Here’s a good current example of medical irony: the same week that our drug regulator, Health Canada, approved the first generic version of semaglutide—the active ingredient in weight-loss drug Ozempic—a major medical journal published findings highlighting the medication’s troubling connection to eating disorders.
The timing couldn’t be more paradoxical: just as this powerful appetite suppressant becomes more accessible and affordable to millions of Canadians, we’re learning more about its potential to trigger dangerous psychological relationships with food. What we do know, as the New England Journal of Medicine reminded us, is that these drugs come with a range of troubling side effects, which you can discover if you have the fortitude to unwrap the numbing medicalese they use to describe them. The NEJM article describes the link to eating disorders as well as a range of other troubling effects including “nutrient deficiencies, electrolyte abnormalities, orthostatic hypotension, osteopenia, sarcopenia, thinning hair, and other signs of malnutrition.” Then the last spike, unlikely to deliver any discomfort is that “the effects of long-term use are still largely unknown.” Amen to that.
This same week, two different generic drug companies, one from India and one from Canada, were given licenses to sell generic semaglutide. This has been called a “long-awaited moment for diabetes and weight management treatment,” yet let’s not break out the champagne yet. We Canadians are going to be the canaries in the coal mine on this, as we’re the first G-7 country to approve the generic version of Ozempic. Up until now it has mostly been sticker shock preventing a lot of people from jumping on the Ozempic bandwagon, but when that barrier is gone? Open the floodgates.
The Canadian media was all over this exciting new development, delivering fulsome praise for the arrival of the cheap stuff which will massively increase the size of the GLP-1 market in Canada. The generic version (which is currently only approved for type-2 diabetes) will probably enter the market at 75% the price of the brand name, but as more and more companies start producing generics, the price could fall as far as a quarter of its current price.
I imagine citizens of the United States have no sympathy for Canadians as the price of our Ozempic is already about one-fifth what it currently is in the US. When the generics hit the market we might be paying about one-tenth of what Americans are paying. Expanding the use of this class of drugs to countless patients previously priced out of treatment might be cheered as a major public health victory, but the triumph is shadowed by emerging evidence about semaglutide’s darker psychological effects.
As the New England Journal of Medicine reported, recent studies and clinical reports have documented concerning patterns: Some patients develop restrictive eating behaviors, obsessively monitor their food, and in some cases, develop full-blown eating disorders. The very mechanism that makes these drugs effective—dramatically suppressing appetite and slowing gastric emptying—can apparently trigger psychological responses that mirror anorexia nervosa and other eating disorders.
With one in eight US adults — or approximately 33 million people — reportedly having taken GLP-1 drugs, this proportion translates to more than 420,000 people who could develop a related eating disorder with long-term use. About 3% of Canadians are currently prescribed GLP-1 medications (including semaglutide/Ozempic, liraglutide, tirzepatide, etc.) equating to potentially tens of thousands of cases of eating disorders.
The irony runs deeper than mere timing. Semaglutide medications like Ozempic were originally developed for type 2 diabetes but weight loss soon emerged as the most beneficial (and profitable) side effect. As these drugs gained popularity for cosmetic weight loss—often prescribed off-label to people without diabetes—clinicians began noticing troubling patterns. Some patients reported disturbing relationships with hunger cues, developed anxiety around eating, or experienced what researchers term “food aversion.” There is often guilt around what people eat and an intense obsession with maintaining the weight loss already achieved. This, of course, has no end date as the drugs are only effective as long as they are taken, and some patients who stop the treatments gain most of the weight back, and more.
So what is going to happen in Canada when more and more people, who can now afford the drugs, head in that direction? Some say that better availability serves those with legitimate medical needs—diabetes or obesity-related health complications and possibly some cardiovascular and metabolic benefits. On the other hand, increased accessibility raises concerns about how inappropriately these drugs are going to be used and if patients will be adequately monitored.
Here’s the rub: will more people seek the cheaper drugs for cosmetic weight loss without proper psychiatric screening? Will family physicians, already stretched thin, have the resources to check whether their GLP-1 patients are falling into an eating disorder trap?
The solution isn’t to restrict access to beneficial medication, but rather to ensure that expanded availability comes with appropriate safeguards.
All I can say is that we’ve seen this rodeo before, where almost every weight-loss drug that has come around finds hype and hope eclipsing rationality and appropriate drug use. Even if the authorities were able to somehow manage to get doctors to identify patients at risk for eating disorders before prescribing could they, or would they do it? Instituting some kind of high-grade “informed consent” seems needed but that is also very unlikely to happen.
The marketing of these drugs, in the form of propaganda mostly, has pretty much swamped the information ecosystem so the likelihood that patients understand both the benefits and harms of these powerful medications is low, to non-existent.
While the generic approval of semaglutide might represent progress in making effective treatment accessible, the simultaneous emergence of eating disorders among all the known adverse effects of these drugs looks like a disaster in the making.
The Ozempic paradox—life-changing medication becoming more accessible just as we discover its psychological risks—perfectly encapsulates the complexity of modern medicine. It’s a reminder that even our greatest therapeutic advances require careful, nuanced implementation, not the full-on weapons-grade marketing juggernaut that has exemplified Ozempic’s short life on this planet.
As generic semaglutide reaches more Canadian patients, the challenge will be ensuring that expanded access enhances health outcomes rather than creating new categories of medical harm. Canada will be the test case in how generic semaglutide might compete with the branded GLP-1s. We’ll see how that experiment goes when widespread access to a drug known to cause serious adverse effects is unleashed on a modern healthcare system.
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