As more weight loss drug pills move onto the PBS this year, Niki Waldegrave finds a new trial at Royal North Shore Hospital offers more options for those with chronic conditions – but including exercise is key.
Obesity is killing Australians, the economy and the health system, with one in three Aussies overweight/obese, and 46% in Northern Sydney – but hope is on the horizon.
Around 2% of Aussies are already using ‘miracle’ weight loss drugs glucagon peptide-1 receptor agonists (GLP-1RAs) such as Ozempic, Wegovy and Mounjaro to shift kilos.
Currently, Ozempic is listed on the PBS for those with Type 2 diabetes under strict criteria, meaning a private fee of $134 comes down to $25 per unit.
Until then, residents like Louise Trey can pay up to $600 a month for private scripts.
Last month, Health and Ageing Minister Mark Butler announced incoming PBS subsidies for Wegovy in patients with established cardiovascular disease and obesity.
But until the subsidies roll in, Louise is paying $500 for her monthly Wegovy script, on top of other specialists she sees.
“And there are many, because I’ve got so many chronic conditions,” says the Seaforth business consultant.
“I’ve been diagnosed with Type 2 diabetes, but because my blood sugar results sit just below the PBS threshold – about half a point off – I’m forced to keep paying privately.
“I’ve seen countless specialists, and every appointment comes with a $200 to $500 fee.
“I hit the Medicare Safety Net every single year, but to get it subsidised, I’ve either got to be dying from diabetes or be obese and have had a heart attack.
“I get one every time I look at my bank statements!”
Research shows life-long use of GLP-1s provides the best outcomes – but cost and side effects are the main barriers, and health experts warn this can be dangerous.
Oxford University data shows people regain around 0.4 kilos a month once medication stops, and heart disease risk markers return to pre-treatment levels in less than two years.
Oral GLP-1s are already available in the USA and expected to be rolled out in Australia within the next few months – but data shows they can shrink more than just waistlines.
Up to 60% of the weight lost can be attributed to vital lean muscle mass and bone density – equivalent to 10 years’ of ageing. Yet this can be managed.
Deakin University research shows regular structured exercise like resistance training and weights can avoid or limit this – and even boost bone density in the spine, neck and legs.
Backing the World Health Organisation’s strong recommendation to integrate GLP-1s with exercise, new AUSactive CEO Ken Griffin says: “This cannot be ignored. Decisions made now will shape Australia’s health for decades. If taxpayers are funding these drugs for life, exercise must be part of a GLP-1 prescription.
“Otherwise, the true cost will be felt in frailty, brittle bones and future hospitalisations.”
During Mr Griffin’s 12-year tenure at the Primary Health Care Nurses Association, the group drove major policy changes, including helping influence the Strengthening Medicare Taskforce, Scope of Practice reform.
The body also elevated the (now) 98,000 primary care nurses to frontline reformers, and Mr Griffin adds: “Hospitals must always be well funded, but the focus must shift upstream.
“We need to build a fence at the top of the cliff, not keep sending more ambulances to the bottom of it.”
With cost and side effects barriers to ongoing use, Royal North Shore Hospital is one of many hospitals currently conducting clinical trials with both the current medication and new pills.
The trial is led by endocrinologist Professor Sarah Glastras, clinical trialist and principal investigator, who says trials are a good option to consider for interested patients – though she warns they may end up with a placebo.
“These medications provide better weight reduction than we’ve ever seen before,” she says.
“Weight management for people living with obesity is a lifelong journey. It is important that people starting GLP1-RAs are fully aware about the tendency towards weight regain if the medication is stopped, and regaining the lean muscle mass can be a problem.
“We don’t want people developing frailty. We’ll see lots of changes in this space over the next five to 10 years, and the more options there are, the better.
“But to make leaps and bounds in the weight management space, it has to be more holistic than just the medication, backed up with sound multidisciplinary team advice.
“A national treatment program with qualified practitioners, exercise physiologists, and physiotherapists, who can offer patients structured and safe programs, would ensure everyone is on the same page.”
Liz Nable from XFit Mosman reveals her clients on GLP-1s are mainly women in midlife, when bone density naturally declines as menopause hits.
“Exercise is a crucial part of a safe weight loss plan long-term,” says the mum-of-two.
“But women, especially, think weights will make them ‘bulky.’ But the opposite is true.
“Weights and resistance training boost muscle mass and bone health, and some of our clients have even reversed osteoporosis by doing this.”
AUSactive CEO Ken Griffin
Seaforth business consultant Louise keeps fit with walking and swimming, but reveals she wasn’t aware of the importance of strength-bearing exercise.
She says national guidelines around exercise and diet would stop conflicting advice, and ‘weight-loss clinics with everything under the one roof would be better than navigating everything from bone scans to blood tests yourself.’
She’s hoping to get on a hospital trial, adding: “The PBS rules are far too restrictive. I don’t understand why people have to deteriorate further before qualifying.
“Under the PBS, I was required to try Metformin first because I have diabetes. The side effects were severe, both physically and mentally, and I simply couldn’t tolerate it.
“I’m not being facetious when I say it was so much worse – I was suicidal.”
Royal Australian College of General Practitioners (RACGP) President Michael Wright states this proves the urgent need for funding to deliver critical wraparound care.
“We need a health system that supports patients to ‘gain health’ – rather than simply ‘lose weight.’
“The best way to achieve that is with a specialist GP who knows you, your medical history, what you have tried and what you have found works for you.”
The body is calling on pharmaceutical companies that have made huge profits from GLP-1s and the government to fund holistic obesity management programs.
He says doubling the current funding for allied health professionals and boosting Medicare rebates would provide patients with affordable access and support.
“Funding practices to employ the nurses and allied health professionals our patients need, like dieticians, pharmacists, psychologists, and diabetes educators, will immediately improve access to care for patients.
“In the long term, it will improve health and wellbeing, and mean fewer people end up in hospital.”
Trial callout: long-term weight management research
The North Shore Diabetes and Obesity Research team is inviting participants to apply for two new clinical trials* focusing on long-term weight management.
Study 1. Participants must:
- Have obesity – BMI over 30, or
- Be overweight (BMI over 27) with a weight-related health condition such as high blood pressure or pre-diabetes
- Type 2 diabetics cannot apply
Study 2
Overweight/obese adults on a stable weekly weight-loss injection who would like to explore options for additional weight loss.
For applications or more information, email:
nslhd-endocrineresearch@health.nsw.gov.au
*Participants must be 18 years or older and meet specific study requirements.
