Dr. Sanjay Gupta (0:00)

You know, it's no surprise that around this time of year, many people are thinking about losing weight. It's part of their New Year's resolutions. There was this Pew survey conducted last year which found that 79% of people who made a New Year's resolution said that theirs had to do with their health or their exercise or their diet. Now it's really interesting to see what these new weight loss medications will do to those resolutions. After all, it is a new, powerful tool. But. But at the same time, as with most medications, they are not for everyone. I want to make this point over and over again. In fact, last week, you may remember, we met Rashida and Brian Bush, mother and son. They really found incredible success with these drugs. But as you're about to hear, their journey is not over. And the rest of their story is Critically important. I'm Dr. Sanjay Gupta, and here's part two. Is Ozempic right for you? As the sun sets on a beautiful spring night in Williamstown, New Jersey, we arrive for another visit with Rashida and Brian Bush. We're just in time for their weekly shots. It stings, but it goes right away. This is a routine which has helped them lose more than 200 pounds. They have never felt better. That is, until tonight. Last shot. Last shot. Of a drug that she credits with changing their lives. I've made a lot of progress, and I can't turn back now. This was just emails. You see, after losing her job and her insurance, Rashida can no longer afford her monthly supply. Keep in mind, these are wildly expensive drugs for her. $1,600 every month. Does it feel like the clock is sort of running on these medications? It does. It's not the first time this has happened. Last year, her insurer stopped paying for Ozempic. That's the medication she initially had so much success with. It was why she switched to Mounjaro, a drug similar to Ozempic that's made by Eli Lilly. But now she's at risk of losing that as well. I think it's utterly ridiculous. And last one, it's been extremely hard. At least 10 patients a day cannot get these medications. Here's the problem. Private coverage varies from company to company, and even Medicare can vary from state to state, making it all very confusing and hard to navigate. And a lot of this disproportionately affects the black community. You see, black people are more likely than white people to have diabetes or obesity, but they're also about four times less likely than white people to get a prescription for these medications. I'm angry at the system. I think anyone who wants the meds should be able to have access to the meds. But there's another reason that so many people all over the world were unable to access these drugs. You see, when they were first introduced, there was actually little fanfare. But starting in 2021, celebrities, a tech mogul, social media influencers, they all began talking and tweeting and posting about these drugs. On TikTok, the hashtag ozempic was viewed hundreds of millions of times, whether 5 or 50 pounds. People looking to lose weight were desperate for these medications, even if they weren't diagnosed with diabetes or obesity. So doctors began increasingly prescribing them for what's called off label use. Demand skyrocketed and drug companies could not keep up. Three times I had to in a short period of time, only take half the dose. Yeah. The doctors were allowed to prescribe Ozempic to people without diabetes so that they could lose weight. And there wasn't enough for both of the groups. There's no point in blaming people wanting to lose weight. They still have a problem. We didn't how much of the shortage is sort of being driven by people who don't necessarily qualify. I think even if there was no use outside of that population, we still wouldn't be able to make enough. Why not? Well, first the medications. Now remember we told you that harvesting enough hormones from nature that would be impossible. So Novo Nordisk created a GLP1 like ingredient or a mimic that's called Semaglutide. It's what they use in their diabetes medication Ozempic and their weight loss medication Wegovy. And at Eli Lilly they formulated a mimic of two gut hormones, GLP1 and GIP. It's called tirzepatide. And that's what they use in their versions, Mounjaro and Zepbound. Here's the thing, mimics of Semaglutide and Tirzepatide. They are readily available, but experts estimate that it takes months for the drug companies to purify them and and then mix them to the right strength and potency to be an FDA approved medicine. Now even if they could speed up that process, they still have to make enough of these special pens that dispense a pre measured amount of medication. And that takes time. The Eli Lillypen for example, has 14 unique parts. Each one of them has to be molded, snapped together and then quality tested. All we know is essentially the more we make, the more gets used. I've Made my way to a pharmacy outside of New York City here on Long Island. It's probably going to look a little different than any pharmacy that you've seen before. This is called a compounding pharmacy. And one of the goals here is to provide alternatives for medications that are currently in shortage. Let's take a look at how they do it. Pharmacist Joe Navarro has been compounding medications for decades, and lately his business has been booming. Going to the left, he takes me into the sterile lab where it's all done. This is what a product with semaglutide or semaglutide would look like. So it comes packaged on ice. It comes from an FDA approved wholesaler with a certificate of analysis. This is what it is. So it's literally one gram of powder. That powder is then diluted, sterilized, packaged, and quality tested. Now, that's not the actual FDA approved product, but it is thought to have a similar effect. So this is what comes in as the active pharmaceutical ingredient. And this is what your final product goes out to the patient along with a syringe. Syringe. So instead of a pen, you got this and this? That's correct. A monthly supply costs anywhere from $250 to $500. But I want to be clear about something. Compounding pharmacists like Novara are only allowed to make these copies when there is an official shortage. These drugs cannot just be thought of as low cost alternatives. But as long as the FDA calls it a shortage, consumers with limited finances can benefit. Consumers like Rashida. After a lot of research and a virtual doctor's visit, she got compounded semaglutide from an online pharmacy. You didn't even want to take Ozempic initially. You want to be very careful. How are you feeling about a compounded version of this? That's a band aid. I wouldn't want to do that. Long term. It's a band aid. And incidentally, it's a band aid Brian can't use. So I think step one is we his doctor won't prescribe the compounded version for him. She wants the FDA approved version. So he's going to have to wait until Rasheeda can get new coverage. He's been saying he's hungrier this week. Yes, we need to get you back on as soon as possible. A week after taking her final dose of Manjaro, we arrive back in time for her first shot of the compounded drug. Rashida is worried about drawing up the right amount of medication with the syringe those pens are so much easier. Will it work? Is it safe? The first time I ever took Ozempic I was really scared and really reluctant, but I was really excited as well. Our next stop, Oxford, England, to investigate the unbelievable story of Michelle sword. In late 2020, she was newly divorced and a few pounds heavier. And after COVID lockdown, Michelle's close friend, a nurse, told her about a then relatively unknown drug, Ozempic, that she said was pretty easy to get and could help her lose weight. And I was able to have it sent to my house through proper pharmaceutical company. Don't forget to say Oona when you're on your last card co you'll go. And it worked. In just four months, Michelle lost £30. I ended up being really, really quite petite at £112. I felt great. Ozempic worked well for her the first time, definitely. But her best friend, Vicky Blissett was worried about her. I've got pictures of her birthday in 2020. She did look too skinny. Friends and family pointed out, you've lost too much weight, you don't look healthy. So Michelle stopped taking Ozempic. But like a lot of people who stopped the meds, Michelle regained most of the weight within a year. I felt much bigger. So it created that sort of, sort of like a dark thought in your mind. I have lost 27.8 pounds. I've been down 50 pounds since March. It was winter 2023 and miracle weight loss stories were everywhere. So Michelle was tempted once again. But this time it wasn't as easy to get. I just picked a company online, the silliest thing that you could probably do. When the box arrived, it looked like the Ozempic pen she had used years earlier. So Michelle tried it. The clicker turned different. So how the clicker on the end of her nose empic pen would turn within about 10 minutes. I couldn't hold myself up. Michelle's daughter panicked and called Vicki to come help. Michelle was completely unresponsive on the floor. We were really lucky actually. That night the ambulance was with Michelle. I think within seven minutes. These images may be a little hard to see. The paramedics trying everything, an IV glucose tablets, nothing worked. Michelle's veins had collapsed. She couldn't even swallow. Unable to stabilize her, they raced her to the hospital. I truly thought that I was going to watch my best friend die. They just fought very hard to save my life. They later found fast acting insulin in my body and it was just killing me. Fast acting insulin that the doctors would later learn came from that fake Ozempic pen Michelle had used. It's what caused her blood sugar to plummet. And that was when it hit me. My poor little family. If they lost me, I don't know what would have happened when I was so angry at myself. I'm so angry and so ashamed. Sorry. I gotta tell you, Michelle's story is not at all surprising to the man I'm about to introduce you to. We're heading to this secret location outside of London to meet the Director of Criminal enforcement for all counterfeit drugs in the uk. He tells me that so far his team has seized upwards of a thousand of fake Ozempic or faux as it's called. That's the most of any country in Europe. I did not know what to expect. Andy, this is a full warehouse of problem drugs. It's more than full, Sanjay. In Andy Morling's decades of experience, he has never seen anything happen like he has with these weight loss drugs. Criminals were buying up or somehow getting hold of insulin pens and then crudely relabeling them. These people who are buying these and potentially harm, they think they're buying the real thing. Sure. I don't know if you can tell and with good reason, but which one would you say is the genuine. Which one is the fake? I'm gonna. And it's funny because they always say, check with your doctor. I'm a doctor. So we're now doing that. I'm gonna say this is the real thing. Yeah. Well done. You can see years of medical training have enabled you to make that judgment. The label has not been put on particularly. Yeah, that's what I noticed. Right. The label sort of overlapped and patients don't have the benefit that we have been able to compare one with the other. You know, if you receive this through the post, it's on its own, you know, and it looks like a genuine product because it is a genuine product. It's just not genuine. A zempic. Across the pond back here in the United States, at the nation's capital, the dangers of these counterfeit products, it's troubling. The FDA says in 2023 it seized thousands of units of fake Ozempic. America's poison control centers said they saw a 1500% increase in calls related to injectable weight loss drugs. People are accidentally overdosing. Hoyten center, how can I help? So anytime you have an increase in the prescribing of any medication, the number of overdoses is going to go up. Dr. Maryanne Amarsahi is the co medical director at the National Capital Poison Control Center. Now you have people that are not diabetic. They're using it for weight loss, and all of a sudden they're giving themselves injections, which with something that is a lot less familiar to them. And then to make matters even harder, you could just dial up as much as you want. You were losing weight and you're like, this is great. If a little bit is good, more is better. Sometimes that happens intentionally. People will dial up more medication like this. With the compounded drugs, though, it can happen accidentally. You could draw up too much medication into the syringe. But whether intentional or accidental, these overdoses can lead to side effects. They could be mild nausea, vomiting, dehydration. They could be severe. Your stomach doesn't empty at all, or it becomes paralyzed and you get something called gastroparesis. Everything gets backed up. You can damage your kidneys. And we even had somebody have a small tear in their esophagus from retching. And then finally, some people also get pancreatitis as well. Do you know approximately how much your child weighs? And just like we saw with Michelle's sword, some of the poisonings also involve counterfeits. They are tracking those reports here, as are the drug manufacturers. It's been a while since we've seen any medication that we made subject to this degree of counterfeiting. This is the most insidious one I've seen. This is a box of Manjara that Lily sells. So just even looking at the. Somebody bought this on the Internet, there's pens that look pretty similar. So this is the counterfeit? Yes. And this is the real medication? Yes, real medication. Counterfeit. Yes. It's a lesson Michelle had to learn the hard way. If this one saves one more person or stops one more person from doing it, that's got to be a winner. That's got to be good. When we come back, could these medications take away your joy for food? Professor, hello. Good to see you again. Good to see you. You feeling hungry? I'm back with Dr. Jensjul Holtz in Copenhagen. Thank you for a tasty treat and a dose of reality about these medications. I still have tremendous joy for food. But you are not undergoing. I'm not undergoing. If I was, would I enjoy this as much? I don't think so. No. No, most people do not feel a lot. Cheers. Cheer. My passion for food started with me making food with my father. But it just has no interest in me anymore. Scientists have mapped the neural pathways of these Medications and found that they do disrupt the brain's reward system. That means they could take away your joy. Yes, for food, but maybe also for drugs and cigarettes and alcohol. We see a lot of reports of patients who are drinking less or quit smoking. Maybe there could be benefits. So there's a lot of work to do to study these. One common question, could losing the pleasure in things lead to depression or suicidal thoughts? Dr. Holtz doesn't think so. There are very good nowadays suggesting that showing that this is not something to worry too much about. In fact, a brand new study shows that adolescents treated with GLP1 drugs had a lower risk of suicidal thoughts as compared to those treated with behavioral interventions like diet and exercise. But Holtz does worry about that loss of enjoyment of food. He thinks that might be a heavy price to pay. It's not fun to eat the way it was and I think that may be a problem. Yeah, you and I both enjoy food. I know you're a foodie. I love food. But potentially losing that part of my joy, that would bother me. So these drugs are very effective, but they're not going to be for everyone. And I think that's the point we have to drive home. I got antisocial because if you are invited to eat with friends and you can't eat, it's like, oh well, I'll just stay at home. It's part of why Lean stopped Ozempic. It's a critically important thing to consider. One study shows that for a variety of reasons, more than half the people who go on these medications stop taking them within just 12 weeks. The point is that for most people these are not turning out to be lifelong drugs. Lean ultimately quit because she got too skinny too fast and she was just tired all the time. She started to look different as well. She was dealing with a new phenomenon called over esompic phase that's sagging loose skin. Because the weight loss that we're getting akin to some fasting that you're actually getting, then you end up losing lean mass and fat mass. And that's a problem as well. Especially for older people. Losing too much muscle can lead to falls. It's been associated with a shorter lifespan. It's why the next generation of these drugs could be coupled with other drugs to build muscle at the same time you are losing fat. It's all happening so fast and at the same time. We have to proceed with caution. We still have a lot to disentangle about the long term effects of these medications. Where most of the research does seem to point in one clear direction. Significant benefits on the heart and the brain. If these medicines can do that, they can probably improve brain health. With aging, we know, for example, even in Alzheimer's disease, most patients eventually will have both Alzheimer's pathology but also vascular pathology in their brain. So maybe these drugs could have a role there. The potential is huge and so is the payday. Novo Nordisk, for example, is now worth more than the entire country of Denmark where it is based. And that is largely due to the success of Ozempic and WeGovy. It's why so many companies, more than 45, are now trying to make their own drugs. Something that's better, something that's stronger, something that has fewer side effects. Maybe it's easier to take a once monthly injection or even once a year. Maybe it's a pill. Is that a good thing to have all these companies? Oh, yeah. More brains to solve the problems and competition to lower the prices, which would be fantastic. It's late fall in New Jersey. The leaves are changing color outside Rashida and Brian Bush's home. Seven months after my first trip here, we've come back for an update. I was hoping for continued results and I wanted to lose like 20 more pounds, but it stalled. The compounded tirzepatide that she turned to when insurance wouldn't pay for her pharmaceutical medications did not work. It was very frustrating because when you're trying to reach a goal, you want to get there. Like, you can see it, you can taste it, you can feel it. And now it's like, come on, hurry up. Feeling a lot better. So we'll see. So for months now, Rasheeda has been working with her doctor to try and get those prescription meds back. And she gets some good news at last. So it came in this box here and it has four different little mini boxes inside. Eli Lilly recently introduced a new, less expensive Zepbound. Do you have to change out the needle all the time or just set? No pen. But a single use weekly vial and syringe does make the price more affordable. It's still not cheap enough though, for Rashida. For now, she can only afford for Brian to use it. How that feels? That actually hurts. A little bit of pain, but also a lot of relief that he's now back on the medications that helped him lose more than 50 pounds. I actually was very worried. Like, I thought I was going to be back at where we started, which I didn't want to do that. So I told myself that I was not going to give up Rashida's. Not giving up either. While she waits to start the medications again, she is exercising. She's eating right. She is hoping to maintain the hundred plus pounds of weight loss. It's what Lean also credits with keeping the weight off since she stopped Ozempic a year ago. So you've made some significant lifestyle changes. Do you regret having gone on Ozempic? Oh no. Oh no. I needed to lose the weight and I needed the process. I would never do it any other way. I feel seen. I feel seen. And that's knowing that I am enough. Knowing that I am capable, knowing that I'm a rock star. You look really happy and healthy. You feel happy and healthy. I do. I do. You know, I have to say, it is amazing to sort of look at the science and the decades of work that led us to this point, the stories of how these medications started and where they ended up. Now, there's no doubt that these medications have helped people control their blood sugars, lose weight, decrease their risk for certain diseases. But they've also done something else. They've helped us gain a better understanding of obesity itself as a disease. Now, as I've said so many times, these medications are not for everyone, but at the same time, they could provide a lifeline for those who have struggled for too long trying to lose weight, trying to do all the right things, and simply not having success. We'll definitely continue to talk about this in the new year. Thanks for listening. 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