SINGAPORE – In early 2022, when Ms A’s doctor told her about a new drug that could help her manage her weight and her diabetes, she took it.

It was free then, and it worked beautifully for her.

Ozempic is a once-weekly drug that she injected under the skin of her abdomen. The first time she took it, she felt nauseous for a few days, as her body adjusted to the drug, but she was otherwise fine.

“The moment you take it, you don’t want to eat more, after a few spoonfuls of rice,” said the 47-year-old, who wanted to remain anonymous. “You don’t get hunger pangs... So, you just get into the habit of feeling fuller.”

The property agent has been going to the National University Hospital to see Dr Khoo Chin Meng, the head and senior consultant at the division of endocrinology, for her diabetes for a few years, and had been exercising and watching her diet.

But it all went haywire when her weight shot up by some 10kg, to 84kg, after she took the steroids prescribed for her autoimmune disorder, immune thrombocytopenic purpura, in 2019.

“Dr Khoo saw that I was not losing weight as fast as he wanted me to, because my blood sugar levels will go up,” she said.

With Ozempic, Ms A said her weight dropped to as low as 72kg over several months. But she stopped using it when the drug trial ended after six months, as she found it tough to cough up around $300 for the weekly dose over the long term.

Without it, she is still trying to keep to a few mouthfuls of food. The oral tablet she was prescribed does not seem to work. She is now 74kg, and considering going back to Ozempic as she feels hungry and her appetite is coming back.

“If it comes back, my sugar levels will go haywire as well.”

Ozempic’s active ingredient is semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist drug that was developed for type 2 diabetes patients but then was found to be also effective in helping them lose weight.

It helps to lower blood sugar, curb the appetite and slow the emptying of the stomach. It also affects hunger signals to the brain.

Danish pharmaceutical company Novo Nordisk sells a higher-dose version under the brand name Wegovy for those with obesity. Both drugs have gone viral on social media for their off-label use as weight loss drugs.

Wegovy has been shown to help those who have obesity or a high-risk body mass index (BMI) lose about 15 per cent of their weight.

While not everyone lost that sort of weight after taking it, about 86 per cent of study participants managed to achieve a weight loss of at least 5 per cent.

Dr Khoo said semaglutide is game-changing as it is more effective than the current available obesity drugs, and generally well tolerated.

With obesity being such a major and complex problem, the drug spells hope for the growing number of patients here and around the world battling the chronic disease, which has a high degree of relapse, he added.

However, Dr Khoo said that any anti-obesity drug, including Wegovy, must be used in conjunction with a management plan that includes healthy eating, physical activity and cognitive behavioural therapy.

According to the National Population Health Survey, about one in 10 Singapore residents aged 18 to 74 years was obese (with BMI of 30 or more) in 2019-2020. And one in five (20.7 per cent) Singapore residents in the age group was in the high-risk BMI category for Asian population, meaning they have a BMI of 27.5 or more.

Obesity is linked to many health issues, including type 2 diabetes, high blood pressure, obstructive sleep apnoea, increased risk of certain cancers, knee and back pain.

Dr Lee Yingshan, chair of Tan Tock Seng Hospital’s weight management service, said that many people with obesity have mental health issues, and some patients may have maladaptive eating disorders.

Both doctors stressed the importance of societal participation in tackling the obesity problem.

A key barrier is that obesity is often viewed as an aesthetic issue, rather than a complex disease that it is, and “what can move us in the right direction is when everyone is willing to talk about obesity... as a medical condition”, said Dr Lee.

One of her patients, retired secondary school teacher Rajeswaren Boopalan, who was 139kg about two years ago, has tried many ways to lose weight over the years, including trying all available commercial diets and even going for lap band surgery, but each time, the weight would bounce back.

One time, he even lost more than 20kg after undergoing a weight loss programme at a centre in India when he took a three-month sabbatical, but he regained the weight within a month upon returning to Singapore.

“It was hard. It was a very difficult period. I guess only a person who’s been fat and who has my problem can understand what it is,” he said.

Dr Rajeswaren, 61, enjoys eating with his family, and always thought he was just fat, but he had a rude awakening in his mid-40s when he went to a heart clinic for his heart issue and saw a description of himself as a morbidly obese patient.

After his 50th birthday, the problems came fast and furious. First, it was the knee pain, then deep vein thrombosis and swollen legs, back pain and other issues. He had to take leave from work because of pain, and it would upset him.

When he was 58, he had to reluctantly retire because his knee problem became so bad that he could not stand for long, and his legs were swollen, itchy and painful. 

“My name is Dr Rajeswaren and the children used to call me Dr Largest One... I used to laugh... I made jokes about being fat, so that I wouldn’t be hurt,” he said. “I was large. God, I was large. Now that I look back, I wanted to cry. I could have had so many good years.”

There were also the stereotypes of obese people as lazy, slow, incapable and so on, that he faced.

Dr Rajeswaren has since gone for knee replacement surgery. He is taking Ozempic, made dietary changes, and doing a lot of walking, which enabled him to get his weight down to 117kg. This meant that his headaches are gone, his legs are no longer swollen, and he is managing his blood pressure and blood sugar better.

Semaglutide is not the only GLP-1 drug, but it is the newest and more effective than the one before it.

Liraglutide, sold as Saxenda, was approved for adults with obesity or high-risk BMI in late December 2014 by the US Food and Drug Administration, and in 2017 in Singapore for those with obesity or high-risk BMI.

The daily injectable drug is now reportedly being considered by the World Health Organisation for inclusion in its essential medicines list as an obesity drug, which would make it more widely available.

Another injectable diabetes drug, Mounjaro (tirzepatide) from Eli Lilly, which has been shown to help people with obesity lose around 20 per cent of their weight, could reportedly be approved some time this year for weight loss in the US.

Said Dr Rajeswaren: “It wasn’t an easy journey being obese and not recognising that you are growing big. People need to know it is a disease... that eats into so many places, in your social life, in your career, in everything.”