Debra Wells-Hopey, seen in an undated handout photo, battled anorexia nervosa decades ago. Now she's a program manager with Eating Disorders Nova Scotia and says the mass promotion of Ozempic reinforces harmful diet culture and weight shaming.

Image Credit: THE CANADIAN PRESS/HO-Debra Wells-Hopey

TORONTO - As a teen and into her 20s, Debra Wells-Hopey bought women's magazines by the dozen and devoured all the articles about weight loss she could find.

She tried diet after diet and counted every calorie. When a diet finally worked, Wells-Hopey kept restricting her food intake until she found herself in the throes of anorexia nervosa.

Had Ozempic been around in her dieting days back in the 1980s and '90s, the Halifax woman, now 53, believes she would have taken it.

"It won't cause an eating disorder because eating disorders are more complicated than that — there's social, psychological and biological stuff going on," Wells-Hopey said.

But the act of restricting food often "pulls the trigger" for people prone to eating disorders — so for them, Ozempic could be "a one-way fast-track ticket," said Wells-Hopey, who recovered with hospital treatment and is now a program manager for Eating Disorders Nova Scotia.

The mass promotion of Ozempic and its sister drugs is feeding into a harmful "diet culture" and weight shaming in Canada, some eating disorders specialists say.

"Any time there's mass media coverage about different strategies ... to achieve short-term weight loss, that is obviously going to be something that is a trigger for our patients and clients," said Ali Eberhardt, a dietitian with B.C.'s provincial eating disorders program at St. Paul's Hospital in Vancouver.

"Any time we have a lot of coverage about the idea that we will pursue thinness at any cost, it has detrimental mental and emotional impact."

Manufactured by Novo Nordisk, Ozempic is an injection approved by Health Canada for treating Type 2 diabetes. Its sister drug, Wegovy, has been approved for treating obesity but is not yet available in Canada. Because the active ingredient — semaglutide — is the same in both medications, some Canadian doctors have prescribed Ozempic off-label at higher doses for patients with obesity.

Endocrinologists, who specialize in metabolic disorders, have said that when prescribed for weight loss,both drugs are meant to treat obesity that threatens a patient's health due to risks of cardiovascular disease and other concerns — not as a quick-fix way to trim down or get into shape. They have also said that people with obesity need to stay on the drugs for life.

Novo Nordisk has previously said that it does not endorse off-label use of Ozempic for weight loss.

But eating disorders specialists say Ozempic's widespread promotion reinforces the message that weight loss should always be a goal. The drug is promoted in TV ads,on billboards, streetcar wraps and during sports games, and has also received unofficial endorsements from influencers online.

Health Canada has said that Novo Nordisk is in compliance with drug advertising regulations, because the ads give the drug's name but do not say what it is for. Instead, the Ozempic ads tell people to "ask your doctor."

But health experts have also said the ads, social media promotion and media coverage are so widespread that people know Ozempic is used for weight loss.

"(Ozempic promotion is) just another example of how diet culture is telling us that we should lose weight if we can because living in a larger body is a bad thing. And that's what keeps us in a cycle of diet culture," Wells-Hopey said.

Although Ozempic and Wegovy are only approved for adult use, advertising has also appeared in Canada for Saxenda, another drug manufactured by Novo Nordisk that works in a similar way to suppress appetite. Saxenda has been approved by Health Canada not only for adults, but also for children between 12 and 17 years of age who have obesity.

In a recent emailed statement to The Canadian Press, Novo Nordisk said Saxenda is only intended for adolescents with obesity who "meet specific requirements" and that its ongoing Saxenda marketing campaign is "intended for an adult audience."

Still, eating disorders specialists say the promotion of a weight-loss drug that is approved for teens is concerning.

"There's young people who come in lots of different shapes and sizes," said Dr. Leanna Isserlin, a psychiatrist with the eating disorders program at Ottawa pediatric hospital CHEO.

"Once you start inserting this thinking and advertising around the importance of weight loss, you start to cause people to think more about their weight and potentially be ... ashamed or concerned or think that they need to change their weight using a medication as opposed to lifestyle changes," she said.

"Adolescents are very vulnerable to messaging and media messages, so they're a very high-risk population to begin with," Isserlin said.

"Sometimes they can feel because they see it everywhere ... it must be safe. Or (because) it's everywhere it must be a really good thing."

Eberhardt, the dietitian in Vancouver, agreed.

"We're seeing eating disorders and body image concerns impacting, you know, kids younger and younger and younger," she said.

"(Society is) saying 'your body is a problem and really at any cost we will help you to change your body. Those are messages that stick with kids for their life," Eberhardt said.

Although the public hears more about anorexia and bulimia, the most common eating disorder is binge eating disorder (BED), Isserlin said.

People with BED often have difficulty accessing mental health services, and they often feel "shame" instead of recognizing that they have a "true" psychological illness, she said.

Isserlin worries about people mistakenly thinking Ozempic is a way to deal with BED because it suppresses appetite, instead of getting treatment.

The danger of misusing medications has always been a concern when it comes to all eating disorders, she said, from using laxatives, diuretics and caffeine pills to misusing insulin or thyroid medications.

Now, the potential for misuse of Ozempic or Saxenda by people with eating disorders is an additional concern, Isserlin said.

"We have a good history to suggest that this does happen and that it's really a risk with any of these types of products," she said.

Although Wells-Hopey recovered from anorexia, she said it's still a battle, especially when she's under stress, to quiet the thoughts that tell her she's "too fat."

"I think it is extremely difficult to live in the culture in which we do and not have disordered thinking around body image and your relationship with food," she said.

This report by The Canadian Press was first published Aug. 1, 2023.

News from © The Canadian Press, 2023