Billionaire Elon Musk wrote his significant weight loss. According to gossip sites, there are many more big stars who use it to stay slim. And TikTok is full of influencers who proudly display their weight loss in amazing before and after photos.
What is it? A drug called semaglutide, which is sold under several brand names, such as Ozempic and Wegovy.
The hype surrounding these drugs has created a shortage of both, according to the US Food and Drug Administration (FDA). This is expected to take several months, leading to anxiety among diabetes patients who rely on Ozempic to control their blood sugar levels. Experts warn that it is not a panacea and that there are risks associated with using it for other than its intended purpose.
Here’s what you need to know about semaglutide, such as how it works and what the risks are.
What is the scientific explanation for how the medicine works?
Semaglutide helps lower blood sugar because it resembles a hormone that is naturally released when food is eaten, said Ariana Chao, medical director of the Center for Weight and Eating Disorders at the University of Pennsylvania. Thanks to the drug, which is administered by injection, people feel full for longer and have less appetite or hunger.
There is a significant demand for the drug. In 2019, more than 11 percent of Americans had been diagnosed with diabetes, while in 2020, more than four in ten adults were in the ‘obese’ category.
In 2017, the FDA approved Ozempic for use in people with type 2 diabetes. Chao says these patients often have low levels of insulin in their blood. Insulin is a hormone that helps break down food and turn it into fuel for the body. Ozempic sends a signal to the pancreas to make more insulin. This maintains blood sugar levels and limits the amount of glucagon (a hormone that raises blood sugar levels). It may ultimately lead to weight loss, but experts point out that Ozempic is not approved for that purpose.
Wegovy was only approved last year for obese or overweight patients, making it the first drug since 2014 to be approved for long-term weight control. The difference between these two drugs is that Wegovy contains a higher dose of semaglutide than Ozempic. Clinical studies showed that this higher dose resulted in greater weight loss but only a small improvement in blood sugar levels.
What are the risks
As with any medicine, this medicine also has drawbacks.
The most common side effects are gastrointestinal symptoms, such as nausea, constipation and diarrhea, says Chao. In rarer cases, pancreatitis, gallbladder disease and retinal damage have also been reported.
The drugs have been extensively studied, but the fact that they were approved relatively recently means that researchers do not yet know what the effect is when taken for a long time. There is also little data on what happens when people suddenly stop using it. Many people may be forced to do so due to the current shortage.
Research shows that patients can regain weight if they stop taking the medication, especially if they have not changed their lifestyle.
“In almost all weight loss research, it really comes down to the basics,” says Stanford University endocrinologist Sun Kim. ‘What you do with your lifestyle determines how much weight you lose. If you have the basics right, eat well, exercise and sleep, you will succeed. If not, you may regain as much as twenty percent of your lost weight per year.’
These drugs can also be very expensive, especially if insurance does not cover them. According to Kim, an injection pen can cost more than a thousand euros.
What does it mean to take this drug off-label?
Off-label use of medicines means that you use them for something other than what they are intended and allowed for. They may not be effective or even safe. Ozempic is only approved by the FDA for people with type 2 diabetes and Wegovy only for patients with a BMI over 30 or over 27 if they are co-morbid with a weight-related condition such as high blood pressure.
“There is no scientific evidence that this medication has an effect in humans that does not meet the indication for which the FDA has approved the drugs,” Chao said. ‘We also don’t know the side effects or the risks for these people; there may be unknown reactions to the agents. Obesity is a chronic disease. These drugs are not intended as a quick fix.’
And even if you meet the requirements, experts advise against buying them without a prescription in countries where they are available.
“If the drugs are used without a health care provider’s supervision, they may not be used correctly,” Chao said. ‘It can lead to even more severe symptoms.’
In addition, experts argue that diabetes patients should be prioritized given the lack of Ozempic.
“I’m really worried about the supply issues. I just hope they’re temporary,” Kim said.
“If I was in charge, I would give the drug to someone trying to control their diabetes. I’d rather it be available to people who really need it.’
Robert Gabbay, chief of science and medicine for the American Diabetes Association, says the organization is “deeply concerned” about the Ozempian shortage.
“This drug is an important tool for people with diabetes,” he says. ‘It not only lowers blood sugar and weight, but also appears to reduce cardiovascular disease (heart attacks). They are one of the leading causes of death for people with diabetes.’
A last resort?
Still, Kim says she sometimes feels like “a superhero” when she prescribes drugs like Ozempic and Wegovy to patients desperate for an alternative way to lose weight. By the time they come to her, they’ve often already tried it through Weight Watchers or advice from dieticians. In such cases, resources like Ozempic and Wegovy can be a gift, she says.
‘I can see that sometimes when you manage to lose weight, it has a positive effect on your lifestyle. Then people manage to be more active,’ says Kim. ‘Losing weight is difficult. 57 percent of the American population is overweight or obese. I don’t think we should hesitate with this if it could help’.
Chao agrees that these drugs can be a good alternative for people who are unable to lose five percent of their body weight within three months of changing their lifestyle. Still, she recommends trying it before people start taking medication.
Patients should “first make sure they’re eating healthy and consuming fewer calories, as well as getting more exercise,” she says. “It’s important that they know they have to do something about it, even when they’re on medication: They still have to adjust their lifestyle.”
This article was originally published in English on nationalgeographic.com