Wegovy is currently the only GLP-1 receptor agonist approved and available in New Zealand specifically for weight loss. Photo: (RNZ AFP / Jens Kalaene)

Wegovy has arrived in New Zealand, three years after the US — and with it, the possibility of up-ending how we treat obesity, diabetes, and other chronic diseases.

However, the early data tells a complicated story. While tens of thousands have started using Wegovy here, many of those who stand to gain the most, especially Māori, now appear the least likely to receive it.

Here’s Fred Christensen on what we know about Wegovy in New Zealand so far.

Wegovy is the first of a powerful new generation of therapies and has only been on the market since July this year. It contains the same active ingredient as Ozempic, semaglutide, although Wegovy is for obesity and Ozempic is for diabetes.

Ozempic, Wegovy, Trulicity, Victoza and Saxenda are all a class of medications called GLP-1 agonists, meaning they activate “glucagon-like peptide-1”, a natural hormone the gut releases after eating. That hormone signals satiety, or fullness, reduces hunger, helps release insulin, and lowers blood sugar.

Wegovy is the most potent and long-acting GLP-1 currently available in New Zealand. And while it reduces appetite and slows stomach emptying, its strongest effect is actually on the brain, where it activates the hypothalamus, our centre for hunger. It also works on the dopamine reward pathway, driving motivation, reinforcement, pleasure and addiction. In clinical trials, Wegovy was responsible for a 16 percent weight loss, far beyond other options like Saxenda.

According to the World Health Organisation, obesity starts at a BMI of 30, which would include about 1.5 million people, about 34 percent of adults in New Zealand. Among Māori adults, the situation is even worse — roughly half are classified as obese.

But this is not just an adult condition. One in nine children in New Zealand is now obese. This year, the UK medical journal The Lancet took a pivotal step in reclassifying obesity from a condition to a chronic illness. Instead of just BMI, which is a blunt instrument and doesn’t effectively capture a patient’s condition, The Lancet took a more detailed approach.

The new classification uses adiposity (accumulation of body fat) based on specific body ratios and defines two stages, preclinical and clinical, based on whether that adiposity is causing harm. Unfortunately, this new classification has not been adopted by New Zealand.

“That’s unfortunate,” says Dr Lara Courtenay, a GP specialising in obesity. “Drugs like Wegovy are life-changing, but they must include wraparound care. Some people are obtaining GLP-1s without making changes in what they eat, not just how much they eat. Other lifestyle factors, like exercise, are equally important.

“I hope that Pharmac can fund Wegovy for those who need it the most. Perhaps the UK model, based on qualifying those who agree to support from a dietitian plus monitoring, is one way to make it work in New Zealand.”

Because Wegovy patients experience significant weight loss, the implications are enormous. But research indicates that semaglutide also lowers inflammation, improves blood-vessel function, and reduces the risk of heart attack, stroke, chronic kidney disease, and fatty liver disease. Many of these benefits are independent of weight loss.

In the SELECT trial of nearly 18,000 adults with cardiovascular disease, semaglutide was shown to reduce heart attacks, strokes and cardiovascular deaths by 20 percent, independently of weight loss. A separate study (the FLOW trial) found that in people with both diabetes and chronic kidney disease, semaglutide significantly reduced kidney failure. For every 22 people treated, about one major kidney event was prevented.

The findings were so strong that the trial was stopped early.

Finally, a study published this year in the journal Addiction analysed data from 100 million Americans. The results were startling. Among individuals with alcohol use disorder, those on GLP-1s and a similar drug called GIP had a 50 percent lower rate of alcohol intoxication. Those with opioid use disorder had a 40 percent lower rate of overdose.

The strong protective effect of GLP-1s could have a significant impact on society by helping those with drug or alcohol dependence and possibly even smokers and vapers.

So why don’t we fund it?

While it’s still too recent to determine the cost-benefit ratio, Wegovy isn’t funded and costs about $500 a month per patient. Funding Wegovy at current prices and obesity levels would undoubtedly overwhelm the health budget.

The situation is fluid, however. Two weeks ago, the US issued new guidance allowing Medicare to cover Wegovy for patients with cardiovascular disease. This will dramatically raise the number of eligible people in the world’s largest market.

As the US market expands, manufacturers will probably increase supply and drop their prices. Medicare expects up to a 75 percent drop in Wegovy costs over the next two years.

Other countries may follow suit. In fact, Wegovy isn’t that expensive for everyone — in the UK, it only costs about $150 per month. Given that one in eight US adults is taking GLP-1s at today’s inflated prices, one could assume that 10 percent of our population or 500,000 people might use Wegovy.

Professor Peter Shepherd at the University of Auckland says that if GLP-1s “could be expanded for use in obesity with Pharmac funding, it would have even greater impacts on improving health outcomes in even more disease areas, especially in heart disease and kidney disease.

“Again, though this would be hugely expensive, it depends on the price of semaglutide. At current prices, I roughly estimate this would cost more than $3 billion per year to treat everyone, so it really isn’t affordable. However, semaglutide is coming off patent next year, so pricing is likely to keep falling, so it may become affordable in future.”

Patents will expire next year in Canada, Brazil, China, India, Turkey and some other emerging markets, exerting more downward pressure. Sooner or later, prices will drop, but when the Pharmac cost-benefit lines will cross is hard to predict. With a combined population of 31 million, Australians and New Zealanders may already have the buying power to negotiate with manufacturers.

Caroline De Luca, Pharmac’s Manager of Expert Advisory, says the agency will be seeking clinical advice in December. “Our expert advisors will assess how effective the medicine is compared with current funded options, and consider its impact on individuals, whānau, caregivers, and the wider health system.”

New Zealand, like other governments around the world, faces a very real dilemma: fund these drugs or face difficult decisions about eligibility, cost-sharing and discrimination. This is especially true for Māori, who carry higher rates of obesity, diabetes and many other chronic diseases. If access is limited to only those who can afford it, then healthcare will be skewed in favour of the affluent, depriving those who need it the most and worsening health inequities.

Based on the SELECT and FLOW trials, if New Zealand treated every high-risk person with semaglutide, it could prevent an estimated 5,000 heart attacks, strokes and kidney failures within just three to four years. Every stroke is estimated to cost our health system over $30,000, while a coronary bypass runs about $80,000. And that doesn’t account for kidney dialysis, liver treatments, foot amputations or stents.

Despite the cost, we know some New Zealanders are already using Wegovy.

Following a request to the Ministry of Health, I obtained aggregated prescriber data for Wegovy from the last four months. The results reveal that since July, almost 62,000 people have started using Wegovy, one of the fastest adoption rates in New Zealand history. Of those, Māori account for about 12 percent of total users, while about 78 percent are classified as “Other”, a category that includes Pākehā.

Source: Te Whatu Ora, November 2025

Adjusted for obesity rates, the results show a stark disparity in access. Adults in the “Other” category are using Wegovy at about 2.5 times the rate of Māori adults. Māori communities now represent a litmus test of whether New Zealand can close the gaps in healthcare. Māori have the highest rates of obesity and diabetes in the country, yet face the greatest barriers to new therapies.

So there you have it.

Those who need it most can’t afford it, don’t receive it, and are being sidelined. Meanwhile, usage has tripled in just four months, and the gap between the haves and the have-nots is increasing. By mid-2026, it’s estimated that there will be more than 80,000 Wegovy prescriptions per month in New Zealand.

Obesity is driven by several factors: genetics, family, lifestyle and diet. On top of that, we live in a world of unhealthy choices like sugary drinks, ultra-processed snacks, smokes and vapes, just to name a few. These products modify our behaviour by stimulating dopamine release in the same areas of the brain that GLP-1 drugs act on. In effect, one may be able to balance out the other.

That doesn’t mean there aren’t risks, however. More than half of the people who start GLP-1 medication discontinue it within a year because of side effects, the inconvenience of injections, or cost. GLP-1 drugs can also cause muscle loss, digestive issues and nausea. It’s also not recommended for those with a history of pancreatitis, or who have a personal or family history of a certain type of thyroid cancer.

However, Wegovy is so effective that it could represent a major step toward solving New Zealand’s healthcare crisis by preventing thousands of hospitalisations. Losing weight is undeniably hard, but it can provide a jump start and once the weight comes off, moving and exercising become easier.

The journey requires more than simply a magic pill. Manawa titi (resilience), healthy kai, increased exercise, whānau support, and wrap-around care from a provider are all needed. Finally, we must also rethink our two-tier health system and open the door to those who need access the most.

Fred Christensen hails from Bend, Oregon in the United States, where he led IBM strategic partnerships for over 20 years. After coming here on holiday, he fell in love with New Zealand, and moved here with his wife in 2024. Fred has a Bachelor of Science from University of Oregon, a Master of Science from Humboldt State University and a Master of Business Administration from Northwestern University. He works for the Wairoa District Council, volunteers teaching math at Wairoa College, writes a weekly HealthTalk column for the Wairoa Star and supports his wife who is a GP.

E-Tangata, 2025