2024-02-01 09:00:00
Between the Clarendon Hotel and the Hôtel-Dieu, in Old Quebec, there are a few hundred meters. Sabrina Vallerand makes the journey on foot. She leaves her job, where she is a chambermaid, to go to the hospital’s hemodialysis center. For four hours, three evenings a week, she is hooked up to a machine to clean her blood. Because his kidneys have stopped working.
In recent months, his step has been lighter. A touch of hope shines in his eyes. She learned last November that she had been placed on the waiting list to receive a kidney transplant. If all goes well, in a few months, she will return to a more or less normal life.
To qualify, she had to fight. When her doctors diagnosed her with kidney failure two years ago, they told her she needed to lose 45 kilos, or regarding a hundred pounds. The success of the operation depended on it. Ms. Vallerand consulted a nutritionist and changed her lifestyle habits.
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Sabrina Vallerand suffers from kidney failure.
Photo : Radio-Canada
It was ultimately with the help of a drug, semaglutide, that she achieved her goal. This medication saves lives, says the 37-year-old woman.
Shortage and prejudice
Semaglutide, known by the trade names Ozempic and Wegovy, sparked a revolution in the treatment of obesity. First developed to treat type 2 diabetes, this drug has experienced meteoric popularity since it became known that it helps you lose weight.
Public figures have admitted to taking it to get back in shape. Since then, prescriptions have exploded. So much so that health specialists say they are concerned regarding abuse.
At the same time, extremely sick people who suffer from obesity struggle to access it.
For some of my patients, it is a matter of life and death.
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Dr. Marie-Philippe Morin is a specialist in bariatric medicine at the University Institute of Cardiology and Pneumology in Quebec.
Photo : Radio-Canada
Ozempic, Wegovy and Mounjaro (another drug in the same category) are currently in shortage in Canada. And those who manage to find doses must have deep pockets. Ozempic can cost up to $400 per month if you take the highest dose.
The Régie de l’assurance santé du Québec (RAMQ) covers the costs only for patients with type 2 diabetes. Those who take it to lose weight must pay out of pocket.
Dr. Marie-Philippe Morin is fighting to ensure that patients suffering from obesity have access to semaglutide.
If it were a drug to treat cancer, everyone would ask RAMQ to reimburse, she said. But people who suffer from obesity are stigmatized. So we don’t pay.
The science of obesity
The decision not to reimburse obesity medications was taken by the Quebec government at a time when these medications increased cardiovascular risks and were not very effective.
However, the science of obesity has evolved a lot since then.
We better understand the role of hormones behind hunger. GLP-1, for example, is produced in the intestine following eating food. It acts on the brain to signal that the stomach is full. GLP-1 also slows stomach emptying. It prolongs the feeling of satiety following a meal.
In certain people who suffer from obesity, the hormonal signals associated with satiety may be a little weaker, explains Dr. Morin. Hence the interest in prescribing medication. Semaglutide is a GLP-1 agonist. That is to say, it produces the same effect: it suppresses the appetite.
Patients who are prescribed medications like Ozempic will likely need to take them throughout their lives. Otherwise, they risk regaining the lost pounds.
People who suffer from chronic lung disease due to smoking, we pay for their pumps for the rest of their lives, argues Dr. Morin. The same goes for patients who suffer from hypertension or type-2 diabetes. Why wouldn’t we pay for those who suffer from obesity?
The report by Dominique Forget and Yanic Lapointe Obésité : who should pay? will be featured on the show Discovery Sunday at 6 p.m. h 30 on HERE TV.
Teenagers too
In Canada, semaglutide is not yet approved for weight loss in children, but Dr. Mélanie Henderson, a pediatrician and endocrinologist at the Sainte-Justine University Hospital Center (CHU) in Montreal, has started prescribing it to children. teenagers who are running out of options.
It has been used in children for diabetes for a number of years, she points out. So, it’s not a molecule for which we have no experience.
She is also fighting for RAMQ to reimburse semaglutide for patients who need it the most.
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Dr. Mélanie Henderson is a pediatrician and endocrinologist at the Sainte-Justine University Hospital Center, located in Montreal.
Photo : Radio-Canada
Obesity is not a personal choice. It is a chronic, multifactorial disease, and genetics has a lot to do with it.
Physical activity, healthy eating and reducing screen time are at the heart of the treatment offered at CHU Sainte-Justine. But for some, these efforts do not have the expected results. And the complications of obesity in young people are generally more serious than in adults, particularly when it comes to type 2 diabetes.
Like Dr. Morin, Dr. Henderson regularly sees patients unable to afford the medication that might change their lives.
If we don’t help young people at a young age, the consequences on the health system will be catastrophic, she says. We have not yet seen the impact of the pediatric obesity epidemic on health needs when these young people reach adulthood.
In other words, not reimbursing semaglutide today will end up costing much more tomorrow, she believes
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