A new weight-loss medicine, Wegovy, has been available in Belgium since 1 July and is shaking up the debate on the cost of obesity to public health.
Almost half of Belgian citizens are overweight or obese, according to national research institute Sciensano. Slimming medicines like Ozempic, Mounjaro, and Wegovy could spark a public health revolution if the Belgian government financially backs their use. However, their cost and availability make it challenging.
Since its approval by health authorities in 2017 (US) and 2018 (Europe), Ozempic has generated considerable buzz on social media. Initially designed for type-2 diabetes, this injectable drug has shown a positive effect on weight loss, hence its huge commercial success, leading to regular supply disruptions.
Other treatments quickly entered the scene. Rybelsus, produced by the same Danish manufacturer Novo Nordisk, is the oral version of Ozempic. Wegovy, a third medicine of this type, targets only overweight people, using the same molecules but at higher dosage.
Miracle molecules come with a price
Their active ingredient is semaglutide, an innovative molecule that regulates blood sugar levels and reduces appetite by mimicking glucagon-like peptide-1 (GLP-1), a hormone that helps decrease blood glucose levels. The GLP-1 analogue was also found to decrease appetite, especially for high-fat food. These medicines give hope to overweight and obese people to eventually reduce their food intake and lose weight.
Mounjaro, a competing medicine developed by the US pharmaceutical company Eli Lilly, contains an active substance called tirzepatide, which stimulates both GLP-1 receptors (like semaglutide does) and Glucose-dependent Insulinotropic Polypeptide (GIP) receptors, thereby enhancing the effect of sugar level control. It is also now available in Belgium.
These products claim to lead to an average weight loss of 15% (semaglutide) to 22% (tirzepatide). Similar results have been possible so far only with bariatric surgery, a last-resort treatment that alters the digestive system to limit food intake. Intended for obese people with serious health conditions, they are not exempt from risks and secondary effects.
Diabetes drug Ozempic. Credit: Belga / Dirk Waem
Firstly, these treatments come with a hefty price tag. A self-injection pen of Ozempic costs around €103 when refunded by health insurance, but is only available to people with diabetes and a prescription by an endocrinologist.
On the other hand, Wegovy is available to anyone with a prescription from a GP for €145, which is non-refundable. Mounjaro, at €180 per pen, is refundable by health insurance for people with diabetes under certain conditions since July 1. The refunding of this treatment for obese people is currently being examined by Belgian health authorities.
For non-diabetic people, the monthly cost of weight-loss treatments can therefore reach several hundreds of euros, which is often unattainable for many people suffering from obesity, Pascale Brughmans tells The Brussels Times. She is the founder of VoxO, an independent association representing obese people in Belgium.
She recalls a recent study by Yale from early 2024, which showed that India and Pakistan could produce this type of medicine for less than €5 while staying profitable. “Equal access to treatments is crucial in the fight against obesity,” Brughmans added.
Fighting obesity: a national cause?
However, obesity is in itself difficult to define. It is not only an abnormal expansion of fat cells, but they also become dysfunctional, disrupting the body’s hormonal balance and sending incorrect signals to the brain. The obesity threshold is set at 30 kg/sqm of Body Mass Index (BMI) by the WHO. The definition remains valid until the age of 65, because as people age, the ratio of fat to muscle changes. At a BMI of 25, however, people are already overweight and likely to spiral down to obesity.
The main ‘incorrect’ signal sent by dysfunctional fat cells to the brain is the message that the body is not sated. In other words, people are not obese because they eat a lot, but quite the opposite: they eat a lot because they are obese.
And that’s exactly the point of taking innovative slimming medicines. The treatments are intended to derail this vicious circle. These medicines stop the hunger call from fat cells, giving obese people a life without the permanent urge to eat.
“Preventing obesity is a public health issue and must therefore be funded by the state,” Brughmans argued.. She explains that by covering the costs of these treatments, the state could prevent costly comorbidities associated with obesity, such as type-2 diabetes, heart disease, hypertension, depression and even some cancers.
Credit: Belga/Anthony Devlin
Science has even demonstrated a much higher risk of catching an infectious disease because of the loss of immunity associated with obesity. “These conditions, associated with obesity, amount to a significant chunk of public health spending,” Brughmans recalled.
Sciensano, in its 2022 study, based on 2013 figures, states that the cost of obesity to Belgian society is €4.5 billion per year. The paper concludes that “the mean annual incremental cost of excess weight in Belgium is of concern and stresses the ned for policy actions aiming to reduce excess body weight.”
Another finding states that excess weight and obesity are associated with levels of education. Socioeconomic factors, therefore, play a crucial role in the spread of obesity.
Lasting solution
The problem, Brughmans argues, lies first in the fact that obesity is not recognised as a disease. “For decades, obesity has been considered exclusively as a lifestyle issue. Today we realise that it is a genuine biological disease,” Brughmans added. She advocates for the recognition of obesity as a disease by health authorities, a prerequisite to facilitated access to treatments, an institutionalised holistic approach in tackling obesity and financial backing to help more people access treatments.
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Namely, GPs, endocrinologists, nutritionists, psychologists, dietitians, and kinesitherapists should be part of a comprehensive scheme to support patients.
“Obesity requires a multi-disciplinary approach to be treated efficiently,” Brughmans said. But on the ground, “few practitioners are trained to manage the condition in a global and multi-disciplinary way.” Today, they lack training and skills to deal with obesity and even with handling slimming medicines.
The latter go hand in hand with physical activities, better nutrition schemes, and psychological support. With proper management, these solutions could well trigger a virtuous circle for obese and overweight people by stopping the urge for food and tackling the root causes of obesity.
These treatments, however, are still hindered by high costs, limiting their rollout and highlighting the need for bold public action to curb the plague of obesity.
