It all started with the treatment of diabetes. The Danish laboratory Novo Nordisk discovered that its antidiabetic drug, Ozempic, caused significant weight loss as a side effect. Exploiting this property, the company developed Wegovy, specifically designed to combat obesity. The American giant Eli Lilly followed a parallel path with the Mounjaro and the Zepbound.
These molecules belong to the class of GLP-1 analogues, an intestinal hormone which accelerates the feeling of satiety and slows gastric emptying. Semaglutide is the most often cited analogue.
Why are generic medicines so rarely prescribed in Luxembourg?
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For Nicolas Paquot, head of the diabetology, nutrition and metabolic diseases department at Liège University Hospital, this progress is unprecedented: “For years, there was no solution. The few treatments developed quickly had to be abandoned due to very serious side effects. This is not the case here, with concrete results,” he explains in the columns of Evening.
An underestimated disease, complex causes
Obesity is still seen as a matter of personal discipline. But specialists rebel against this reductive vision. They point out that weight is the result of complex hormonal and neuronal balances, disrupted in overweight people. 70% of our weight is linked to genetic factors.
Epigenetics also plays a determining role: poor eating habits can modify the expression of certain genes, particularly during the first thousand days of life, including pregnancy. These changes are transmissible, which partly explains the intergenerational persistence of obesity.
Ultimately, the social bill is colossal: obesity costs Belgium around 4.5 billion euros per year, between hospitalizations, induced illnesses and work incapacity.
Anti-obesity medications effective, but rapid weight regain after stopping
The public health challenge represented by new treatments is therefore enormous. But be careful: they are not free from side effects. Nausea, vomiting and intestinal disturbances are common. Pancreatitis has been reported in rare cases. In the long term, taking these medications also leads to loss of muscle mass. Above all, the effect is not lasting: according to a study by the University of Oxford, patients return to their initial weight less than two years after stopping treatment. Some specialists therefore believe that medication should be considered for life, as with any chronic illness.
An exploding market, dissuasive prices
In Belgium, the number of reimbursement requests from private insurers increased twenty-fold between 2021 and 2025. The share of 21-40 year olds doubled over the same period. Social security reimbursed nearly 76 million euros for semaglutide-based drugs in 2024, three times more than in 2021.
Also in Belgium, Wegovy has been marketed since July 2025 for between 144 and 226 euros per month depending on the dosage; the Mounjaro between 173 and 321 euros. Neither is refunded.
Last fall, the World Health Organization included semaglutide and tirzepatide on its list of essential medicines, calling for the development of affordable generics for developing countries. Studies indicate that generic production of semaglutide could be as low as $4 per month. Patents will expire in some countries as early as 2026; in Belgium, the deadline is expected for 2031.
To refund or not to refund?
Until then, should these medications be reimbursed? This is the heart of the debate. For the National Institute of Health and Disability Insurance (Inami), “taking into account the price of a treatment and the number of potential patients, it would cost a colossal sum”.
Novo Nordisk returns the argument in Litter. “The question is not whether we can afford to reimburse treatment, but rather whether we have the capacity not to do so,” says Axel De Muyt, general manager BeLux of the company. The manufacturer emphasizes that targeted reimbursement would reduce the financial and social burden linked to some 200 diseases associated with obesity – diabetes, hypertension, cardiovascular diseases.
The office of Minister of Health Frank Vandenbroucke indicates for its part that the files are being analyzed by the reimbursement commission, with no timetable announced.
Ozempic increasingly used in Luxembourg
The solution would be in the middle of the ford, as often. The medical world is calling in particular for reimbursement limited to people who have significant risk factors. But nevertheless insists: reimbursing the drug without financing the support – nutritionists, physiotherapists, psychologists – “does not make sense”.
Medicine then, but also better lifestyle? The response from specialists is unanimous: medicine cannot do everything. We need global support. The problem should cross all public policies, from land use planning to mobility, including food taxation, work organization and sport. We are far from it.
New perspectives… and new debates ahead
Other debates are pressing on the doorstep of Western society. Beyond weight loss, new molecules are opening up unexpected avenues. A study published at the beginning of March in the British Medical Journal suggests that GLP-1 analogs could reduce addictive behaviors — alcohol, nicotine, cocaine, opioids. So why not investigate this avenue further?
In high-level sport, moreover, semaglutide is put under surveillance by the World Anti-Doping Agency, which must decide by the end of 2027 on a possible classification as a doping product.
Finally, there is the phenomenon known as the “Ozempic face” – an emaciated face resulting from too rapid fat loss – which illustrates how these treatments serve the strong return of the cult of (extreme) thinness. Demi Moore has, despite herself, become the controversial symbol in the celebrity press and on social networks, ruthless towards the American actress of Ghost and of Indecent proposal.
