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Tips for successfully managing
weight loss during the medication shortages

Welcome to Alevia’s 4 part series on managing through this time of medication shortages.

(NB You may know of others who might find this information useful – feel free to share this with them).

The last 6-7 months have proven to be a very difficult time for many of our patients, who have, for the first time, found a really effective treatment for their health condition – only to find supply of this medication to be intermittent or non existent.

First of all, a word about Obesity

Obesity has been recognised by the World Health Organisation as a disease (James, 2008), and the behind smoking, is the leading cause of poor health in our society (DHHS, Vic 2022). Our appetite is regulated in the brain with feedback from our gut and fat cells. In obesity, appetite becomes dysregulated and weight trends up. We become more efficient at storing energy, and it becomes increasingly hard to lose it, as the body defends us against weight loss, with counter-regulatory increases in hunger and appetite hormones. The end result: weight increases and we start accumulating complications of obesity.

So what has it been like to finally access effective treatments for obesity?

Here’s what our patients are saying..

“I feel like a magic switch has been flicked off in my brain, and I’m no longer thinking about food all the time”

“There is more space in my brain, now that I am not constantly thinking about food”

“This medication has been more effective than years of therapy for binge eating”

“Eating is no longer a battle”

Our patients have been pleasantly surprised at how much easier it has been to manage their weight and reduce their health complications such as Type 2 diabetes, blood pressure, sleep apnoea, but more importantly, feeling better in themselves physically and emotionally.

So then, what impact has the intermittent or non existent supply been like for you?

“I feel like Im back in hell, but the difference is, I now know what it feels like to have been out of it!”

“I’m now back to battling what to eat /not eat, every moment of the day”

“My binge eating habits are back”

Our patients have also reported a huge fear of weight regain after working so hard to get weight off, a sense of failure when weight does creep back on again, return of physical complaints such as joint pain, lack of energy, difficulty with mobility, as well as worsening of health conditions such as poor control of diabetes, return to use of sleep apnoea devices, back on blood pressure medications. Then there has been the issue of the shame and frustration of having to front up to the pharmacy and being told, (sometimes in a not too pleasant way) “No, you can’t have that medication. It’s only for people with diabetes”

So, we’ve had highly effective treatments available, and then not available.. How can this happen in 2022?

Let’s set the scene for how this problem came to be.

In March 2021, a paper by Wilding et al., was published in the highly regarded scientific journal the New England Journal of Medicine, showing the benefits of a once weekly injection for the treatment of obesity. This study demonstrated that patients who had a BMI of 30 and above, or 27 and above with obesity complications, were able to achieve, on average, 14.9% weight loss with once weekly semaglutide 2.4mg, compared to the placebo group, who achieved 2.4% weight loss.

Subsequently, several other papers in the STEP trial series (STEP 2, STEP 3, STEP 4), demonstrated between 10-18% weight loss with different study designs.

On the back of these scientific papers, semaglutide 2.4mg (Wegovy) was approved by in the USA by the FDA in June 2021 (FDA June 2021) and then released into the market. By November 2021, due to the huge demand for this medication (USA has obesity rates of 41.7%. – NHANES 2022), we saw the first signs of a shortage of this medication, and directives were issued for doctors not to start any new patients on this medication, as there was insufficient supply to meet the huge demand. The increase in demand was also fuelled by social media posts and TikTok users promoting their success with this medication.

At around the same time that Wegovy was approved in the USA, semaglutide 1mg (Ozempic) became available in Australia and was subsequently listed on the Pharmaceutical Beneifts Scheme (PBS) in September 2021, to be subsidised for patients with Type 2 Diabetes, who had an Hba1c of >7% and who were on, or couldn’t tolerate, metformin or a suphonylurea oral medication for diabetes.

These demand issues started to have a flow on effect, and by early 2022 worldwide supply of Ozempic was insufficient to meet the demand. This was also due in part to quality control issues in the manufacturing plants (filling of the ozempic syringes), but by far and away, the biggest factor has been due to huge demand for this highly effective medication.

So why haven’t the manufacturers been able to keep up with the demand? 

It has been reported that demand for semaglutide has been 10-15 times what was predicted. So even with multi-million dollar investments in manufacturing plants in Denmark and North America, the demand has far exceeded the ability to supply this medication.

On May 17th the TGA put out a directive that Semaglutide 1mg (Ozempic) was in short supply and was to be prioritised for patients with Type 2 Diabetes (TGA May 2022). This unleashed a backlash of highly emotive media campaigns with headlines such as “Stop stealing my life saving diabetes treatment”, further stigmatising patients living with Obesity.

Then the estimated supply dates were June…. then August…..then December and now…. March 23! Arghhhhhh.

Pleasingly, semaglutide 2.4mg (Wegovy) was approved by the TGA for the treatment of Obesity in September 2022, but is yet to reach our shelves in Australia (TGA Sept 2022)

The manufacturing company Novonordisk have stated that they WILL be supplying semaglutide 1mg in the first quarter of 2023 and there is no fixed date for supply of Wegovy, but this is anticipated to be in the 2nd half of next year.

And it’s easy to start thinking the worst during these times

“I can’t do this – it’s all too hard!”

“I think the diabetics need it more!”

“What’s the point?”

If you’ve had these thoughts, then you’d be forgiven for feeling this way! Especially after the difficulty of having, and then not having access to these treatments.

However, all is not lost.. There are things we can do to manage during this time.

We want to turn our attention back to focusing on the things that are in our control, until effective treatments become available again. We want to move;

From hopeless to hopeful.

From frustration to action.

From feeling disempowered, to empowered.

We can’t necessarily control the environment, but we can control what we can do in that environment.

We know it’s hard.

We know that the focus right now, might just be on maintaining your weight or preventing weight regain, until those effective treatments become available again – and that is a great goal to have.

So, over the coming weeks, at Alevia will be providing you with some really useful content to help you to focus on the things that are in your control as well as look at medication alternatives to help you manage the cravings and hunger hormones that drive weight up.

You’ll get some tips from Alevia dietitian Sarah Morgan on what dietary interventions you can use to control weight during this time, and strategies to manager hunger and cravings.

You’ll hear from one of exercise physiologist Grant Jennings, from Kieser, on how you can use exercise to improve mental health and build muscle strength which helps with boosting your metabolism. Because perhaps now is the time to be refocussing on building up your exercise regime again.

And finally, Dr Catherine Bacus, founder of Alevia will be discussing the alternative weight loss medications and future medications that will be coming our way in 2023!

We are here at Alevia to support you in finding your solution to weight control during this time.

Please reach out to our team if youd like to discuss your circumstances and get individualised medical advice or if feel you need weekly support from our team of bariatric GPs and dietitian, to stay on track, then join us in our Starter program.

Finally, remember: you deserve treatment. No one health condition is more important than another.

Stay tuned for next week’s email on dietary strategies to manage cravings and hunger.

Stay healthy, stay well
Warm regards

The team at Alevia Medical Weight Loss

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