Who Deserves Ozempic More? People with Diabetes or People with Obesity?

The current shortage of Ozempic has lead to a lot of somewhat uninformed opinions. You may have read or heard that people using Ozempic for an off label use of losing weight has caused a shortage, and now people with diabetes can't access the drug they need.

Ozempic has been FDA approved as a medication for diabetes since 2017. Ozempic is the brand name for semaglutide, just like Tylenol is the brand for acetaminophen. There is another brand name for semaglutide: Wegovy.

Ozempic and Wegovy are both made by a drug company called Novo Nordisk. The difference between the semaglutide that is branded as Ozempic and the semaglutide that is branded as Wegovy is the max dose for each brand name. The max dose for Ozempic is 2.0mg, and the max dose for Wegovy is 2.4mg. The recommended dose escalation for both are similar: patients start at 0.25mg, increase to 0.5mg, and then to 1mg. For Ozempic, the next two dose escalations are 1.5mg and 2.0mg, while for Wegovy, the next two dose escalations are often 1.7mg and 2.4mg.

The shortage is, in fact, a shortage of both drugs, which in reality are the same drug. There is a shortage of the drug due to increased demand and the drug maker's inability to keep pace with production.

So who deserves Ozempic and Wegovy more? People with diabetes or people with obesity? If you understand weight to be merely an esthetic concern, then it is reasonable to say that those with obesity deserve the drug less. In reality, though, obesity is a medical condition just like diabetes is a medical condition. Who deserves the drug more--those with one medical condition or those with another medical condition?

There are many factors complicating this great ethical dilemma. I think a big factor is the availability of good drugs for each medial condition. There are around eleven categories of diabetes drug. Most of these drug categories have multiple options within the category, leading to more than 100 diabetes drugs to choose from. Of these drugs, there are dozens that are routinely used due to their efficacy in improving blood sugar. In contrast, there are seven total drugs, not drug categories, for obesity. Two or three of these have good efficacy at weight reduction. All are in one drug category.

Another factor is how much the disease is impacting the person's life, quality of life, and life expectancy. Having a HgbA1C of 6.5%, which is in the diabetes range, is arguably less life altering and life shortening than having a BMI of 38 with elevated lipids, sleep apnea, and joint pain. The disease name itself is not an indicator of severity.

At the end of the day, this ethical dilemma is meted out in one place, with no regard for any of these factors: the pharmacy. If your pharmacy has Ozempic or Wegovy in stock, you can get it with a prescription and insurance coverage or money.

I want to take a moment to explain why I didn't address a big topic here--the financial aspect. That is because finances are irrelevant to how much someone deserves the drug. Whether or not someone can afford or has insurance coverage for Ozempic or Wegovy is not a factor in how much they deserve it.