Author: Katherine Gallagher

Ozempic: The New Miracle Weight Loss Drug?

Ozempic is an antidiabetic medication developed by Novo Nordisk in 2012 and the United States Food and Drug Administration (FDA) first approved the medication in 2017. Used for the treatment of type 2 diabetes, Ozempic is designed to be injected once a week in the stomach, thigh, or arm. In February, Novo Nordisk warned of supply constraints this year on Ozempic. In March, after months of shortages, the FDA announced that Ozempic is back on the shelves in the United States. The demand for Ozempic was assumed to be partly driven by prescriptions for non-diabetic patients seeking to lose weight, which is outside the drug’s approved indication.

Ozempic impacts weight via two key mechanisms. First, it affects the hunger centers in the brain,specifically in the hypothalamus, reducing hunger, appetite and cravings. Second, it slows the rate of stomach emptying, which effectively prolongs fullness and satiety after meals. The net result is decreased hunger, prolonged fullness, and, ultimately, weight loss. In a clinical trial sponsored by Novo Nordisk, 1,961 adults with excess weight or obesity who did not have diabetes were given 2.4 milligrams of semaglutide, the active ingredient in Ozempic, or a placebo once a week for 68 weeks, along with lifestyle intervention. Those who took semaglutide lost 14.9 percent of their body weight compared with 2.4 percent for those who took the placebo.

In 2022, Ozempic exploded onto the scene and gained attention among celebrities and TikTok influencers who were trying to lose weight in short periods of time. Although Ozempic can help someone lose fifteen to twenty percent of their body weight, any lost weight reportedly comes right back if you do not take the drug every week. Thus, people who start a prescription typically do not stop taking it, even when they reach their goal weight.

People taking Ozempic for both FDA approved and off-label use may experience side effects. These include nausea, dehydration, fatigue, malaise, diarrhea, and constipation. In rare cases, the medication could increase the risk of pancreatitis. Because the drug has not been systematically tested in people with lower body weights it is possible that patients outside of the group the drug is intended for could experience more intense side effects. Without more research, it is unclear just how damaging those side effects could be.

In addition to these physical side effects, there are also psychological side effects. Dieting is one of the leading risks for developing an eating disorder and medications such as Ozempic could lead to more disordered eating as people try to avoid regaining weight.

Doctors say there is not enough evidence to know whether Ozempic might be beneficial or dangerous for people who fall outside of the FDA’s criteria. As tempting as the prospect of a “miracle drug” for weight loss may be, experts caution against people seeking out the medication for off-label use.

Hungry for Change: The Biden Administration Takes Steps Toward Ending Hunger by 2030

According to the United States Department of Agriculture (USDA), more than 33 million Americans, including five million children, are considered food insecure. The United States Department of Health and Human Services (HHS) defines food insecurity as a household-level economic and social condition of limited or uncertain access to adequate food. While food insecurity does not necessarily cause hunger, hunger is a possible outcome of food insecurity. Adults who are food insecure may be at an increased risk for a variety of negative health outcomes and health disparities. For example, a study found that food-insecure adults may be at an increased risk for obesity. Another study found higher rates of chronic disease in low-income, food-insecure adults between the ages of 18 and 65. Food-insecure children may also be at an increased risk for a variety of negative health outcomes, including obesity. They also face a higher risk of developmental problems compared with food-secure children. In addition, reduced frequency, quality, variety, and quantity of consumed foods may have a negative effect on children’s mental health.

In an effort to address this issue, President Joe Biden hosted the White House Conference on Hunger, Nutrition, and Health and announced over $8 billion in hunger and nutrition commitments. It was only the second-ever conference of its kind and the first in over fifty years. The last time this conference took place was in 1969, under President Richard Nixon. The Nixon-era conference was a pivotal moment that led to the creation of the big programs underpinning the United States hunger response, such as food stamps and the Women, Infant, and Children program (WIC), which provides child nutrition assistance among other things. The Biden administration used this as an opportunity to lay out its plan to improve the nation’s health. This plan includes pushing for Congress to permanently extend the child tax credit, raise the minimum wage, and expand nutrition assistance programs to help reduce hunger rates. This ties to an ambitious goal the president set in May—ending hunger in the United States by 2030.

The $8 billion in commitments comes from some of the largest corporations in America’s private sector—Google, Tyson Foods, Walgreens—and includes $4 billion that will be dedicated by philanthropies that are focused on expanding access to healthy food. Additionally, there will be a focus on expanding nutrition research and encouraging the food industry to lower sodium and sugar. However, some of the most ambitious proposals require Congressional action. Thus, the partisan split threatens the president’s success.

Furthermore, the conference comes at a time of steep inflation and the end of pandemic benefits that staved off hunger rates. While the expanded child tax credit that was part of the American Rescue Plan of 2021succeeded in reducing poverty and hunger in the United States, Democrats were unable to make that measure permanent in the Inflation Reduction Act that they passed this year. Now, lines at food banks keep getting longer, food prices are rising at their fastest rate in four decades and fears of a recession that could result in higher unemployment rates are growing.

Unfortunately, while the Biden-Harris administration’s strategy includes many great ideas, it also seems to let the food industry off the hook and fails to adequately address the impact that racism, gender inequality, and the climate crisis on food insecurity. Though the conference served as a good first step toward future investments and policy changes around combatting food insecurity, there is still a long road ahead and the administration must do more to achieve its goal of ending hunger by 2030.

Racial Disparities in Opioid Use Disorder Treatment

Over the past twenty-five years, the United States has experienced an increasingly devastating opioid crisis.  According to the Department of Health and Human Services (HHS), in the late 1990s, pharmaceutical companies offered reassurance to the medical community that patients would not become addicted to opioid pain relievers, leading healthcare providers to begin prescribing them at greater rates.  Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.  

The Centers for Disease Control and Prevention (CDC) outlines the rise in opioid overdose deaths in three distinct waves.  The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids increasing since at least 1999.  The second wave began in 2010, with rapid increases in overdose deaths involving heroin.  The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.  The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine.  In 2017, HHS declared a public health emergency to address the national opioid crisis and announced a five-point strategy with the following priorities: improve access to prevention, treatment, and recovery support services; target the availability and distribution of overdose-reversing drugs; strengthen public health data reporting and collection; support cutting-edge research on addiction and pain; advance the practice of pain management. 

The COVID-19 pandemic has created a devastating public health crisis and has posed significant challenges for health care delivery, including opioid use disorder (OUD) treatment.  Like the opioid crisis, the COVID-19 pandemic has had a disproportionate impact on racial and ethnic minority groups, particularly those who use drugs.  For example, one recent study showed that Black people with OUD are not only at significantly increased risk for COVID-19, but also have greater odds of hospitalization and mortality.  This reflects how Black communities have been subjected to the dual burden of disproportionate COVID-19 deaths and rising overdose mortality.

Methadone has been successfully used for over forty years to treat OUD and must be dispensed through specialized opioid treatment programs.  To receive the treatment, individuals have to show up every day for ninety days to receive their dose.  Only after that, are they able to take home a weekly bottle.  To get a full month’s worth of take-home methadone, individuals need to have been going to the clinic for two years.

Buprenorphine reduces cravings without becoming addictive itself and has been found to have similar effectiveness as methadone for treating OUD when given at a sufficient dose and for sufficient duration.  However, unlike methadone, buprenorphine can be prescribed by certified health care providers.  This eliminates the need to visit specialized treatment clinics, thus expanding access and providing an option for individuals with OUD who are unwilling or unable to attend a licensed methadone treatment program.

While both methadone and buprenorphine have been shown to reduce opioid misuse compared to abstinence-only interventions, buprenorphine has the greatest potential for widespread dissemination due to its relative ease of use and safety.  However, findings from several studies suggest buprenorphine and methadone treatment rates are correlated with race and ethnicity.

The following recommendations have been proposed by public health professionals and, if adopted, could help address the racial disparities in access to medications for OUD.  First, the requirement that a health care provider must complete a course before they are able to prescribe buprenorphine should be lifted. Second, newly diagnosed OUD patients should be offered both buprenorphine and methadone as treatment options.  Furthermore, patients currently receiving methadone should be offered the option to transition to buprenorphine.  Third, policies and regulations should be changed to allow pharmacy-led methadone dispensing.  Steps such as these must be taken to ensure all Americans, regardless of race or ethnicity, have equal access to health care.  Otherwise, this would be a missed opportunity to improve public health. 

I Can’t Breathe – Health Disparities in the Impact of Air Pollution

Prior to the 2021 United Nations Climate Change Conference (COP26), the World Health Organization (WHO) released a special report on climate change and health. The ten recommendations in the report propose a set of priority actions from the global health community to governments and policymakers, calling on them to act with urgency on the current climate and health crises. One of the recommendations focuses specifically on creating energy systems that protect and improve climate and health in order to save lives from the harmful effects of air pollution. Not long after the WHO’s report was released, ProPublica, a nonprofit organization headquartered in New York City that focuses on investigative journalism, released what it is calling “the most detailed map ever of cancer-causing industrial air pollution.” The map is based on an analysis of Environmental Protection Agency (EPA) data and exposes the sources of cancer-causing industrial air emissions down to the neighborhood level. 

According to the Natural Resources Defense Council (NRDC), air pollution is the release of pollutants that are detrimental to human health and the planet as a whole into the air. Most air pollution comes from industrial plants burning fossil fuels for energy use and production, which releases gases and chemicals into the air. The air pollution from these industrial plants alone is elevating the cancer risk of an estimated quarter of a million Americans. The Clean Air Act(CAA) was designed to protect public health by setting pollution standards. However, the worsening impact of climate change will not only make it harder to meet these standards but will continue to exacerbate air pollution. The effects of air pollution depend on three factors: the type of pollutant(s), the length and level of exposure, and individual health risks. For example, smog can irritate the eyes and throat and also damage the lungs. Even worse, people who suffer from asthma or allergies can experience asthma attacks and intensified symptoms. Soot can penetrate the lungs and bloodstream and worsen bronchitis, lead to heart attacks, and even hasten death. Benzene can cause leukemia and ethylene oxide can lead to lymphoma and breast cancer. 

Over the last couple of decades, study after study has found that the burden of air pollution is not evenly shared and has impacted racial minorities at a much higher rate. These findings are corroborated by the “hot spots” identified in ProPublica’s map, which are disproportionately Black. These disparities have roots in historical practices, such as redlining. According to an organizer for the Sierra Club, “[c]ommunities of color, especially Black communities, have been concentrated in areas adjacent to industrial facilities and industrial zones, and that goes back decades and decades, to redlining.” The COVID-19 pandemic has further contributed to the burden placed on these communities. The already high rates of respiratory and cardiac illnesses due to air pollution have contributed to the disproportionate toll the pandemic has taken on communities of color. The overwhelming message from COP26 has been that we have reached a turning point and bold legislation addressing longstanding racial disparities as a top concern for climate policy will be critical not only in combatting environmental racism but in saving the world.