Ozempic: a pill form of the divisive weight-loss drug is on the way

A pill form of Ozempic is on its way as drugmakers reportedly race to become the first comapny to bring an oral version of the diabetes drug (which is also used off-label for weight-loss) to the market. Until now, semaglutide – sold under branded names including Ozempic, Wegovy and Mounjaro – has been predominantly available as an injection, but data from several new studies suggests that a new pill could be just as effective in reducing weight and blood sugar for people both with and without diabetes. Pharmaceutical companies Eli Lilly, Novo Nordisk and Pfizer are all working on developing a pill, which doctors believe will be more palatable to people than injections.

The research was presented yesterday (Sunday 25 June) at the American Diabetes Association Scientific Sessions conference. The first trial, which was funded by Novo Nordisk, the company that manufactures Wegovy and Ozempic, found that 50 milligrams of semaglutide taken orally each day is roughly as effective as weekly Wegovy shots in reducing weight in people who are ‘overweight’ or ‘obese’ and do not have diabetes. For reference, one injection of Wegovy contains up to 2.4 milligrams of semaglutide.

The pill would be a “game changer”, Dr Robert Gabbay, the ADA’s chief scientist, told NBC News. He suspects that many people are not using the treatment because it requires an injection. “The nice thing about tablets is that virtually everyone is used to taking a tablet for something, even if it’s just a vitamin. It’s not a big deal.”

While the pill might entice more people to take semaglutide, the higher dose does mean there are more side effects. In the trial of overweight or obese people without diabetes, 80 percent reported gastrointestinal issues like vomiting, nausea, constipation or diarrhoea. Nearly 13 percent said they experienced “altered skin sensation” like tingling.

This comes on top of the emotional side effects that come with taking semaglutide. Earlier this month, Professor Jens Juul Holst, a scientist whose work in the 1970s helped pioneer Ozempic, warned that people will struggle to take it for more than a few years because it takes the pleasure out of eating. “Once you’ve been on this for a year or two, life is so miserably boring that you can’t stand it any longer and you have to go back to your old life,” he said. Emerging reports that semaglutide also suppresses the desire to do activities like drink alcohol and go shopping has led some people to believe the drug also has a future as anti-addiction medication.

Higher side effects were also seen in the second trial, also funded by Novo Nordisk, which focused on oral semaglutide for people with Type 2 diabetes. Participants in this study were given different daily doses of the pill. Those who took the higher doses (25- and 50-milligram doses) lost more weight and had greater reductions in blood sugar compared to those who took the lowest dose (14-milligram). However, 80 percent of people on the 50-milligram dose reported adverse effects which occurred more frequently than those on the lowest dose. 13 per cent of people on the highest dose stopped taking the medication because of the side effects. 

An oral version of semaglutide, called Rybelsus, is currently available from Novo Nordisk but it is a low dose (14 milligrams) and is only approved for adults with Type 2 diabetes. It is less effective than Ozempic and Wegovy, according to Dr Gabbay. It’s not just Novo Nordisk that is racing to develop this pill. Eli Lilly presented a trial at the conference looking at orforglipron, a different oral compound that belongs to the same class of medication as semaglutide. Participants taking the drug lost an average of 9.4 percent to 14.7 per cent of their body weight, depending on the dose given, after 36 weeks. Pfizer is also testing its own pill in that drug class.

Oral forms of semaglutide will probably not become available until at least next year, but the possibility of the drug already has some experts worried about the impact it will have on people who use it for cosmetic weight loss. “I am concerned about these medications being broadly used just to promote weight loss and how it contributes to our general diet culture, our cultural obsession with thinness,” Dr Scott Hagan, an assistant professor of medicine at the University of Washington who has studied obesity, told the New York Times.

Since the weight-loss effects of Ozempic have become known to the general public, the drug has dominated the cultural conversation and it is reportedly being widely used in Hollywood, New York City and Westminster, as well as in the fashion industry. Kim and Khloé Kardashian were famously accused of taking the drug following their extreme weight loss. The medication’s soaring popularity has exposed how, despite the body-positive movement and the “slim-thick”, BBL hourglass figure that celebrities like the Kardashians championed last decade, our culture is as diet-entrenched and skinny-obsessed as it always has been.

Semaglutide is so popular that diabetics are now struggling to get their hands on it thanks to consumer demand. It’s therefore unsurprising to see the speed at which these new medications are being developed. While no doubt the good scientists at companies like Novo Nordisk are very concerned about treating diabetes, big pharma has been known to do what needs to be done to make a profit at any expense – and Ozempic is making a lot of money. Ozempic is forecast to have 2023 sales of $12.5 billion and up to $17bn in 2029. It accounts for 98 percent of Novo Nordisk’s 42 percent overall growth last year.

Advertising for Ozempic and Wegovy has been plastered all over the US – on the sides of trams, the walls of subway stations and even the stairways of cinemas. And people are taking it because, as a society, we are still trapped in the clutches of the fatphobia that is and has always been so pervasive. In New York Magazine’s cover story about Ozempic, Aubrey Gordon is quoted as saying that the hype around the drug boils down to: “Can we finally be rid of fat people? Can we finally stop having fat people around so I don’t have to look at them anymore?”

Also in that piece, a woman who is taking Ozempic for non-diabetic reasons admits that she would prioritise weight loss over her overall health. “I mean, this is so humiliating, but I’m like, Thyroid cancer’s not that bad?” she says.