Ozempic patients risk muscle, bone loss instead of weight loss, doctors warn

An explosion of new patients receiving the weight-loss drug in the mail do not understand how to use it properly, risking dangerous side-effects, medicos warn.

Surging demand for diabetes and weight-loss drugs Ozempic and Wegovy has made Danish pharma group Novo Nordisk Europe's most valuable company.

Leading doctors are becoming ­increasingly concerned at the health risks to people being prescribed the diabetes drug Ozempic who are not getting comprehensive healthcare, warning that many risk becoming “lean but malnourished” with significant loss of muscle and bone mass.

There has been an explosion of patients being prescribed Ozempic for weight loss since commercial telehealth providers gained access to prescribe the drug. But many health experts are worried about the subscription-based model in which many patients receive the medication in the mail and do not access support to change their underlying diet and behaviours.

Because the drug reduces appetite, food intake often drops significantly and many people do not understand the importance of eating sufficient protein. This is ­especially important in the light of the fact that much of the weight loss on GLP-1 agonists tends to be muscle mass rather than fat if ­nutrition is insufficient.

Associate professor Suong Le, chief medical officer and founder of the telehealth start-up Juno, has raised concerns that some telehealth operators were not sufficiently managing drug risks. Professor Le labelled some telehealth providers “drug vendors”.

“What you have now, quite dangerously, is what appears to be a panacea, which is a group of drugs that you can just take, and you don’t need to do anything else,” Professor Le told the Private Healthcare Australia annual conference this week.

“You can order online, there’s no barriers, it gets sent to you.

“My concern is that this model across the world, which tech companies have seized on – which is drug delivery – that conversation about risks is not part of it.

“If you’re not part of that ­patient’s entire health journey at a primary-care level, and you’re being used as a drug vendor, how do you actually know what is happening with these patients?”

Professor Le cited clinical trials that showed the majority of the weight loss in people taking GLP-1 agonist drugs was muscle loss. That can lead to a cycle in which basal metabolic rate is reduced, and weight regain occurs, which is mostly fat, further negatively ­altering the body’s composition.

“So if people are losing muscle, and they are going on these cycles where they relapse and go back up in their weight, but they’re regaining fat, and their muscle is not up to its baseline, what are the long-term implications in terms of musculoskeletal complications, in terms of osteoporosis, infection complications?” Professor Le said.

She also raised concerns that women of reproductive age did not sufficiently understand the risks to the foetus of taking weight-loss drugs during pregnancy.

Leading nutrition and exercise researcher and physician Luigi Fontana backed Professor Le’s comments.

“The solution is fantastic for the companies that are producing these drugs, and for the stakeholders, but for the society and for the governments it is a disaster,” he said. “Basically a lot of these patients are going to be lean but malnourished and with a lot of chronic issues.”

Matt Vickers, the clinical director of telehealth company Eucalyptus, the parent company of Juniper that prescribes Ozempic to many ­patients, took issue with the “drug vendor” descriptor, which was not directed at Juniper doctors. He said patient risks were carefully managed.

“Juniper patients are required to complete a detailed questionnaire about their medical history that is in excess of 80 questions, prior to a consultation with a registered health practitioner,” Dr Vickers said. “This is far more extensive and granular than is often the case during a 15-minute in-person GP consultation.”

He said women who were pregnant or planning to conceive were screened and deemed ineligible for Ozempic.

“Regarding sarcopenia, Juniper’s model incorporates a multidisciplinary team of dietitians and health coaches in order to ensure patients are also advised on appropriate lifestyle changes, in addition to medical intervention,” Dr Vickers said.

“This includes specific advice about avoiding muscle mass loss, which is a risk in all instances of weight loss whether or not medication is involved. This holistic treatment model is beyond what a patient would receive at any normal GP practice.

“Juniper promotes ongoing relationships with our patients through continual support and follow-up processes.”