On June 2, several insurance companies announced the cessation of reimbursement for Ozempic in obesity. In 2018, 26.8% of Canadians suffered from obesity, i.e. a BMI greater than 30 kg/m2. Since 1985, people with BMIs above 35 kg/m2 increased by 455%. Several learned societies agree on the fact that obesity is a chronic disease (ASMBS, AMA, TOS, CON, OMS, Canadian Medical Association, etc.) and is characterized by the excessive accumulation of adipose tissue. This state of health leads to metabolic, psychological and functional complications.
Currently, there is no public reimbursement option. Private insurance coverage, on the other hand, was more permissive and, until very recently, made it possible to offer treatment to those who needed it.
According to Canadian guidelines, the mainstays of obesity treatment are psychological, pharmacological and surgical interventions. Among the pharmacological treatment options, semaglutide 2.4 mg has been studied in 16 countries in adults with BMIs greater than 30 kg/m2. Semaglutide 2.4 mg demonstrated a weight loss of 16.9%; 34.8% of participants lost more than 20% of their weight. In this study, side effects were reported and led to treatment discontinuation in 7% of patients, compared to 3.1% in the placebo group. Health Canada approved the use of semaglutide 2.4 mg in November 2021.
With this information in mind, it should be explained that Ozempic is the trade name for semaglutide. The 2.4 mg semaglutide formulation is currently unavailable in Canada, but is marketed in the United States as Wegovy. Both Ozempic and Wegovy are the same product, at different strengths. We must therefore stop demonizing the use of Ozempic in obesity. The real problem is not having access to Wegovy currently, in Canada.
Political inertia
The real concerns lie in the costs associated with the reimbursement of the medication, whether by the public or private insurance plan. The prevalence of obesity is considerable and is constantly increasing. Financial considerations, while legitimate, often omit analysis of the indirect costs associated with obesity. These were estimated at 7.1 billion dollars in 2010. According to the INSPQ, obese patients are 94% more likely to require nights of hospitalization.
It is obvious that to face the important burden that is obesity, the only reimbursement of the medication is insufficient. The establishment of physical, economic, political and social environments is essential. Care trajectories must be optimized. The political inertia linked to the recognition of obesity as a chronic disease is deleterious and amputates health professionals from the few means available for the management of this disease.
Some medical situations require weight loss. For example, during hernia repair surgery in someone who is severely obese. Weight loss beforehand is essential in order to obtain good surgical results and prevent recurrences. In addition, people awaiting an organ transplant must reach a specific weight so that the surgical risk is reduced and the chances of transplant success improve. If the weight is not achieved, they are simply not listed for surgery. These realities are not sufficiently visible in the public space.
The treatment of obesity as a chronic disease does not benefit from the same rationale as other chronic diseases, such as diabetes or arterial hypertension. It has been raised in articles that the reimbursement of obesity treatments was questionable, since there was no proof that the treatments were effective in the long term. Concerns that discontinuation of the medication will lead to weight regain have been expressed.
Equal care
This type of argument demonstrates two things: a major misunderstanding of this disease and also the internalization of several prejudices with regard to obesity. The very definition of a chronic disease is that it is a long-lasting disease that often worsens over time. So, how can we hope for a treatment that definitively solves this problem?
It is exactly as if we came to the conclusion that the insulin of diabetic patients was ineffective and that it should not be reimbursed, since the lifelong administration of this treatment is necessary. Or as if a patient with high blood pressure had to pay for his antihypertensive medication, because his blood pressures rose again when he stopped taking the pills. Any health professional would be outraged by such arguments. However, it seems that for obesity, these arguments are legitimate…
Obesity Canada’s ACTION survey report, published in 2019, demonstrated the presence of prejudice and discrimination on the part of health professionals in the country. These negative perceptions are also very present among the decision-makers exerting an influence on the reimbursement of medical treatments for obesity. Unfortunately, these biases are normalized in addition to benefiting from a certain social acceptability.
For many people, the responsibility of patients for their weight is complete and justifies the non-reimbursement of treatments. Actions to fight against obesity are insufficient and treatment options are limited. Access to bariatric surgery is difficult and often involves more than 2 to 3 years of waiting. The retreat of private insurers is making the situation worse and risks costing society much more in the long run. Reimbursement must be legislated on the basis of other countries, such as Australia and England.
In a public health care system like Quebec’s, the fight to obtain equal care for patients who suffer from severe obesity is complicated by significant societal prejudices. You need to educate yourself on the issue in order to make better decisions and have informed discussions on the subject.
Finally, the biggest loser in this story is the patient who inevitably finds himself in a precarious health situation. A patient who could be offered effective care, but who is instead left to fend for himself — is this really a reflection of the Quebec public health system of which we boast so much?
*Also co-signed this letter:
Marie-Pier Ferland, IPS on the front line
Stéphanie Labrecque, IPS in adult client care
Marianne Legault, nutritionist
Jessica Marcotte, IPS on the front line
Jessica Rainville, IPS on the front line
Mélanie Tardif, IPS on the front line
Audrey Tremblay, IPS on the front line
Jessie Vyboh, Frontline IPS
Marie-Philippe Morin, internist
François Dubé, internist
Isabelle Labonté, internist