When Novo Nordisk's chief executive Mike Doustdar addressed the National Press Club this week, he painted a compelling picture: Australia has the capacity to tackle obesity at scale, not just treat it. His company's blockbuster drug Ozempic, he suggested, could help young people avoid the lifelong health consequences of excess weight.
The pitch sounds reasonable. The public health reality is grimmer. One in four Australian children are already living with overweight or obesity. Projections suggest that by 2050, more than half of young Australians will fall into these categories, accompanied by rising rates of diabetes, fatty liver disease and psychological distress.
But when it comes to putting GLP-1 drugs like Ozempic into the hands of adolescents through government subsidy, the medical profession is reaching a different conclusion.
The Cost Question
Novo Nordisk is asking the federal government to expand taxpayer subsidy of Ozempic, but GPs say there are better options. Currently, only people with Type 2 diabetes can access subsidised Ozempic through the Pharmaceutical Benefits Scheme. The company argues millions more would benefit, including adolescents. But the price tag gives pause.
The figures are striking. Half a million people in Australia are estimated to be taking GLP-1 medications, which typically cost patients more than $400 a month. More than 400,000 Australians are paying as much as $5,000 a year for private GLP-1 medications.
For comparison, GLP-1s are already subsidised for patients with type 2 diabetes, where the government negotiates the price down to around $30 per script. Scaling that arrangement across the entire adolescent population living with obesity represents what Health Minister Mark Butler himself has described as a "very big bill for taxpayers." This is not abstract fiscal theory: this is about weighing a genuine health intervention against the opportunity cost of other programmes.
The Evidence Gap
Dr Michael Wright, president of the Royal Australian College of General Practitioners, said "we certainly need more evidence" before expanding access to these drugs for young people, especially when the company's own advertising says Ozempic is not for children.
The reasoning reflects more than bureaucratic caution. None of these drugs are currently listed on the PBS for weight management; they are PBS-subsidised for type 2 diabetes management only, and costs to the patient can be hundreds of dollars per month. The research base for adolescent use, while growing, remains incomplete. There is limited research on GLP-1 safety and effectiveness for children under 14, with most clinical trials and FDA approvals focusing on adolescents 12 and older.
The medications also demand ongoing commitment. Obesity is not cured by GLP-1 or dual GIP/GLP-1 agonists; for most patients, maintaining weight reduction requires long-term use along with multidisciplinary input and sustained behavioural and lifestyle modification; when treatment is stopped, regaining weight is the norm. This creates a practical problem: subsidising a drug is only part of the equation if young people lack access to the dietetic support, physical activity programmes and family-level behavioural change that make the medication effective.
Dietitians Australia flagged this concern in January. According to the organisation, GLP-1 drugs suppress appetite, and without appropriate nutrition support, people will be at risk of malnutrition and loss of muscle and bone mass; without a dietetic guarantee in the use of medicines and expanded patient access to dietitians in primary care, the public health investment is wasted.
A Broader Context
The disagreement over Ozempic sits within a larger debate about how Australia should respond to childhood obesity. The scale of the problem is undeniable. By 2050, 2.2 million Australian children and adolescents are forecast to be living with obesity, a further 1.6 million will be overweight, representing a combined prevalence of 50 per cent and an increase of 146 per cent between 1990 and 2050. This is not merely a health crisis; it carries enormous economic weight. In 2017–18, excess weight and obesity cost the Australian government $11.8 billion, and the projected disease burden will add billions of dollars to these health costs.
But solutions go beyond pharmacology. As local farming and food supply systems become overtaken by "big-food" companies, populations transition to high-calorie diets, and our environments become more "obesogenic" as people are surrounded by convenient, affordable and addictive high-calorie foods. This points to why researchers emphasise environmental and structural approaches to prevention.
Doustdar did acknowledge this in his remarks. He noted that "healthier environments, healthier schools, taking care of exercise and food intake" are the "first and foremost solutions." On that point, doctors and the pharmaceutical company may find unexpected common ground. The disagreement is about whether subsidising expensive medications represents the best use of finite health resources, or whether those funds might achieve more through targeted prevention, built-environment change and universal support for physical activity and nutrition.
The Path Forward
The government has already moved on some recommendations. Health officials recommended Wegovy, another GLP-1 drug, be added to the PBS as a treatment for severe obesity and cardiovascular disease, though the Health Minister has not yet specified how much the medication will cost or when the subsidy will be introduced. This more targeted approach reflects a pragmatic middle ground: expanding access to those with established disease burden rather than scaling up to all adolescents with obesity.
What remains unclear is whether the government will fund the wraparound services that make GLP-1 treatment work. A medication sitting in a pharmacy does not deliver health outcomes by itself. The question facing policymakers is not just whether to subsidise the drug, but whether the investment includes the clinical infrastructure that determines whether money is wisely spent or wasted. That conversation, which GPs and dietitians are pushing for urgently, has barely begun.