The Trump effect on high drug prices

US President Donald Trump said on May 11 that he wants prices of drugs sold in the US to reflect the cheapest prices globally. PHOTO: AFP
News analysis The Trump effect on high drug prices Salma Khalik explains why US leader Donald Trump is up in arms against high drug prices, how pharmaceutical companies have reacted, and what effect his executive order could have on the rest of the world.
SINGAPORE – If US President Donald Trump had his way, the price of medication in the US would fall drastically – while the rest of the world would end up paying more, possibly a lot more.
His declaration on Facebook on May 11 that he wants prices of drugs sold in the US to reflect the cheapest prices globally sent shares of large pharmaceutical companies tumbling across the world, with several losing 3 per cent or more of their stock market value within hours.
But the steep plunge reversed just as abruptly once the executive order signed by Mr Trump on the morning of May 12 was made public. This was because the order lacked details, which led some observers to note that there was more bark than bite in his words .
Today, the US, with 340 million people, or less than 5 per cent of the world's population, spends about US$5 trillion (S$6.5 trillion) a year on healthcare – and accounts for about 45 per cent of global pharmaceutical sales.
One reason is that people in the US consume more medicine per capita than the rest of the world. Since they use more, they buy more, and hence spend more on drugs.
Another reason, which is what upsets Mr Trump, is that prices of drugs, particularly those still under patent, are generally much higher in the US than anywhere else in the world.
Pharmaceutical companies say the high prices paid in the US allow consumers there to be among the first to get any new treatments.
Mr Trump gave the example of a 'fat drug', without naming it, that costs 10 times more in the US than in some other countries.
He was likely referring to the highly popular diabetes drug Ozempic, which is also prescribed for weight loss under the trade name Wegovy.
A 2023 comparison of prices by the independent Peterson-KFF Health System Tracker found 'the list price for one month of Ozempic in the US (US$936) is over five times that in Japan (US$169), and about 10 times more than in Sweden, the United Kingdom, Australia and France'.
Drug companies have historically priced their products differently in different countries. Generally, richer countries tend to pay more than poorer countries with lower purchasing power.
The Singapore Association of Pharmaceutical Industries (Sapi) told The Straits Times: 'Pharmaceutical companies work with local governments and healthcare systems to offer flexible and tailored pricing solutions based on each country's needs, helping make medicine and vaccines more affordable and accessible, especially in countries with fewer resources.
'Tiered pricing is one of the most effective and sustainable ways in which pharmaceutical companies help to improve and sustain access to medicine globally.'
The cost of medication in Singapore, for example, is much higher than in neighbouring countries, so it is not uncommon for people to cross the Causeway, where savings could be significant, to buy their medicine.
Having said that, rich countries also can get drugs more cheaply because of their buying power and ability to negotiate better prices.
Australia, for example, sets a cap on the price of drugs it allows to be sold in the country. This can mean, however, that fewer drugs are available in Australia – compared with Singapore, for instance – as some pharmaceutical companies will refuse to sell at the designated prices.
Even within the US, drug prices do vary. But the US does not benefit from its large purchasing power because the prices were negotiated individually between drug companies and their buyers – typically insurance companies, pharmacy chains and hospitals.
Mr Trump's executive order states: 'The inflated prices in the United States fuel global innovation while foreign health systems get a free ride.'
Associate Professor Wee Hwee Lin of the Saw Swee Hock School of Public Health said one of the main reasons drug prices are so high in the US is that there has been no direct price control mechanism, unlike in many other developed countries.
Drugs have to prove only safety, efficacy and quality – but not cost-effectiveness, as is required in some other countries. She added that many pharmaceutical companies also choose to launch in the US first, as they can command the highest prices there, thus setting the bar for the rest.
This may change with the passage of the Inflation Reduction Act (IRA) in 2022, which, for the first time, empowered Medicare to negotiate prices directly with drug companies.
It had previously been legally prohibited from negotiating drug prices under a 'non-interference clause' in the Medicare Prescription Drug, Improvement and Modernisation Act 2003.
Medicare, the national insurance for people over 65 and those with disabilities, is the single largest payer of healthcare in the US, and covers more than 55 million Americans for outpatient prescription drugs.
Said Prof Wee, whose teaching areas include pharmacy practice: 'Prior to the IRA, Medicare was explicitly prohibited from negotiating prices directly with pharmaceutical companies. Therefore, drug prices in the US may be considered to be market-based pricing, based on supply and demand.'
Even with the passing of the IRA, the cheaper negotiated prices will start to take effect only from 2026.
Since the IRA was passed, Medicare has completed negotiations on 10 drugs that alone cost it US$50.5 billion in 2022, or about 20 per cent of its gross total drug spending . The drugs, which are used to treat chronic diseases such as diabetes and cancer, will have maximum prices that are 38 per cent to 79 per cent cheaper from January 2026.
The IRA allows it to negotiate prices for 10 drugs in the first year, 15 in the next two years, and 20 a year thereafter.
It has embarked on negotiations for the next 15 drugs, also for chronic diseases like diabetes, cardiovascular disease and cancer, to take effect from January 2027. Ozempic is one of them.
Legal challenges have been mounted against the drug negotiation programme. According to a US Congress report, 'beginning in June 2023, several pharmaceutical manufacturers and trade associations filed lawsuits in various federal district courts alleging that the programme was unconstitutional'.
So far, most have failed, but some court cases are still ongoing. In contrast, some Congress members want to expand the programme to more drugs in the market.
Prof Wee said most other developed countries exert some control over drug prices by government intervention that will 'thus introduce market failure'.
Britain's National Institute for Health and Care Excellence is a forerunner of healthcare technology assessment, which looks at whether the benefits of new treatments justify the price asked for.
If they do not, the treatment would not be recommended to the National Health Service, which pays for almost all drugs used in the country.
Many other countries in Europe and Asia have similar agencies to control the cost of new and expensive treatments.
Singapore recently tasked the Agency for Care Effectiveness with studying new treatments and deciding if they provide value for money – changing the nation from being a passive price taker to one that has some clout in deciding the 'correct' pricing for the benefits from a treatment.
It resulted in the Cancer Drug List, a list of treatments approved for insurance coverage, which has led to across-the-board savings of about 30 per cent in the public sector. At the upper ranges, the prices of cancer drugs fell by as much as 60 per cent.
Pharmaceutical companies are still free to sell their cancer drugs at any price – but unless their price to the public sector is deemed cost-effective, they cannot be covered by MediShield Life or Integrated Shield Plan insurance, which pays for the vast majority of cancer treatments here.
Singapore, being a small market, continues to pay a lot more than places like Australia, Taiwan and South Korea for many other drugs.
Prof Wee pointed out that another major reason for the high drug prices in the US is the use of middlemen such as pharmacy benefits managers (PBMs). She said PBMs were originally intended to streamline procurement processes and help drive down costs for insurers and employers.
'However, over time, many unintended consequences arose. For example, there is a lack of transparency as regard the amount of rebates PBMs receive from the pharmaceutical companies relative to the list price,' she said.
On the day the US President's executive order was signed, Mr Stephen J. Ubl, president and chief executive of the Pharmaceutical Research and Manufacturers of America, released a statement saying: 'The US is the only country in the world that lets PBMs, insurers and hospitals take 50 per cent of every dollar spent on medicine.
'The amount going to middlemen often exceeds the price in Europe. Giving this money directly to patients will lower their medicine costs and significantly reduce the gap with European prices.'
Prof Wee said the influence of PBMs goes beyond just taking a big cut from the sale of drugs: 'PBMs may purchase based on how much rebate they can obtain rather than what is the least-cost option. Many of the PBMs are also owned by insurance companies.
'It is not clear how the financial interests of the insurance companies are prioritised over cost savings or patient outcomes.'
Many drug companies argue that a large drop in their revenue could affect their ability to research and develop new treatments, which would be a sad loss to the world. However, there is no evidence to suggest this would actually happen.
Mr Trump, who has not mentioned the Medicare programme, nevertheless wants drugs in the US to be sold at the 'most-favoured-nation price'. If that happens, prices of drugs elsewhere could go up as a result.
The order said: 'My administration will take immediate steps to end global freeloading and, should drug manufacturers fail to offer American consumers the most-favoured-nation lowest price, my administration will take additional aggressive action.'
However, it did not spell out what such aggressive actions might be.
Furthermore, Mr Trump had tried something similar in his first term in office, only to be blocked by the courts. Most attempts to control drug prices will need congressional approval – something that could take years to achieve, if at all possible.
Mr Trump ordered his Secretary of Health and Human Services, Mr Robert F. Kennedy Jr, to establish a mechanism through which American patients can buy their drugs directly from manufacturers, bypassing middlemen.
This sounds promising on paper, as it would cut the price of drugs by half. But in reality, it is far more complex. If the current intermediaries between drug company and patients are removed, some other mechanism needs to take their place to ensure drugs get to patients. It might cut the price, but there would certainly be some distribution cost.
Mr Trump also suggested importing 'prescription drugs on a case-by-case basis from developed nations with low-cost prescription drugs'. Even if the laws in the US can be amended to allow for this, the quantities imported are unlikely to be large enough to move the needle.
Prof Wee said that to systematically bring down the prices at which drugs are sold, the US first needs to define the set of countries that it will refer to for international reference pricing – and whether this is based on the list price or the net amount paid after negotiations, including volume discounts.
While list prices are readily available, negotiated prices are usually kept confidential.
She added that the US would also need to conduct health technology assessments to decide on what drug pricing is justifiable, at a national level. Any moves in this direction will certainly be challenged as unconstitutional, as it could prevent patients from assessing treatments deemed not to provide value for money.
In contrast, many countries in Europe and Asia, including Singapore, are willing to forgo access to new therapies if they are found to be too costly for the additional benefits provided.
In spite of the difficulties in implementing Mr Trump's directive, his declaration of war against high drug costs in the US is likely to result in some price reduction.
Most industry experts expect pharmaceutical companies to reduce prices somewhat in an effort to allay his wrath. This will be especially for drugs that are nearing the end of their patent – so that Mr Trump can declare his move a success.
Prof Wee said it is 'hard to say at the moment how the pharmaceutical companies will respond'. Should there be significant cuts in drug prices in the US, she anticipates a chain effect, which will lead to a new equilibrium in pricing globally, including in Singapore.
US Secretary of Health and Human Services Robert F. Kennedy Jr at a news conference about prescription drug prices at the White House on May 12.
PHOTO: AFP
Going forward, exactly what will happen remains anybody's guess.
But should the US government try to impose severe price cuts, the drug companies will likely take legal action to block such moves, given that billions of dollars are at stake. And pharmaceutical companies have deep pockets – with the top handful each raking in revenues in excess of US$50 billion in 2024.
Mr Trump's diatribe on high drug prices in the US appears to target Europe. Referring to how countries there 'force' pharmaceutical companies to cut the cost of drugs, he said 'the European Union has been brutal, brutal. And the drug companies actually told me stories, it was just brutal'.
So, rather than going after the pharmaceutical industry directly, he just might penalise countries that he feels are 'suppressing' drug prices to the detriment of the US.
Mr Trump is known for doing the unexpected, such as linking a 20 per cent tariff on goods from China to the inflow of fentanyl to the US. So, the penalty could be anything, including higher tariffs on totally unrelated goods to something no one has even thought about.
Any changes, big or small, in drug prices in the US will likely have some spillover effect for Singapore.
Ms Poh Hwee Tee, president of Sapi, told ST: 'While it is too early to determine the full extent of the impact of the US government's most-favoured-nation executive order, Sapi and its members are closely monitoring the developments and remain committed to working in close partnership with the Ministry of Health and other stakeholders to identify and address any potential challenges.
'Our focus remains on supporting Singapore's healthcare ecosystem and working collaboratively with stakeholders to ensure sustainable access to innovative medicine and vaccines for patients in Singapore.'
Singapore spends about $1 billion a year on medicine. If prices were to go up by, say, 20 per cent across the board, that would be an additional $200 million a year.
While this might not amount to much for government coffers and much of the price increase for subsidised patients might be cushioned by higher subsidies, the increase may be significant for private patients.
A reassuring thought is that any increase in prices will affect only drugs that are still under patent. A lot of commonly used drugs here for conditions like diabetes, high cholesterol and blood pressure, are generic, and hence cheap. There is unlikely to be any impact on these.
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The weight limit for riding the zip-lines was 280 pounds. Back home, Ms Elizabeth wept when she watched the video Austin shared of him gliding through the trees. 'He couldn't have done this before,' she said. Soon after his return, he was hit hard by the death of his elderly friend. His psychiatrist prescribed a more powerful anti-depressant. Austin then panicked when, after Dr Lindquist stretched out Austin's dosages, he started eating more and putting on pounds. That stopped when he went back to regular weekly injections. The family got another shock in January, when Ms Elizabeth's insurance through University Health quit covering Wegovy and other so-called GLP-1 drugs for weight loss. Wegovy had been free, after insurance and Novo-provided coupons. Now, the health system would be providing Wegovy at US$250 for a three-month supply through its own pharmacy. 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His weight has leveled off at about 200 pounds – a 30 per cent loss in two years. He doesn't want to contemplate life without Wegovy. 'I feel I would be bigger,' he said. 'I don't want to go back.' 'What I'm doing isn't working' WILMINGTON, Delaware – At 15, Katie Duncan, 6-foot-1 and 270 pounds, was growing increasingly anxious and depressed about her weight. Some of her clothes no longer fit, she was easily winded while walking, and her back ached. Classmates occasionally lobbed mean comments about her size. Blood tests showed she had high triglyceride levels, which can increase the risk of stroke and heart disease. But Katie's hunger never let up. She often ate four or five meals a day. She would devour an entire pizza and hide snacks in her bedroom to satisfy cravings. She had tried an older weight-loss drug that did nothing. 'We need to change something,' she told her father, Randy, in the summer of 2023. 'What I'm doing isn't working.' Ms Katie Duncan uses Wegovy for weight loss. PHOTO: REUTERS Randy scheduled an appointment at the Healthy Weight and Wellness Clinic at the nearby Nemours Children's Hospital. The Duncans knew the hospital well: Katie had been treated there after she was diagnosed at age seven with a brain tumor. Doctors had given her a 20 per cent chance of surviving the cancer. Katie took an experimental drug and underwent months of chemotherapy and radiation. She was tiny at the time, only 42 pounds. The cancer went into remission within a year. However, the tumor had damaged her hypothalamus, the portion of the brain that controls hunger, and the nearby pituitary gland, which releases hormones that regulate growth and metabolism, among other key functions. Her doctors put her on a lifelong regimen of synthetic hormones and a low-dose steroid to replace what she lost. The brush with death forged a fierce bond between father, divorced since Katie was 3, and daughter, the youngest of five siblings and the only one still living at home. Randy, a paramedic and volunteer firefighter, took off from work to go to every doctor's appointment and physical therapy session with her. Katie treasured a locket with her father's photo inside and refused to go to school without it. He accompanied her on every school field trip. Katie tried a sleepaway camp hosted by the hospital and called her dad to pick her up after the first night. 'I don't like being away from my family,' she said. But by the time Katie was 9, Randy, now remarried, noticed something was wrong. Katie was constantly hungry, and the two clashed repeatedly over it. During a trip to SeaWorld in Florida, they shouted at each other when Katie complained that she was starving, even after a big breakfast at their hotel. Katie steadily put on weight during her middle-school years. She avoided running and other sports due to painful neuropathy in her feet, likely caused by her cancer and chemotherapy. She couldn't keep pace with classmates in physical education. At her appointment in 2023, Katie saw Dr Thao-Ly Phan, medical director of the Nemours weight clinic. After examining Katie and reviewing her medical history, Dr Phan determined that Katie probably has 'hypothalamic obesity' from her brain injury, for which the replacement hormones don't fully compensate. 'Her body isn't helping her out,' Dr Phan said. While brain cancer isn't common, Dr Phan said, teens can have other, more common underlying conditions or treatments that lead to obesity and complicate their care. For example, polycystic ovary syndrome can cause hormonal imbalances and weight gain, especially around the belly, in young women. Antidepressants, mood stabilisers and other psychiatric medications can lead to weight gain, too. After prescribing Wegovy, Dr Phan had Katie see the clinic's psychologist and nutritionist, a routine step the doctor requires of her patients. 'We don't want kids to lose so much weight that they develop eating disorders,' she said. 'We want to make sure that they're still getting the nutrition they need to grow and to thrive.' Katie got her first dose of Wegovy in November 2023. She lost about 20 pounds in the first couple months, with only mild side effects. At times, Katie had no interest in eating and skipped meals, despite Dr Phan's warnings not to. Poor nutrition and eating habits during adolescence can have long-term consequences, from impairing cognitive development to increasing the risk of osteoporosis and bone fractures, research shows. About six months after Katie started treatment, the family's insurer cut off coverage of her Wegovy. Randy's appeal of that decision failed, and he switched Katie's prescription to her secondary insurance with the state Medicaid program, which had been in place since her cancer treatment. Delaware is one of 14 states with Medicaid coverage for the newer GLP-1 weight-loss drugs. Katie missed only one weekly dose. At an appointment with Dr Phan in March, Katie weighed 209 pounds, down 60, or 22 per cent of her body weight, in about 18 months. Her triglycerides were no longer elevated. The weight loss has brought welcome changes. Katie said she used to lack motivation to do much at all and would lounge for hours in bed. 'I used to always feel yucky before,' she said. 'The weight loss has actually helped a lot with my energy.' The 17-year-old now enjoys regular visits to the Planet Fitness gym with her father and stepmother, Denise, and spends more time on her painting and crafts. She has more stamina to cook two hours straight in her high-school culinary class. She also doesn't get winded chasing after her two-year-old niece at family gatherings. While she used to hide herself in baggy clothes, she now feels comfortable wearing sundresses. Randy is pleased with Katie's progress. He worries that Delaware may stop covering GLP-1 weight-loss drugs through Medicaid due to budget shortfalls or proposed cuts in federal funding. California and North Carolina are seeking to rescind Medicaid coverage of the drugs to save millions of dollars. 'I hope to God they keep Wegovy around for kids,' Randy said. Katie wants to stay on the drug and trusts that her dad and her doctor wouldn't let her take anything harmful. 'Wegovy doesn't scare me,' she said. 'I've had so many needles in my life.' 'I'll do whatever it takes' DODGE COUNTY, Wisconsin – Early in 2024, after eight months on Wegovy, Leo had a choice to make. He could stop taking the drug, end the side effects that were wreaking havoc on his life and risk regaining some of the more than 25 pounds he had lost. Or he could stay on it, keep losing weight and hope the severe stomach aches, nausea and diarrhea would abate. For this article, Leo and his mother, Jamie, asked Reuters to withhold details such as their precise location and Leo's surname, and Leo declined to be photographed. They said they feared the exposure would lead to more teasing from Leo's peers about his appearance and his decision to take a weight-loss drug. Leo had been a strong candidate for Wegovy when he first saw an obesity specialist, Dr Leslie Golden, in mid-2023. He was a compulsive eater from an early age, due in part to his attention-deficit/hyperactivity disorder, for which he takes medication. He was diagnosed with obesity at 11 years old. Three years later, he was carrying 181 pounds on his 5-foot-4 frame. Jamie tried to stock the kitchen with healthier foods. But Leo's older sister and two older stepbrothers wanted ultra-processed snacks and sugary drinks around. Leo would gulp down five cans of Coke in a day. He sneaked snacks and sodas into his bedroom at night, leaving empty wrappers and cans for his mother to find strewn about the next morning. One of his stepbrothers was severely underweight, complicating Jamie's food choices for the family. The teasing and bullying started in middle school. When he walked the halls between classes, other students hurled jeers and jokes at him. 'It was always directed at my weight,' he said. 'The comments just got to me.' Leo knew he had a problem but felt powerless to do anything about it. 'I was eating way too much,' he said. 'I was worried I was going to get way too overweight.' Jamie, a pharmacist, thought Wegovy might help. Frustrated with her own efforts to lose weight, she had started taking the drug in January 2022. She, like Leo after her, suffered severe gastrointestinal side effects, but they faded, and after a year, she had lost 50 pounds. Leo, having learned what Wegovy did for his mother, was open to trying it. In June 2023, Leo had his first appointment with Dr Golden, at her obesity clinic in a town near where he and his family live about an hour outside Milwaukee, Wisconsin. He already bore troubling signs of the effects of his obesity. His blood pressure was high. His elevated blood sugar level put him at increased risk for type 2 diabetes. The doctor worried that Leo could develop liver and heart disease if he didn't lose weight. She prescribed Wegovy. Dr Golden doesn't require families to undergo counseling on lifestyle changes as a prerequisite for prescribing the drug for children. She said most families have already tried other ways to lose weight before they reach her office, and imposing a months-long delay before drug therapy 'is really just another form of bias and stigma'. She does ask for monthly visits so she can monitor a child's progress. Her patients pick three goals for the coming month – for nutrition, movement and behavior. For Leo, at one point, that meant eating more carrots and cauliflower, playing basketball in the driveway and downing fewer sugary drinks. Soon, Leo was eating a lot less, though what he ate didn't change so much. At restaurants, he could stomach only three bites of the double cheeseburgers he usually ordered. He was happy with the weight he was losing. The bullying was easing up, and some classmates even complimented him on looking thinner. He grew comfortable raising his hand in class. 'It feels pretty good to get myself out there,' he said. But as his doses steadily increased – the standard of care for GLP-1 medicines is to up the dose every four weeks – the side effects started taking a toll. He took medicines to quell the nausea and diarrhea. He dropped off anti-diarrhea pills with the school nurse. Some days, his stomach upset was so bad that Jamie had to pick him up at lunchtime. Leo was experiencing by far the most common side effects of Wegovy. In the largest clinical trial of the medicine on teens, 62 per cent of patients experienced nausea, vomiting and diarrhea. Most reported mild to moderate side effects that lasted two to three days. Since their launch, Wegovy and other GLP-1 drugs have also been associated with much rarer incidents of gastric paralysis, pancreatitis, depression and blindness. As his absences piled up, Leo's grades suffered, and he grew moodier. At a parent-teacher conference in October 2023, teachers told Jamie that Leo had become more withdrawn in class. At a checkup with his regular pediatrician later that month, his answers on a questionnaire indicated depression. The doctor prescribed an antidepressant. That didn't lessen the side effects, though, and Leo's school absences persisted. In February 2024, the high school notified his mother that he had missed 10 days, the maximum allowed for the year. Soon after that is when Dr Golden presented Leo with the choice about continuing with Wegovy. Jamie favored sticking with the drug. The doctor wanted the choice to be Leo's. 'Jamie is a very involved parent who wants to protect and do what's best for him,' Dr Golden later told Reuters. 'I had to really zone in on Leo: Do you want to keep taking this?' Despite the physical pain and discomfort, the problems at school, the depression, Leo was adamant. 'I'll do whatever it takes,' Leo told Dr Golden. 'No matter how sick I get, I don't want to stop.' Several weeks later, the side effects began to ease. By last summer, Leo had dropped under 150 pounds. His waist had shrunk by five inches. Based on his body mass index, he no longer had obesity. 'I am happy that I don't get called names anymore,' Leo said. Then last autumn, he started to put on weight. Dr Golden had reminded Leo that some additional weight was expected as he grew three inches taller over the span of a year, eventually reaching 5 foot 7. But Leo's mother found food wrappers and soda cans in his bedroom. In November 2024, Leo wept when he stepped on the scale at home and saw that he had gained 14 pounds, up to 164. 'I'm getting fat again,' he told his mother. At an appointment with Dr Golden the following month, the doctor put Leo on the highest weekly dose of Wegovy to help counter his cravings. That worked, without the side effects he had experienced earlier. At a checkup in April, Leo weighed 154 pounds, down nearly 30 pounds in the past two years. Leo took a cooking class during his sophomore year and hopes to attend culinary school one day. He also took a part-time job stocking shelves at the local hardware store. Leo's pediatrician was pleased with his improved self-esteem and energy level. She asked Jamie: 'What is the end game? When is Dr Golden going to stop it?' That's an open question. Dr Golden has repeatedly advised Leo that he will probably have to take Wegovy for the rest of his life to maintain a healthy weight. Leo and his mother are OK with that. 'There is no end game,' Jamie told the pediatrician. Afraid of gaining it back FREDERICK, Maryland – Ms Stephanie Serrano didn't want to take a weight-loss drug. She didn't think it would work, and even if it did, she didn't like injections, especially if she had to get them for the rest of her life. But Ms Stephanie was desperate. At 320 pounds, she had already been diagnosed with type 2 diabetes and liver disease. She was tired of being the biggest kid in class and had become a virtual shut-in after years of failed dieting. 'Every doctor that I had ever seen would just tell me to eat healthier, like it was that simple,' Ms Stephanie said. In 2022, her family doctor referred the then-16-year-old to the obesity clinic at Children's National Hospital in Washington, DC. There, initial tests revealed that she had polycystic ovary syndrome, a common cause of weight gain in young women. 'That diagnosis changed everything,' she said. 'I wasn't lazy or not trying hard enough. My body was actually working against me.' In October that year, Ms Stephanie's doctor at Children's National, Dr Susma Vaidya, prescribed Ozempic, Novo's drug for type 2 diabetes with the same active ingredient as Wegovy, which hadn't yet been approved for teens. Ozempic has been widely used off-label for weight loss, both prior to Wegovy's launch and after due to shortages and spotty insurance coverage of the latter. By the time she saw Dr Vaidya, Ms Stephanie had her heart set on weight-loss surgery, swayed by TikTok videos of young adults showing their dramatic before-and-after transformations. 'Seeing how much they changed, it's incredible,' she said. 'So that's kind of what I wanted for my life. I wanted a permanent change.' Ms Stephanie Serrano lost weight by using Ozempic and undergoing bariatric surgery. PHOTO: REUTERS Dr Vaidya, medical director of the obesity clinic at Children's National, persuaded Ms Stephanie to accept a compromise: Ms Stephanie would give Ozempic a try while undergoing a six-month evaluation, including sessions with a dietician and a psychologist, to determine whether she was a good candidate for surgery, based on factors like adequate family support and eating regular, well-balanced meals. Ms Stephanie started taking the lowest recommended dose of Ozempic. The side effects were mild, though she occasionally experienced nausea and stomach pain after a big meal. She lost nine pounds in the first month. After four months, in February 2023, she was surprised – and pleased – that she had lost about 30 pounds. 'I had never seen the number on the scale go down,' she said. At that point, Dr Vaidya told Ms Stephanie she could continue taking the drug, or she could undergo surgery. Ms Stephanie's father, Jose, who was taking Ozempic for his type 2 diabetes, preferred that she stick with the drug. He worried about her risk of complications from a major operation. Ms Stephanie held firm. Despite her weight loss on Ozempic, she felt that surgery was the only way to end the isolation she had endured for years. Since the start of the Covid-19 pandemic, Ms Stephanie had retreated from school and friends. In 2021, during her sophomore year, her high school gave students the option to return or continue with online classes. She never went back to the classroom. Through the lens of social media, she watched classmates gloat about their beauty 'glow ups' and post photos of themselves with new makeup routines and outfits. MS Stephanie quit the school's Junior Reserve Officers' Training Corps, a leadership program sponsored by the US military, to avoid being around other people. 'I hid myself for those years,' she said. 'I no longer wanted to be a prisoner.' In April 2023, Ms Stephanie, at about 285 pounds, had gastric-sleeve surgery, which involved removing a large portion of her stomach to reduce food intake. She came through the surgery and recovery without complications. Today, the 19-year-old college freshman is down to about 175 pounds. She eats small meals and exercises regularly. Her diabetes is in remission, and her liver function is normal. She takes a full load of classes at a nearby community college and plans to transfer to a four-year university soon. She aspires to be a sports psychologist. As Ms Stephanie lost weight, she became more outgoing at school and in church and found she could make friends. She opened up to the possibility of a relationship and flirted with a young man at church. That didn't go anywhere, but she had surprised herself with her willingness to even try. 'Having a crush on anyone seemed so silly before. I could never imagine someone loving me,' she said. 'I was always ashamed of myself.' Amid all this progress, another problem emerged: Ms Stephanie was consumed with fear of gaining the weight back. She started skipping meals and guzzling energy drinks. After eating a small meal, she would run a mile to burn off the calories. Her legs and back began to ache, and she sometimes lost her balance – signs of possible muscle loss. Dr Vaidya told her, 'This is your body asking for protein.' Dr Vaidya diagnosed Ms Stephanie with an eating disorder in April 2024 and referred her to a hospital psychologist. Dr Vaidya also prescribed bupropion, an anti-depressant sometimes used to manage binge eating. The possibility that weight-loss drugs may put teens at risk of disordered eating is why some doctors urge rigorous screening of patients and continuous monitoring during treatment. Research on any association between weight-loss drugs or bariatric surgery and eating disorders is limited. Some small studies found that the use of GLP-1 drugs may decrease binge eating episodes among those who already had the disorder. But the studies only tracked patients for three to six months, leaving longer-term effects unknown. Ms Stephanie's psychologist urged her to stop counting calories and poring over the nutrition labels on packaged foods. She's making progress, but it's a 'constant battle,' she said. Stephanie still gives in sometimes to count calories, and when she exceeds her target, 'I completely shut down.' At home, Ms Stephanie does much of the cooking for her parents and older sister, Lily. She rarely eats what she cooks. At a recent dinner, her family enjoyed the carne asada, beans and pico de gallo she had prepared while she picked at a small bowl of rice and a homemade tortilla. She didn't finish either. Later, Ms Stephanie, her mother, Ms Vanessa Serrano, and Lily visited a local mall – a place she used to avoid because it was hard to find clothes her size there. At the American Eagle store, she tried on a pair of black jeans. She emerged hesitantly from the dressing room to have a look in a mirror. After Lily told her she looked incredible and snapped photos, Ms Stephanie checked herself out from several angles. She bought the jeans and wore them to church the next day. REUTERS Join ST's Telegram channel and get the latest breaking news delivered to you.

CNA

4 days ago

• CNA

Dr H A Hellyer on Israel-Iran conflict

Israel has warned that Iran will pay a heavy price for a missile attack that struck a hospital. Meanwhile, US President Donald Trump is weighing Washington's involvement in the conflict. CNA speaks to Dr H A Hellyer, Senior Associate Fellow of the Royal United Services Institute for Defence.