When Willpower Isn't Enough

Findings from a large-scale international study, recently published in The New England Journal of Medicine, found a drug used to treat diabetes is also effective against obesity.  Researchers report when semaglutide is given in high doses to people struggling with obesity, the amount of weight loss seen far exceeds the amount lost by participants in trials of other weight management medications.

About the Trial

The researchers conducted a double-blind trial with nearly 2,000 adult participants that met the following criteria:

• A body-mass index of 30 or greater
• Did not have diabetes

The participants injected themselves with either a subcutaneous 2.4mg dose of semaglutide or a placebo at 129 centers across 16 countries.  To give you a perspective of just how large a dose participants received, the recommended dose of semaglutide for Type-2 diabetes is .5mg subcutaneously once a week.  Both study groups, semaglutide and placebo, also participated in lifestyle interventions that included:

• Face-to-face phone counselling sessions with registered dieticians every 4 weeks
• Reduced calorie diet
• Increased physical activity
• Behavioral and motivation strategies 
• Incentives such as kettlebells or food scales in recognition for reaching set goals

"Game-Changer" Findings

The study's authors found 75% of participants taking 2.4mg semaglutide lost more than 10% of their total body weight and more than one-third lost greater than 20%.  Dr. Rachel Batterham, one of the study's authors, states "No other drug has come close to producing this level of weight loss--this is really a game changer.”  Other significant study findings include:

• Participants lost an average of 15.3kg or an impressive 33.7lbs.
• Improvements were also observed in participant risk factors for heart disease and diabetes, such as
  • Waist circumference
  • Lipids
  • Blood sugar 
  • Blood pressure
• Participants reported improvements in overall quality of life

What is Semaglutide?

You may recognize semaglutide by it's brand names, Ozempic and Rybelsus, and both are used in the treatment of type-2 diabetes. Ozemic comes as a single use subcutaneous injection pen for self administration and Rybelsus is the brand name for the oral form.

Action for Weight Loss

Semaglutide is a "mimic" drug because it has similar effects on the body as the hormone GLP-1.  GLP-1 is a natural hormone that is released from the small intestines and acts to improve blood sugar levels by:

• Stimulates the release of insulin from the pancreas.
• Reduces the amount of glucose stored in the liver
• Causes a feeling of "fullness" and less hunger

Basically, semaglutide mimics the action of GLP-1 to decrease our appetite, which lowers caloric intake, and ultimately leads to weight loss. 

How is it Different?

Even though Semaglutide has almost the same structure as human GLP-1, it is synthetically manufactured and structurally modified.  The modifications prevent the drug from being broken down and the effects last longer.  This is why semaglutide can be administered just once a week.

Potential Side Effects

Researchers reported some participants did experience side effects that were short lived and generally resolved without any long-term effects.

According to manufacturers, semaglutide on the market for diabetes management may cause the following side effects:

• Nausea
• Vomiting
• Diarrhea
• Abdominal discomfort
• Constipation
• Heartburn

More serious side effects include:

• Symptoms of allergic reaction (rash, itching, swelling of face, tongue or throat)
• Difficulty breathing or swallowing
• Decreased urination
• Swelling of legs, angles or feet
• Vision changes

Semaglutide for weight management hasn't been studied long enough to know the effects (if any) of taking the higher doses for longer periods of time.

Additional Considerations

We now know that obesity increases the risk of death in individuals with COVID-19.  The pandemic has increased the focus of how obesity impacts other serious illnesses, such as heart disease, type-2 diabetes, liver disease, and certain types of cancers. The benefits of semaglutide for weight management are far reaching in both personal health and health policy.

Currently, most insurance companies do not cover medications for weight loss.  Semaglutide is covered when prescribed for diabetes, but is expensive at nearly $1,000 a month.  However, the study's findings may persuade insurance companies to cover the use of semaglutide for weight loss, especially given the high cost of bariatric surgery.

 What other implications do you think the study findings may have in the future? 

References

Ozempic