IWCR INSIDERS: FALL 2023 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.
Some of the GLP-1 agonists are not recommended for people with a history of pancreatitis or a personal or family history of medullary thyroid cancer. They are also not recommended for pregnant or breastfeeding women. 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 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, the percentage of people who stop taking GLP-1 agonists after one year ranges from 29.5% to 36.4%. This means about a third of people who start taking GLP-1 agonists will stop taking them within a year. In another study, 47 percent of patients stopped taking their GLP-1 at 1 year, and after 2 years that figure ballooned to 70 percent.
There are a number of reasons why people might stop so quickly. 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 can be effective in many people, but not for 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.
The drugs do not deal with the root cause of the problem, say researchers such as Robert Lustig, MD. He warns that the medications do not target fat specifically, and the rapid weight loss causes reductions in healthy lean mass too.
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 more accessible. What do you do to reach and maintain your goals? Join us in your private Facebook group to discuss this.
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.
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 with GLP-1 agonists, 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. We should be mindful of a long history of former blockbuster weight loss drugs that proved to have unacceptable dangers. From amphetamines in the ‘60s to Fen-Phen in the ‘90s, and Belviq’s cancer recall in the ‘10s, history has proven some medication risks take time to emerge. However, with careful management, these may indeed prove to be one valuable, though expensive, tool in the 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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