IWCR INSIDERS: WINTER 2023/24 EDITION
You can thank the Gila monster. Ozempic wouldn’t exist without these poisonous lizards from the southwest. In the mid-1990s, researchers found their venom contained a hormone called exendin-4, that stimulates insulin production in the pancreas.
This discovery led to the development of GLP-1 agonists like semaglutide, the active ingredient in the blockbuster drugs Ozempic and Wegovy
After this class of drugs was first approved for diabetes in the late 2000s, a curious thing happened. People receiving the drugs for diabetes were losing both weight and their appetites. Scientists don’t yet understand how appetite works. But we can see experimentally that these medications have an effect. Here’s what we do know.
People receiving the drugs for diabetes were losing both weight and their appetites.
This class of medication reduces people’s appetites and makes them feel full. They work in three ways. First, they encourage insulin secretion, which lowers blood sugar. Second, they slow stomach emptying, so you feel full longer and may eat less. Finally, they seem to have an effect in the brain, reducing appetite, and many users report thinking less about food.
Some studies are also beginning to show benefits in cardiovascular risk, such as fewer heart attacks and strokes, better blood pressure, and also improved kidney health — in those with kidney disease related to obesity. These results are not seen in every variant, and more studies are needed.
The most common side effects are: nausea, diarrhea, stomach pain, constipation, vomiting, hypoglycemia (dangerous lowering of blood sugar). About 20% of patients can’t tolerate them at all. Others feel the side effects, but find it’s worth the weight loss results. In some, the side effects go away with continued use.
If you are considering requesting a prescription for any of the drugs related to Semaglutide, talk to your doctor about the risks and benefits of the drugs.
Americans spend about $50 billion a year trying to lose weight…
The FDA has approved some GLP-1 agonists for the treatment of Type-2 diabetes and obesity. The FDA guidelines state they should be used in addition to diet and exercise, they should only be used by people for whom other medications or lifestyle changes have failed, and that patients should receive close monitoring for side effects and complications such as pancreatitis.
| Trade Name | Dosing | Delivery | Approved For | |
| Semaglutide | Ozempic | weekly | injection | Type 2 Diabetes |
| Semaglutide | Wegovy | weekly | Injection | Weight Loss |
| Semaglutide | Rybelsus | daily | Pill/Oral | Type 2 Diabetes |
Americans spend about $50 billion a year trying to lose weight — and based on the success of these medications, we may start spending even more. These medications have become so popular that there are shortages, and Novo Nordisk even paused advertising recently because demand was outstripping supply.
Although insurance coverage is sometimes possible, many people using them primarily for weight loss must pay out of pocket, at retail prices currently ranging from $800 to $1,700 per month. That’s a cost one would expect to bear for the rest of their lives — or as long as they want to maintain their weight loss. Because in most cases, stopping the medication results in weight regain.
According to a study published in the journal Diabetes, Obesity and Metabolism, about a third of people who start taking GLP-1 agonists stop taking them within a year. In another study, the percent of patients who stopped taking their GLP-1 after 2 years was 70 percent.
There are a number of reasons why people might stop. These include:
Side effects: As discussed above, side effects range from mild to severe, and can sometimes lead to people stopping treatment.
Cost: GLP-1 agonists can be expensive, and this can be a barrier for some.
Lack of long-term efficacy: GLP-1 agonists are effective in many people, but not everyone. Some people may find that they do not lose enough weight or that their weight loss plateaus, causing them to question the cost/benefit ratio.
Any form of rapid weight loss can cause reductions in healthy lean mass (muscle) too, and this can lower metabolism overall, or increase frailty as the patient ages.
As with any drug that helps manage a condition, stopping the medication allows the condition to return. This is true of blood pressure and cholesterol medications, and now also Ozempic. Recent studies of GLP-1 agonists show that weight regain ranges between 2/3 and 3/4 of the initial weight lost, if treatment is stopped.
If drugs like Ozempic are delivering results only as long as they are taken, what other solutions might provide more sustainable results? Lifestyle changes such as modifying food choices and adding healthy daily activity are lower-cost and accessible. What do you do to reach and maintain your goals? Join us in your private Facebook group to discuss this.
Obesity is now considered to be a chronic disease, and if so, it should receive the same level of care, including the use of appropriate medication. It is still early days in terms of using these for weight management, and many more drugs with similar active ingredients are in development, but are not yet approved by the FDA for weight loss.
The rapid expansion of their use has brought more side effects to awareness. GLP-1 agonists have been used safely for diabetes management — but at lower doses. With careful management, these may indeed prove to be one valuable tool in the weight management toolbox.
Would you ever take a medication specifically to stimulate weight loss or reduce your appetite? How might you see this new class of medications fitting into your journey? Where and how much do you think people should place their focus: in the kitchen, in the gym, or in the pharmacy? Do you personally emphasize lifestyle changes or medication, or both? Join us in your exclusive Facebook group to discuss this important topic.
There are as many answers to these questions as there are people, and many ways to achieve success. Just like so many things we study in the IWCR, the answers may be very individual. Help us understand what works for you and what might work for others. We want to know what you think and what you do!
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We look forward to staying in touch with you on this important lifelong journey.
