabetes. Treatment with semaglutide led to similar weight loss even in the non-diabetics, and the SELECT trial mirrored the results of SUSTAIN-6 in terms of cardiovascular benefits. In effect, even if patients did not have diabetes, this new diabetes drug not only led to weight loss, but also prevented cardiac events. 

The surge in semaglutide’s popularity is not hard to explain. This was the first class of obesity medications that actually worked and semaglutide only needed to be dosed once weekly, which made it more convenient than its predecessors, like liraglutide. It is easy to become cynical when you see people abusing the system. Semaglutide’s popularity led to a global shortage, driven by social media influencers with dubious credibility hyping the drug and online clinics handing out prescriptions like Halloween candy. But bad actors don’t change the scientific facts. Two recent developments show just how beneficial this drug class can be, not just for weight loss but for general disease prevention. 

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We often look at obesity as a lifestyle problem for which the patient is at fault. It is more useful to think of it as a chronic risk factor for many other conditions. Heart disease is the obvious example and was therefore the target of the early trials. Another consequence of obesity is developing fatty liver disease, metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis. Currently, management involves encouraging weight loss though better diet and exercise because medical options are limited.   

Preliminary Phase 2 studies suggested semaglutide might help, and the big news last week was the announcement that in the Phase 3 ESSENCE study, semaglutide helped reverse the inflammation and fibrosis in these patients. The final results are still pending, but semaglutide may prove to be the first truly effective pharmacotherapy in reversing liver damage in these patients. 

The other big development was the publication of the STEP 9 study. It evaluated the benefits of semaglutide in patients with knee osteoarthritis. While the pathophysiology is complex, the increased load obesity puts on the knee joint contributes to the osteoarthritis pain endured by so many. Weight loss is often recommended to patients with arthritis, but only now is there an effective treatment to turn that recommendation into a practical treatment plan. Semaglutide’s ability to reduce pain scores in those with arthritis demonstrates that weight loss is not an esthetic consideration for many patients. It has very real benefits in terms of quality of life. 

There is no doubt semaglutide is expensive. Without private insurance, you may not be able to afford it. It is a chronic therapy for a chronic problem that needs to be continued lifelong. There are side-effects many people cannot tolerate. But it helps people lose weight. More importantly, it helps prevent heart attacks, seems to reverse liver inflammation and eases the pain of arthritis. Semaglutide prevents and treats diseases and should be covered like all other medications for the same reason. 

Christopher Labos is a Montreal physician, co-host of the Body of Evidence podcast and author of Does Coffee Cause Cancer?

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