Surgeons raise concerns about Ozempic, other GLP-1s

Surgeons and health system leaders are voicing concerns about the unknown long-term risks of glucagon-like peptide-1 receptor agonists, such as Ozempic, Wegovy and Saxenda. 

Most GLP-1s aren't indicated for weight loss, but the approved diabetes treatments skyrocketed in popularity in late 2022 and early 2023 after celebrities freely endorsed the product for weight loss capabilities. 

Because of Ozempic and other diabetes drugs going viral on social media platforms, the number of written prescriptions for GLP-1s have surged. In the last three months of 2022, as #Ozempicweightloss was racking up more than 85 million views on TikTok, physicians wrote more than 9 million new GLP-1 prescriptions, according to a report.

As of Nov. 21, TikToks with #Ozempicweightloss have been viewed more than 421 million times.

"In weight loss surgery or medicine too, there's always a gravitation to what's the sexy new thing," said Tim Schaffner, MD, bariatric surgeon at Bon Secours in Hampton Roads, Va.

Dexter Turnquest, MD, a bariatric surgeon at Houston Methodist Willowbrook Hospital, said obesity is too complex of a disease to warrant the drugs to be "indiscriminately passed out" without other chronic weight loss management, such as correcting exercise and diet. 

Prescribing a medication off-label isn't uncommon, but the rapid increase in these scripts has surgeons concerned about future findings. The first GLP-1 to secure approval, Amylin Pharmaceuticals and Eli Lilly's Byetta (exenatide), was in 2004, and the first approved oral solution was Novo Nordisk's Rybelsus (semaglutide) in 2019. 

Although these drugs have been in the market for years, a big unknown is the long-term effects. 

Joshua Knight, MD, medical director of quality for Pittsburgh-based UPMC, told Becker's his system is carefully watching the rise of off-label GLP-1 prescriptions, especially after the  American Society of Anesthesiologists recommended patients withhold taking their GLP-1 dose within the drug's half life because of the risk of regurgitation and aspiration in surgeries.

"Occasionally, patients will arrive for an electric procedure and they are taking these medications specifically for weight loss," Dr. Knight, an anesthesiologist, said. "[The prescription] may or may not have been seen by a patient's primary care provider or some other perioperative provider that was offering optimization prior to surgery. So, that can present an issue on the day of surgery with what to do when someone finds out that their last dose of one of these medications was within the holding interval."

Other concerns surround the increase in compounded GLP-1s, which are typically cheaper than branded drugs but are in legal trouble as drugmakers try to sniff them out, and the risk of gastroparesis, a stomach paralysis that can be connected to diabetes or neurological issues.

Dr. Schaffner and Christopher C. Thompson, MD, director of endoscopy for Boston-based Brigham and Women's Hospital and co-director of its Center for Weight Management and Wellness, both wonder about the cost-benefit balance between GLP-1s — which can be hundreds of dollars a month — and weight loss surgeries — which are more expensive upfront.

Dr. Schaffner said the "ultimate question" is whether patients taking GLP-1s keep the intended weight off long-term. Alfred Trang, MD, medical director of general surgery for Livonia, Mich.-based Trinity Health Mid-Atlantic, agrees.

"I am concerned that the medication slows down gastric emptying, and so to what extent, how permanent it is, these things we don't know yet," Dr. Trang said. "The studies out there, the [longest] study was only about 68 weeks. What happens when the patients are taking them for five years? For 10 years? We just don't know."

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