Comment: Weight loss drug semaglutide

Professor Jane Ogden, Professor of Health Psychology, at the University of Surrey, said;

“This drug shows promise as a useful addition to the existing tool kit for weight management.  But its no magic pill and will still require professional support, dietary change and activity as well as close monitoring of side effects.  And what we still need are interventions to enable weight loss that is maintained in the longer term.”

Dr Martin Whyte, Clinical Associate Professor in Metabolic Medicine, said:

“The National Institute of Health and Care Excellence (NICE) has given the green light to a new drug called Wegovy for the treatment of obesity. Wegovy is a type of medication that reduces appetite and causes weight loss. This drug is similar to medications that have been used to treat type 2 diabetes for over 10 years.

“At a higher dose, it can cause up to 10 kg weight loss in about one-third of users. However, there are two concerns: first, the drug's effects wear off within months of stopping treatment, and NICE has only approved it for a two-year treatment period. Secondly, because these medications are in high demand, there is limited availability for those who need them most due to people purchasing them on their own without a prescription.”

Dr Adam Collins, Associate Professor of Nutrition at the University of Surrey, said:

“Semaglutide (branded as Wegovy or Ozempic) is an example of a glucagon-like peptide 1 receptor agonist (GLP-1RA).  Initially developed for the treatment of type 2 diabetes these GLP1-RAs were found to not just improve blood glucose control but also cause weight loss. 

“It works by mimicking the action of the hormone GLP-1 that is released from the gut after a meal.  As well as helping insulin action, this hormone feeds back to the brain and makes us feel full.  It plays a key part in our satiety signal from the gut to the brain, regulating appetite and stopping us from overeating.

“The main effect of taking this weekly injection, is that a person’s appetite is much diminished, and they feel full most of the time.   Not surprisingly, they end up eating far less and therefore lose weight.    Heralded as a “wonder drug” because, unlike traditional “diets,” you get results without any conscious effort or strong willpower.   

“But there are downsides to such profound effects. Nausea and vomiting are common side effects in early phase of taking the drug.  But for some people, this constant feeling of fullness can lead to food repulsion and a failure to enjoy food.  Almost like eating is a chore rather than a pleasure.   The dramatic weight loss effects of the drug can also lead to a gaunt face and have been associated with looking older.  So called ‘Ozempic Face.’

“The most concerning aspect of these therapies is their longevity.  The drug is very effective when you are taking it, and so far, has been shown to take for several months.  Yet the guidelines currently are that this is only advocated for use over 2 years. So what happens when you come off of the drug?   The answer is your hunger will return in spades. This is not just due to the lack of the GLP-1 substitute, but because we know that weight loss will reduce GLP-1 levels further.   This is part of your body’s response to try and restore what was lost. So your levels of GLP-1 could literally be dropping off a cliff at the end of treatment.  With the shackles off your appetite, plus other changes, such as a reduced metabolic rate, and overall lower energy requirement, you are super primed to regain that lost weight.

“We also know in this scenario people are highly susceptible to overshooting their original weight.  This is your bodies response to the subjected energy crisis, improving its ability to store energy away for a rainy day, to better cope next time.  

“In this context, Semaglutide is just another, albeit very effective, means of getting people to lose weight.  But the trick is not losing weight, that is easy, It is maintaining that weight that is the true challenge.   It remains to be seen how the emergence of this new class of drugs can be used to meet this challenge.”