If one word has dominated appearance medicine discourse in 2023, it’s Ozempic.
Available in New Zealand under the brand name Saxenda®, this powerful, prescription weight-management medication has been subject to much scrutiny here and overseas, namely for its apparent off-label use amongst A-listers and influencers, and the extent to which it is seen to be upholding cultural and societal ideals that equate beauty with thinness.
But there is no question that when prescribed correctly, this medication has been not only life-changing for individuals, but life-saving. Over the coming years, it is also poised to take immense pressure off Aotearoa’s overloaded public health system, saving even more Kiwis’ lives in the process.
That doesn’t make it any less controversial. So FashioNZ sat down with Dr Ellen Selkon from Clinic42, the only appearance medicine clinic in Auckland to offer Saxenda® for the answers everyone’s been wanting to know since (probably) Oscar season.
Much of the negative press around weight-management drugs like Saxenda® has come about because of the way it’s been misused overseas – evidently by celebrities and influencers for whom the medication is clearly not indicated.
What requirements does a patient have to meet for this treatment to be offered to them at Clinic42?
At Clinic42 we follow the recommended guidelines in order to prescribe Saxenda® for a patient. We do a thorough consultation, discuss all available options with the patient including lifestyle changes. If Saxenda® is an option then they must comply with a BMI above 30 (obese) or above 27 (overweight) with at least one weight related comorbidity such as high sugar or diabetes, high blood pressure, high cholesterol or sleep apnoea.
What does a typical course of treatment look like, and how much does it cost?
You start slowly with 0.6mg per day and generally increase your dose weekly by 0.6mg weekly, as long as you are tolerating the medication, until you reach a maximum dose of 3mg daily. We work out a goal weight for our patients and you stay on the Saxenda until you reach your goal weight and then we gradually withdraw the medication over a period of time. Medication costs $500 per month.
What are the typical effects – how soon after the first treatment can a patient expect to see and feel results, and what might these results look like, by the numbers and in less tangible ways?
The medications starts working surprisingly quickly,with results visible within a couple of weeks. Generally, patients loose between 0.5 to 1kg per week but this slows down after about 6-8 weeks as expected. Once patients start losing weight, they get motivated and tend to increase their exercise and make better food choices as well, so the combination is very powerful.
What are the possible negative side-effects?
Minor side effects that may occur are nausea, some acid reflux and constipation. These can be easily prevented or managed and are discussed in the consultation. Where a lot of people will get these minor side effects, they are transient and don’t cause much bother. A more serious side effect is pancreatitis which is inflammation of the pancreas gland which results in acute abdominal pain. This luckily is extremely rare. This is also discussed with patients, and we check blood levels initially to ensure this is all normal prior to initiation of treatment and after being on treatment.
How long do the effects last? Is this realistically a lifetime investment, or is the idea that patients will form new, healthier eating habits during their treatment, and not require the medication long-term?
Well, that is really the million-dollar question. Good evidence is coming out of the States that the weight loss is maintained for up to 3 years off the medication. As these are relatively new medications long term studies have not yet been concluded. We also know it takes months for us to learn not to get hungry and to eat smaller portion sizes and cement good habits, so staying on medication for a month probably won’t result in long term results.
A significant criticism of weight-management medication is that it feeds into cultural/societal ideals that equate beauty with thinness. Being in the business of beauty, Clinic42 is a likely target for such criticism – despite the fact that this medication is also available at the GP. What are your thoughts on this?
The reason we got involved in this is that our doctors are all either Fellows of the NZ College of General Practitioners i.e., specialist GP’s or one who is a fellow of Emergency Medicine, over and above our Cosmetic qualifications. Primary health is at breaking point and under huge pressure and for a GP to be able to fit in a half hour consultation to discuss weight management with a patient is a luxury.
Most of our patients have tried to discuss it with their GP and have been informed that they don’t prescribe weight management medication. We are therefore ideally suited to give thorough clinical advice and management on this subject. The patient base we are seeing for weight loss only has a 10% cross over with our cosmetic patients, so societal ideals have nothing to do with it.
These are patients who are desperately seeking help with managing long term health goals and weight management. We liaise with their GP if there are any abnormalities found on examination or blood tests, and have also had to refer a few patients to specialists for management of these findings.
It’s well known that New Zealand’s public health system is under extreme pressure, and that our levels of obesity (third highest in the OECD, according to the Ministry of Health) and related health conditions are a significant drain on our health system’s resources. Where do you see medications like Saxenda® helping to alleviate some of this pressure over the coming years?
I am thrilled you asked this question as I want to shout the success stories from the rooftops! We have had so many patients coming in having lost over 10% of their body weight and as a result, changing their lives. They are feeling more confident, they no longer have diabetes, their blood pressure is normal etc. They are happy again! These results are going to save millions in health dollars down the line. It is hard to measure in actual value but will definitely be a significant amount.
What are the roadblocks going to be?
There is always negative publicity about things that seem too good! Unfortunately, the few spoil it for the many in most cases. We need weight and weight management not to be a negative stigma. It is a good thing to lose weight and reach a normal healthy weight. There will unfortunately be people who are a healthy weight and want to use the medication to look great in their bikini, but this is a minute fraction of the population who are seeing help with weight management.
The second roadblock is going to be supply. Already we are being warned regarding supply issues. We also only have one choice in NZ for these medications whereas in the States there are 4 or more available. The raw material is in short supply worldwide and so we can only hope that NZ at the bottom of the world is able to maintain enough supply to meet demands.
Why is the public health element of particular resonance to the team at Clinic 42?
As I previously stated, all the doctors at Clinic 42 are specialists not only in Cosmetic Medicine but also specialist GP’s or Emergency Medicine. We work in the primary and tertiary healthcare system and are aware that access to the public health system is at present dismal and that health care professionals are overworked and cannot see every patient that requires a consultation.
Why is it important to you to demystify Saxenda® to New Zealanders?
Once you have seen the excellent results that patients are achieving, you want as many people as possible who qualify and meet the criteria for the medication to have a chance to be able to use it. This is a medication that every overweight/obese New Zealander should be aware of as an option to help them. The fact that since the launch of Saxenda in New Zealand so many more people have come forward to talk about weight loss and discuss this with healthcare providers is amazing.