Unpacking Wegovy in Canada: The Stigma of Obesity

The landscape of weight management in Canada has seen a significant shift with the arrival of Wegovy, a groundbreaking prescription medication designed to aid adults struggling with obesity. Since its availability in early May of last year, the drug has offered a new ray of hope for many, yet it comes with a considerable price tag, raising critical questions about accessibility, equity, and the long-overdue re-evaluation of obesity as a chronic disease within Canada’s healthcare system. At approximately $400 per month, a cost that can fluctuate based on pharmacy and specific savings programs, Wegovy’s financial barrier is proving to be a substantial hurdle for those who need it most.

The Science Behind the Solution: Understanding Wegovy

Wegovy, with its active ingredient semaglutide, belongs to a class of drugs known as GLP-1 (glucagon-like peptide-1) receptor agonists. This is the same active ingredient found in Ozempic, a drug primarily prescribed for Type 2 diabetes management, though Ozempic has also been used off-label for weight loss. The key difference lies in the approved indications and dosage, with Wegovy specifically formulated and dosed for chronic weight management.

Semaglutide works by mimicking the action of the natural GLP-1 hormone, which is released in the gut in response to food intake. This mimicry leads to several beneficial effects for weight loss:

1. Increased Satiety: It signals the brain to feel fuller sooner and for longer, reducing overall food intake.
2. Slowed Gastric Emptying: Food stays in the stomach longer, contributing to prolonged feelings of fullness and reducing appetite.
3. Reduced Cravings: It can help diminish cravings for high-fat, high-sugar foods, making dietary adherence easier.

Clinical trials have demonstrated Wegovy’s significant efficacy, with participants achieving an average of 15-20% body weight reduction when combined with lifestyle interventions such as diet and exercise. This level of weight loss can lead to substantial improvements in weight-related health conditions.

Eligibility: Who Can Benefit from Wegovy?

Wegovy is not a magic bullet for casual weight loss; it is a targeted medical intervention for specific patient populations. Health Canada has approved its use for adults who are:

• Obese: Defined as having a Body Mass Index (BMI) greater than or equal to 30 kg/m².
• Significantly Overweight with Comorbidities: Defined as having a BMI greater than or equal to 27 kg/m² and at least one weight-related medical condition. These conditions include high blood pressure (hypertension), Type 2 diabetes, dyslipidemia (an imbalance of lipids like cholesterol or triglycerides, often leading to high cholesterol), or obstructive sleep apnea.

This precise criteria underscores that Wegovy is intended for individuals whose weight poses a significant health risk, making it a crucial component of a comprehensive medical management plan, not merely a cosmetic solution.

The Staggering Cost: A Barrier to Equitable Health Care

The monthly cost of approximately $400 for Wegovy presents a formidable barrier to access for many Canadians. Unlike conditions such as diabetes or heart disease, where life-saving medications are often covered by provincial pharmacare plans or private insurance, obesity treatments frequently fall into a grey area. This lack of universal coverage means that the burden of payment falls directly on the individual, creating a two-tiered system where only those with substantial disposable income or generous private insurance plans can afford this potentially life-altering drug.

The disparity is particularly stark for vulnerable populations. For instance, individuals receiving support from the Ontario Disability Support Program (ODSP) often rely on the program to cover most of their prescription drug costs. However, Wegovy is currently not included in the formulary of covered medications under ODSP. This leaves obese individuals on disability, who often face numerous health challenges and financial constraints, completely unable to afford a drug that could significantly improve their health and quality of life. This situation highlights a fundamental flaw in the current system: essential medical treatments are out of reach for those who may need them most, perpetuating health inequities.

Obesity: The Unacknowledged Disease and Its Consequences

A significant part of the problem lies in how obesity is perceived and, consequently, how it is managed within our healthcare system. Despite growing scientific consensus, obesity is still not fully and consistently acknowledged as a chronic disease in the same vein as diabetes, hypertension, or heart disease. Instead, it is often—either implicitly or explicitly—viewed as a lifestyle choice, a lack of willpower, or a moral failing. This pervasive bias and stigma have profound implications:

• Underfunding and Lack of Comprehensive Management: Because it’s not universally seen as a disease, there’s less allocation of resources for long-term, comprehensive management strategies. This includes access to specialized medical professionals, bariatric surgery, and, crucially, pharmaceutical interventions.
• Insurance and Pharmacare Gaps: The “lifestyle” perception contributes directly to the reluctance of provincial pharmacare plans and private insurers to cover treatments like Wegovy. If it’s a “choice,” why should the public system pay? This perspective ignores the complex biological, genetic, environmental, and socio-economic factors that contribute to obesity.
• Patient Blame and Discrimination: Individuals living with obesity often experience significant bias not only in societal contexts but also within healthcare settings, leading to delayed diagnoses, inadequate treatment, and a profound sense of isolation.

Advocates, healthcare professionals, and patient groups are increasingly vocal about the need for a paradigm shift. Recognizing obesity as a chronic, relapsing disease is not just about semantics; it’s about legitimizing the need for comprehensive, evidence-based care, including pharmacotherapy like Wegovy, as a standard part of treatment. The long-term health consequences of untreated obesity — including a higher risk of Type 2 diabetes, heart disease, stroke, certain cancers, and musculoskeletal problems — impose an enormous burden on the healthcare system. Investing in effective treatments like Wegovy could, in the long run, lead to significant cost savings by reducing the incidence and severity of these costly comorbidities.

The Imperative for Pharmacare Coverage

The call for provincial pharmacare plans to cover drugs like Wegovy is growing louder. Proponents argue that such coverage is not merely a matter of convenience but of public health and equity:

• Medical Necessity: For many, Wegovy is not an elective drug but a medically necessary treatment to manage a chronic disease and prevent or mitigate severe associated health complications. Denying access based on cost goes against the principles of universal healthcare.
• Long-Term Health Outcomes: While the upfront cost is significant, the long-term benefits of effective weight management can be transformative. Reduced rates of diabetes, hypertension, sleep apnea, and other conditions can lead to healthier lives, decreased reliance on other medications, and fewer hospitalizations, ultimately easing the strain on the healthcare system.
• Equity and Social Justice: As exemplified by the ODSP situation, the current system exacerbates health disparities, making effective treatment inaccessible to those least able to afford it. Universal coverage would ensure that medical need, not financial capacity, dictates access to care.
• Precedent in Other Jurisdictions: Some other countries and even specific private insurers in Canada are beginning to recognize the value and cover these medications, setting a precedent for Canadian provinces.

Implementing coverage would require a robust framework that ensures appropriate prescribing (adhering to Health Canada’s eligibility criteria), considers the drug’s effectiveness within a holistic weight management plan, and factors in cost-effectiveness over the long term.

A Path Forward: Beyond Price Tags

The arrival of Wegovy in Canada marks a significant advancement in the medical treatment of obesity. However, its prohibitive cost and the lingering societal and systemic biases against obesity as a disease threaten to limit its impact to only a fraction of those who could benefit. For Canada to truly address the rising challenge of obesity, a fundamental shift in perspective is required.

Moving forward, provincial pharmacare plans must critically evaluate and integrate effective obesity treatments like Wegovy. This involves acknowledging obesity as a complex, chronic disease deserving of comprehensive, long-term management, including pharmaceutical interventions. Such a move would not only align our healthcare system with the latest scientific understanding but also uphold the core Canadian value of equitable access to medically necessary care, ensuring that life-changing treatments are available to all, regardless of their financial circumstances, and paving the way for a healthier, more inclusive future.