The craze behind weight-loss injectables

In 2012, Novo Nordisk synthesized a compound called semaglutide in an effort to increase the half-life of its counterpart drug liraglutide. These glucagon-like-peptide-1 receptor agonists, originally formulated for patients with Type 2 diabetes, work by promoting the release of insulin to decrease glucose levels.

Liraglutide is a daily injectable, while semaglutide is a weekly injectable. The diabetes community had been waiting for a drug like this to ease the pain of having to go through daily injections. As patients started to use these medications, many noticed a drastic change in their weight. Patients began to shed the weight they once thought was impossible to lose. However, what neither Novo Nordisk nor the world knew at that time was how these “simple” injectables would transform the idea of weight loss forever.

Semaglutide is used in both Ozempic for those with Type 2 diabetes and in Wegovy, indicated for obese patients. Why is one labeled for diabetes and the other for obesity? The short answer is that only recently did the FDA approve the use of semaglutide for weight loss.

Wegovy is specifically aimed for those with a BMI greater than 30 or overweight individuals with a BMI greater than 26 with additional medical problems like high blood pressure. This drug was created to target the obesity epidemic in America. The CDC identified that roughly 41.9% of adults and 19.7% of children are affected by obesity. With such a significant percentage of the population struggling with their weight, the release of this drug was monumental.

However, alongside an equal amount of excitement resided confusion about the long-term implications of the drug. The main weight loss mechanism happens via the drug’s one major side effect: slowed gut motility.

Semaglutide slows down the gastric emptying time in the gut, increases the transit time of food and makes patients feel “full” for a longer period of time. As patients start to notice their appetite decrease, they begin to eat less, feeling the effects of this weight loss medication.

This is where the big question remains: What do these drugs tell the general public about weight loss? Losing weight via decreased eating can be harmful, as it can foster electrolyte imbalances, nutritional deficiencies and eating disorders.

These injectable drugs have opened the door to quick-fix treatments for a problem that is multifactorial. When a drug is available that promises an “easy,” non-invasive way to lose weight, many will come to the conclusion that it is the best option. 

However, the potential long-term risks of these new drugs have not been properly explored. For example, the major side effect of these medications is GI distress. This includes diarrhea, constipation, nausea, vomiting, etc.

When food remains in the stomach for long periods of time, patients also tend to develop symptoms of GERD. These patients then go to their doctor, who prescribes them a PPI for reflux symptoms, and now the patient is on a new medication they would have never had to have originally.

The popularity of these injectable medications has been referenced by everyone, from Elon Musk crediting his weight loss to “Wegovy and fasting,” all the way to TikTok videos speaking of “Ozempic parties.” The high demand for the compound semaglutide even created a sudden shortage of medication for diabetes patients who needed it.

Although these drugs are meant to be taken alongside lifestyle interventions, depictions on social media portray the drug as a miracle product that causes weight loss without requiring a change in diet or physical activity. It is concerning that the hype surrounding these drugs is leading to unhealthy habits among some patients who are taking them. 

In the STEP 1 trial, 1961 participants without diabetes and a BMI greater than 30 were subjected to a weekly maximum dose (2.4mg) of semaglutide as an adjunct to lifestyle interventions for 68 weeks. After the medication and the lifestyle interventions were discontinued for a year, it was discovered that participants had regained two-thirds of their prior weight loss. In addition, any cardiometabolic improvement seen in the first 68 weeks was also lost.

Medicine is constantly evolving around the creation of new drugs and technology. The craze behind weight loss has become a race of chasing a number, instead of understanding the multifactorial aspects that contribute to it. If the proper time to implement healthy habits is not invested, it is very easy to fall back to one’s original ways. Lifestyle changes take a tremendous amount of sustained, active effort and without the push from society to see that change, quick fixes will always be “in.”

Related reading:

Obesity: Changing the conversation

5 popular fad diets and how to advise your patients on them