When Willpower Isn't Enough

**J.Adderton**, BSN, MSN

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

JBMmom, MSN, NP

I'm sure that for many patients, the positive impact of this study and medication could truly be life-changing. My concern, however, as I think everyone is aware with weight loss medications, it doesn't address the underlying issue that leads to a person becoming obese initially. Unless the person intends to take this medication for the rest of their life, currently without the long-term effects being well known, they will face potential challenges when they discontinue use. The yo-yo dieting of losing and gaining weight seems nearly as detrimental as being continually obese. Are the patients better off with the small to moderate weight loss results in the placebo group associate with lifestyle changes and support that may result in long term success, or are they better off with maybe the motivation of finding initial success and hoping they keep the weight off with a healthier lifestyle? Unclear to me. A magic pill, or injection, could truly be a gift for many, time will tell if this is it.

**J.Adderton, BSN, MSN**

3 hours ago, JBMmom said:

. My concern, however, as I think everyone is aware with weight loss medications, it doesn't address the underlying issue that leads to a person becoming obese initially.

These are great points. My mom participated in a weight loss study at UAB that followed participants over 2 years. She was 71 at the time. She was asked to make only small lifestyle changes (activity ect) and it was amazing how much weight she lost in the midsection. It was in the gut area that greatly increases risk of diabetes, heart disease ect.

TheMoonisMyLantern, ADN, LPN, RN

10 hours ago, JBMmom said:

I'm sure that for many patients, the positive impact of this study and medication could truly be life-changing. My concern, however, as I think everyone is aware with weight loss medications, it doesn't address the underlying issue that leads to a person becoming obese initially. Unless the person intends to take this medication for the rest of their life, currently without the long-term effects being well known, they will face potential challenges when they discontinue use. The yo-yo dieting of losing and gaining weight seems nearly as detrimental as being continually obese. Are the patients better off with the small to moderate weight loss results in the placebo group associate with lifestyle changes and support that may result in long term success, or are they better off with maybe the motivation of finding initial success and hoping they keep the weight off with a healthier lifestyle? Unclear to me. A magic pill, or injection, could truly be a gift for many, time will tell if this is it.

I think we are learning that obesity is actually a complex condition. It's not as simple as just don't eat so much and exercise a few times a week. Certainly that is the ideal solution for people but a lot of people are unsuccessful with this for multiple reasons. I think these new medications are tools that can ease a little bit of the burden of trying to achieve a healthy weight. Long term side effects are always a concern, however I doubt they can compare to the risks of obesity related illnesses such as diabetes or heart disease.

Sugarbear55

There is another factor that has not been considered. Semaglutide is a tier three medication. While the price of tier three medications for the private insured patient is high, the ability to use coupons offsets the price and is a life saver for the low to moderate income patient. This is not true for the Medicare patient. Medicare patients are not eligible to use the coupons and there fore many can not afford the medication prescribed. It is not unusual as one Tier three medication can cost from $ 500 to $1100 dollars a month. I do not understand the discrimination against Medicare patients. I do however, understand the frustration of patients who have to discontinue their tier three no generic alternative drug once they transition to Medicare.

JBMmom, MSN, NP

13 hours ago, TheMoonisMyLantern said:

I think we are learning that obesity is actually a complex condition. It's not as simple as just don't eat so much and exercise a few times a week.

I did not intend to come across as making it sound easy. There are many physical and psychological aspects to things like weight control, addiction, and other multisystem disorders. Having the resources and ability to make long lasting changes in many situations is not available to everyone. I'm sure that this medication could have many benefits, I just meant that unless people are going to take it forever, it may not be the answer.

Davey Do

On 2/25/2021 at 9:00 AM, J.Adderton said:

the recommended dose of semaglutide for Type-2 diabetes is .5mg subcutaneously once a week.

"0.5 mg"

One needs to always endeavor to include a leading zero before a decimal point for dosage strengths less than 1.

Brought to you by just another potshot from the sidelines.

When Willpower Isn't Enough

About the Trial

"Game-Changer" Findings

What is Semaglutide?

Action for Weight Loss

How is it Different?

Potential Side Effects

Additional Considerations

About J.Adderton, BSN, MSN

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