Claire Bugos is a staff reporter covering health and science for Verywell.
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Sarah Bramblette has long sought a sustainable way to manage her weight. She lives with obesity, lipedema, and lymphedema–conditions that cause swelling and fat buildup. Over the years, she had tried bariatric surgery and various medications, only to see her weight return.
Then, in June 2021, a drug called Wegovy (semaglutide) was approved for weight loss, making it the first anti-obesity medication in the U.S. since 2014. Bramblette was hopeful that Wegovy would give her the support she needed to shed some pounds and care for her heart health.
But Bramblette is on Medicare for disability, and the government health program doesn’t cover medications for obesity. Paying for a month of the drugs would wipe out a whole disability check, she said.
By some fluke, her pharmacist had recorded that she was diagnosed with diabetes. That allowed her to get a prescription for Ozempic (semaglutide), a type 2 diabetes drug that is simply a low-dose version of Wegovy. Medicare covers diabetes medications, but not those indicated for weight loss.
Across the U.S., patients like Bramblette are struggling to get their hands on weight loss drugs like Ozempic, even when they have a prescription. The shortage is driven in part by a frenzy of reports on social media from celebrities and influencers who tout the drugs for cosmetic weight loss.
“People with obesity finally have something that's helping us, and it's being hijacked by the same people who mock us for having obesity,” Brambletree said. “The same people who always tell us, ‘you just need to move more and eat less’ are the people out there wanting this to lose 15 pounds. It's just very, very frustrating.”
Shortages of the medication had her driving to pharmacies across south Florida seeking one with available stock. At times, she accepted low-dose samples of Ozempic offered by her doctor, self-injecting four shots to get her full weekly dose.
Now at 400 pounds, Bramblette said she hopes to continue to lose weight, with the help of medication, to keep from developing diabetes and liver problems.
“It's not a fad,” she said. “There's a difference between treatment of obesity and diet culture,” she said.
In May, Eli Lilly’s Mounjaro (tirzepatide) received FDA approval to treat type 2 diabetes. The drug has also shown great success as a weight loss medication, and the company is now seeking an indication for obesity. From its very debut, Mounjaro has been in high demand, partially as an off-label diet pill, and it’s now also on the FDA drug shortage list.
But Eli Lilly recently tightened access to the drug by requiring patients to attest they have diabetes before using a coupon from the company to lower their out-of-pocket costs. The move may be to preserve medication for the diabetes patients for whom this drug is indicated, or to keep Lilly in the good graces of the FDA, said Dan Bessesen, MD, an endocrinologist and a professor of medicine at the University of Colorado.
Despite these medications’ effectiveness in promoting weight loss, they’re often underprescribed for patients with obesity, according to Bessesen.
More than 70% of people with type 2 diabetes take drugs to treat their condition, while only about 3% of people with obesity can say the same.
Part of the reason, Bessesen said, is that providers may recall the fraught history of weight loss drugs. In the late 1990s, “fen-phen,” a combination of fenfluramine and phentermine, was pulled from the market after it was linked to heart valve problems. There are other weight loss drugs still on the market, but they tend to be less effective or come with undesirable side effects compared with semaglutide and tirzepatide.
Tirzepatide and semaglutide, the drugs that comprise the new weight loss drugs, belong to a class of medications that mimic natural hormones involved with insulin production and appetite. They create a feeling of being full when patients eat less than usual.
Tirzepatide achieved a more than 20% body weight reduction in clinical trials, while semaglutide achieved a 17% reduction.
Reshmi Srinath, MD, director of the Mount Sinai weight and metabolism management program, said that many patients she treats have already tried lifestyle changes. Medications are a “crucial step in their path to weight loss.”
“Metabolically, these drugs help to protect the liver, reducing the risk of what's called nonalcoholic fatty liver disease. They're potentially beneficial for the heart, they're helping protect the pancreas and reduce insulin resistance—they’re doing multiple actions at once.” Srinath said.
Some providers argue that prescribing the drugs will distract people from making important lifestyle changes, like adhering to a healthy diet and exercise. Bessesen said that weight bias and stigma often factor into providers’ decisions not to prescribe weight loss medications.
People with obesity finally have something that's helping us, and it's being hijacked by the same people who mock us for having obesity. The same people who always tell us, ‘you just need to move more and eat less’ are the people out there wanting this to lose 15 pounds.
Bariatric surgery, the current gold standard for weight loss, tends to cause 25-30% weight loss while lifestyle changes tend to make a 5-10% difference. For patients who aren’t seeing enough progress with lifestyle changes but may not benefit from surgery, medication can be a middle ground option.
“Diabetes could be treated with diet exercise. But people don't say, ‘I'm not going to give you any medicine until you prove to me that you're not eating any sugar,’ or something like that. And yet that kind of language gets used all the time with people with obesity,” Bessesen said.
But this mindset appears to be shifting, at least among some providers, Bessesen said. Last week, the American Diabetes Association released new guidance for providers, emphasizing the importance of pharmacotherapy for treating obesity and diabetes.
For Bramblette, who lives with lymphedema and lipidemia, the fat accumulation caused by these conditions doesn’t necessarily respond to diet, exercise, or other lifestyle factors. As an advocate for the Obesity Action Coalition, Bramblette works to increase access to treatment options and to encourage research into the causes of metabolic diseases.
“I am a firm believer that it's taken this long to get effective treatments for obesity because of weight stigma,” Bramblette said. “There's always been this idea that we just needed to eat less and move more.”
Medicare does not cover weight-loss drugs, though the program pays for bariatric surgery. List prices for the drugs run upwards of $1,300 per month. Plus, providers aren’t usually compensated for the cost of a weight loss drug for patients with obesity, which may dissuade them from prescribing the medication in the first place.
“The medicine is being selectively prescribed to people who pay for it out of pocket,” Bessesen said. “If you have diabetes and the only way you get a good diabetes medicine is if you pay for it out of pocket, and everybody else gets one that's less effective, I think that's a health equity issue.”
For the weight loss drugs to work, patients must take the drug consistently for life. The cost to insurers of covering the 40% of Americans who have obesity, Bessesen said, is “untenable.”
If Eli Lilly wins approval to sell tirzepatide as a weight loss drug, Srinath said she is hopeful that it’s somewhat affordable for patients.
“With other pills, we sometimes can use generics, but there are no generic forms of some of these newer medications. I'm really hopeful that some of that will change in the near future.” Srinath said.
Bramblette said she’s reliant on medication to continue improving her health. With the existing accessibility challenges, the cost barriers add insult to injury.
“As someone who's on disability and is on a fixed income, knowing that they're not just getting this written off label, but that it's not covered…it kind of makes it burn even more,” Bramblette said. “It’s just the fact that they're laying down thousands of dollars a month for maybe 15 pounds. I've never only been 15 pounds overweight.”
Eli Lilly said it is working to increase its supply but expects shortages to persist in coming months. Nova Nordisk, the manufacturer of Ozempic and Wegovy, said it is working to make Wegovy more widely available by the end of the year, and that it will increase its production capacity in 2023.
If you have obesity or type 2 diabetes and are looking for support with managing your weight, talk to your provider about the possibility of taking a weight loss medication. They can help you come up with a diet and exercise plan and can recommend a weight loss drug that’s right for you.
Food and Drug Administration. FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA.
Centers for Disease Control and Prevention. Adult Obesity Facts.
Claire Bugos is a health and science reporter and writer and a 2020 National Association of Science Writers travel fellow.
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