There was big news in the pharmaceutical world this week: Semaglutide (Ozempic), a drug commonly used for type 2 diabetes, delivered unprecedented results in a new weight loss study.
In the experiment, approximately two thousand adults with obesity (but no diabetes) were randomly selected to use semaglutide or a placebo for 68 weeks. Participants also received diet and lifestyle training. The group that used semaglutide lost 14.9% of their body weight –an average total loss of 33.6 lbs. Side effects were considered mild. The results were published in the New England Journal of Medicine.
These numbers have blown the results of other obesity drugs, none of which have proven very popular with patients and doctors, typically because they are accompanied by serious side effects. To put a 14.9% weight loss in perspective, that is roughly half the average loss from bariatric surgery – an intervention that is obviously far more intense, invasive, and permanent.
Obesity experts touted the results as “breathtaking” and the authors described the study as both a “game changer” and the beginning of a “new era” in obesity therapy.
A really effective weight loss pill is one of the great holy grails of the pharmaceutical industry. With obesity around the world still skyrocketing – nearly a billion adults worldwide are considered obese and many more overweight – the gains from an effective weight loss drug could be almost unimaginable.
Semaglutide was originally developed to treat type 2 diabetes, for which it was approved by the FDA in 2017. It belongs to a class of drugs known as GLP-1 agonists that mimic the effects of a hormone called “glucagon-like peptide 1”, which lowers blood sugar levels by increasing the effect of insulin. The drug also appears to lower hunger and therefore often leads to weight loss. In the years since its approval, GLP-1 agonists have been very popular with diabetes doctors, at least in part because of the beneficial side effects of appetite suppression and weight loss. Doctors also occasionally prescribe these drugs off-label for patients with type 1 diabetes, although insurers rarely pay the full cost. Experts have long debated its potential as an anti-obesity drug.
Dr. Mariela Glandt, a diabetes expert who works for ASweetLife, told me that GLP-1 agonists are “a great adjuvant for patients who have problems or who have had uncontrolled type 2 diabetes for many years.” Dr. Glandt prefers to use the drug in combination with a low-carb diet, which by itself can produce some of the same results as increasing insulin sensitivity, curbing hunger, and facilitating weight loss. “In many cases, a GLP-1 helps people start a new diet and stick to it.”
And now for the disadvantages:
First and foremost is the cost. As some of our readers no doubt already know, semaglutide is a very expensive drug. The New York Times reports that the dosage used today to treat diabetes has an average retail price of about $ 1,000 per month. and the weight loss study used significantly larger doses.
Second, the side effects were “temporary” and “mild to moderate”, but so severe that 5% of the study participants stopped treatment due to gastrointestinal complaints. Dr. Glandt suggested that “many patients experience side effects, but they can be avoided by slowly titrating the drugs.” The drugs are also known to cause increased heart rates, and their long-term safety is still a mystery. It will be years before we really know whether or not taking the drug in high doses indefinitely is really healthy – although, to be fair, the health disadvantages that could result from it, the known benefits of significant weight loss would have to predominate.
After all, the semaglutide only works as long as it is needed. To enjoy permanent weight loss, patients will almost certainly need to take the drug for the rest of their lives. The pharmacologically induced appetite suppression is effective, but not long-lasting. Several articles about the study reviewed participants’ experiences and reported that the weight just came back after the study ended.
Semaglutide is owned by pharmaceutical giant Novo Nordisk, one of the three major insulin manufacturers, and is sold under the brand names Ozempic and Rybelsus. Other GLP-1 agonists on the market include the popular diabetes drugs Victoza and Trulicity, which are known to cause at least some weight loss in patients with type 2 diabetes. The manufacturers of other GLP-1 agonists will no doubt seek to explore the potential of their own drugs as anti-obesity drugs.