A new class of weight loss drugs on the market has been making waves since they were approved as a treatment for obesity in 2021. Semaglutide injections, which you may know as Wegovy or Ozempic, have become all the rage in recent months, thanks to the buzz they’ve been receiving TikTok influencers (and rumored use among some celebrities).
The prescription injections were introduced as a diabetes treatment in 2017but people quickly realized that the drugs — which help people with diabetes control their blood sugar — also led to significant weight loss in obese people who had trouble losing weight with other treatments.
From there, interest in the drugs grew, and after clinical trials confirmed what people suspected — that semaglutide injections help people lose weight — demand skyrocketed, so much so that pharmacies across the country have shortages of both Wegovy and Ozempic. Obesity specialists understand the hype; these kinds of prescription weight loss drugs have been around for a long time.
“For those of us treating obesity, this is a game-changer we’ve never seen before,” says Dr. Dan Azagury, bariatric surgeon at Stanford Health Care. “This is the first time ever that we have really effective drugs to treat obesity.”
obesity is one of the most common chronic health problems in the United States, but until recently, we didn’t have very effective drugs to address the health complications it’s often associated with, such as high cholesterol and high blood pressure. Aside from lifestyle changes like diet and exercise, the go-to intervention for obesity has been surgery (think: gastric bypass or the duodenal switch).
According to Azagury, many obesity specialists noticed that many patients suddenly did not have diabetes after bariatric surgery. In investigating the reason for this, researchers identified new gut hormones, including one called glucagon-like peptide (GLP-1), that responded to food entering the gut.
Further testing revealed that GLP-1, which increases after bariatric surgery, improves blood sugar levels and thereby helps with diabetes. “Therefore, severe diabetes disappears within days of surgery,” Azagury said.
After this discovery, pharmaceutical companies started looking for a diabetes drug that could activate those GLP-1 receptors. That is which led to the development of semaglutide ― a synthetic compound that mimics the effects of GLP-1 – and later the semaglutide-based diabetes drug Ozempic, which received approval from the Food and Drug Administration in 2017.
The other key finding about GLP-1: It slows down digestion and reduces food intake, according to Dr. Janelle Dua, a Yale Medicine internist. This is why Ozempicthat is intended for diabetes has been and continues to be prescribed off-label for weight loss, Azagury said.
The weight loss effects of GLP-1 (which are boosted by semaglutide), combined with the wild demand for Ozempic, led drugmaker Novo Nordisk to create a very similar drug specifically for weight loss: Wegovy. Essentially just a stronger dose of Ozempic, Wegovy got FDA approval in June 2021.
Who is a candidate for the drugs?
Wegovy, an injection once a week, is for adults with a body mass index over 30, or with a BMI over 27 with at least one weight-related health problem (think: high blood pressure, diabetes, or high cholesterol). It is also intended to complement physical activity and dietary changes. That’s why obesity specialists like Azagury recommend that patients work with a comprehensive team of healthcare providers, including dietitians and therapists, if they can afford it. Patients can also get the prescription through their GP.
Many people find that the injections help them feel full longer and reduce sugar cravings. It “makes them crave more protein and fiber — thus helping them stick to dietary changes that can further improve their weight loss,” Duah said. Some people say it also reduced their desire to drink alcohol and helped them sleep better.
Ozempic is approved for type 2 diabetes, not obesity or weight loss, although people get it off-label for weight loss. It’s perfectly legal for doctors to prescribe drugs off-label, but this is likely contributing to it persistent drug shortages — which is a major problem for people with diabetes who can’t get their hands on the drugs.
What is the general take on these weight loss drugs?
Obesity doctors are excited. Often people maintain their weight because of health issues beyond their control, not a lack of willpower or discipline. Many obese patients have tried it all, but saw minimal results. “Now we have something to help them,” Azagury said.
According to Duah, the recent surge in prescriptions is largely justified. “It is by far the most effective weight loss medication on the market, with users losing up to 20% of their original body weight,” said Duah.
And while interest in these drugs is soaring, Azagury believes they could help even more people. The original class of obesity drugs from the 1960s and 1970s had dire consequences and probably soured a lot of people from the whole idea. It may take some convincing for more people to accept that an effective weight-loss drug is finally available, Azagury said.
There is also the problem of cost. These drugs aren’t always covered by insurance, Azagury said, so you can become expensive (at a cost of $1,500 to $1,800 per month). “That’s the biggest challenge people face,” Azagury said. “It’s FDA-approved; that does not mean that the insurance will pay for it.”
According to Duah, this is one of the main reasons providers end up prescribing Ozempic. Unlike Wegovy, Ozempic is often covered for diabetes or insulin resistance, so patients looking for semaglutide injections can access it at a reasonable cost.
There are some risks associated with semaglutide injections
As with any drug, there are risks — but the injections are surprisingly well tolerated, Azagury said. The most common side effects are gastrointestinal problems, such as nausea, vomiting, constipation, gas and heartburn. These GI-related side effects should subside as your body gets used to the injections; until then, they can usually be treated by eating smaller, more frequent meals or taking over-the-counter medications such as bismuth subsalicylate or antacids, Duah said. (If side effects persist, talk to your doctor about finding relief or other more tolerable options.)
In rare cases, semaglutide injections can lead to thyroid tumors, which can be cancerous. Other potentially serious effects include pancreatitis, gallbladder problems, low blood sugar, kidney problems, allergic reactions, and depression. The injections should also not be used with other medicines that contain semaglutide or that target GLP-1 receptors.
We are still learning about long term side effects as the drug is relatively new. The injections aren’t a quick fix, and most people will need to continue taking the drugs for at least a year (and probably longer) to reach their weight loss goals and improve their health, Azagury said. A study found that many people who stop taking the drugs regain weight quickly, supporting the growing belief that the injections are meant to be taken for the long term.
Other than a slightly higher risk of gallstones (which is common with many forms of rapid weight loss), we have not seen any long-term effects with gallstones liraglutide, a similar drug which has been on the market since 2010. Azagury expects the same to be true for semaglutide-based drugs, given their similarity – but time will tell, of course.
If you are interested in semaglutide injections, talk to your doctor. Understand the risks and benefits, and keep in mind that due to inflation, supply issues and growing demand, these drugs are often backordered – often for the people who need them most. Hopefully the supply will increase soon and more insurers will cover the costs. That, Duah said, will help more people get the drugs at a fair price.
“If insurance covered weight loss drugs like Wegovy and increased supply, we wouldn’t see these issues with stocking Ozempic on our pharmacy shelves,” Duah said.
