The Midwest has the highest rate of obesity in the U.S. — could drugs like Ozempic be a solution?
Anndrea Courtney weighed 284 pounds at age 48, and she was sick of it.
Her A1C — a measure of an individual’s average blood sugar level over the past three months — was through the roof. When things got tough, she turned to eating — her “crutch.” She’d tried diets before but never lost more than five or ten pounds.
Four months ago, she went to her doctor’s office, asked for a solution, and left with a prescription for Ozempic — an injectable medication intended for adults with type 2 diabetes. It’s been a game-changer.
“I think this medicine is trying to teach people like [me and my husband] how to eat the right way because we were starved as children,” Anndrea said. “I was a thin person when I was a child and when I was a teenager because I was starving. Then in my 20s, I had money, and it’s my money, I go buy food now, so you almost hoard the food.”
The use of Ozempic and similar drugs exploded across the U.S. a few years ago, with prescriptions multiplying by a factor of 40 between 2017 and 2021. In the last quarter of 2022, doctors wrote 9 million prescriptions for Ozempic, Wegovy, Mounjaro, and Zepbound — equivalent to 2.5% of the U.S. population.
All of these drugs are GLP-1 receptor antagonists. They mimic a naturally occurring hormone that slows digestion, increases the feeling of fullness, triggers the body to release insulin (which lowers blood sugar), and blocks the body from releasing glucagon (which raises blood sugar).
Until a few years ago, GLP-1 receptor antagonists were only used to treat diabetes and high blood sugar. Then, these drugs’ effects attracted attention for a different reason: weight loss. Medical professionals wondered whether these drugs could mitigate America’s obesity epidemic — an epidemic estimated to kill as many as 400,000 Americans annually, primarily due to heart disease and diabetes.
“If these [medications] continue to be proven safe, they should be more widely used to treat obesity, which is rampant, and it would, in the long run, probably prevent diabetes in a lot of cases,” said Jerry Honts, a professor of cell and molecular biology at Drake University. Honts, a type 2 diabetic, takes Ozempic to help manage his blood sugar levels.
36% of Midwesterns are considered obese — the highest rate in the nation. Nationally, 4.8% of all patients with an obesity diagnosis have taken a GLP-1 receptor antagonist in the past year. A few Midwestern states — South Dakota, North Dakota, and Iowa — have among the highest rates of total patients taking GLP-1 drugs at seventh, eighth, and ninth, respectively. Midwesterners like Anndrea, a resident of Des Moines, Iowa, are testing the waters of a potential solution.
The ‘Stigma Against Losing Weight with Ozempic’
Anndrea’s sister, 51-year-old Desiree Hatfield, is also taking Ozempic. When her doctor initially recommended Ozempic to manage her type 2 diabetes, Hatfield was skeptical due to the drug’s portrayal in popular culture.
“I actually didn’t want to get on Ozempic for a long time because of celebrities and stuff,” Hatfield said.
“And [my doctor] said, ‘No, you don’t understand, this is kind of a miracle drug,’”
Hatfield’s miracle is that she no longer gets up three or four times each night to use the restroom due to high blood sugar, and she has more energy. However, doctors told Hatfield that she’ll likely be on the drug for the rest of her life.
“At first, I was angry,” Hatfield said. “But I’m glad that they have a drug like this that can help people because it really does bring my sugar down a lot.”
Both sisters credit Ozempic with helping them eat less and, as a result, lose weight.
“Before, I don’t think I had time to quit eating, I could just eat and eat. Now, I feel full faster,” Hatfield said.
Honts, likewise, has experienced greater control of his glucose levels using Ozempic, which he takes in conjunction with other drugs commonly prescribed to treat type 2 diabetes. Since starting Ozempic in 2022, he has substantially reduced the amount of insulin he takes, thus reducing the risk he’ll experience hypoglycemia. This potentially life-threatening condition occurs when insulin users overestimate the amount of insulin they should take.
“I wasn’t really controlling the glucose levels effectively,” Honts said. “I talked to my doctor about Ozempic, which was just coming on the scene. We decided that we might as well try it, and it made a huge difference.”
In Iowa, where Anndrea, Hatfield, and Honts reside, there are 12 prescriptions per 1,000 residents. By comparison, in Kentucky, the state with the highest rate of these medications, there are 20.7 prescriptions per 1,000 residents.
Side Effects — Imagined and Real
By the time she reached 48, Anndrea figured she was too old to lose weight without medical intervention. She considered bariatric surgery, a procedure that restricts the stomach to reduce eating, but deemed it too dangerous. Ozempic, on the other hand, reduces eating without as many side effects.
“I’ve been eating next to nothing on Ozempic, and that’s what’s helping me lose weight, but you’re eating next to nothing and not starving,” Anndrea said. “It’s amazing how much food you can actually live on.”
Anndrea’s husband, Jeremy Courtney, worried about this precise effect. He was also prescribed Ozempic for his high A1C.
“I was scared that it was gonna make me not want to eat, because your mindset is, ‘I’ve got to be able to live,’” Jeremy said.
Anndrea said doctors advised her and her husband on “how to eat on Ozempic” to ensure they’re properly nourished, including eating smaller, more frequent meals.
“If you’re eating that little, you have to make what you eat count,” Jeremy said.
Both have, however, noted one of Ozempic’s physical side effects, which the internet has coined “Sulfur burps.” Because Ozempic slows down digestion, some users have reported foul-smelling burps.
“The food sits in your gut and it almost rots a little bit, so when you burp, the burp smells like poop,” Anndrea said. “Literally, you will burp all day. People are probably like, ‘Oh my god, what smells like somebody farted?’”
Inconsistent Insurance Coverage
Anndrea’s insurance covered her Ozempic prescription because of her high A1C, but those seeking the drug for weight loss who don’t have a high A1C may end up paying for GLP-1 receptor antagonists out of pocket. Hatfield thinks it’s unfair for insurance not to cover these drugs for weight loss.
“I think that we’re coming upon something that might be helpful to people, and I don’t think anything that is helpful should be regulated to certain people,” Hatfield said.
Honts agreed that the U.S. would benefit from accessible and affordable prescriptions for GLP-1 receptor agonists.
“For a while, they were talking about, ‘We can’t afford to provide Ozempic for everyone. It costs too much.’ But what’s the cost of obesity in terms of all the medical expenditures for something like cardiovascular problems and other things that emerge from obesity?” Honts said.
Despite being on the high end price-wise for diabetes and weight loss management drugs, Honts said the cost is worth it for him. Honts pays $175 to $250/month with insurance and coupons for Ozempic. Uninsured users, by contrast, pay a monthly average of $968.52, according to the drug’s manufacturer, Novo Nordisk.
“For people who have more limited income, it would be a real hassle to have to come up with, say, $400. There’s people now that are paying out of pocket like $1,600 or more,” Honts said.
Anndrea has lost about 30 pounds in the past four months taking Ozempic, and she hopes to reach a weight of 175 lbs using the drug. She expects that her A1C will eventually lower due to Ozempic, possibly prompting her insurance to stop covering it.
Even then, she said $200 per month is a small price to pay for her health.
“Keeping 100 pounds of extra weight on me is not healthy for me in the long run,” Anndrea said. “I am getting to my heart attack years, and I would really love to get all this excess weight off of me so that I can live to see my grandchildren.”