Weight Loss Pill: Fact or Fiction?

Obesity continues to be a prevalent condition in America that poses many health complications, including hypertension, stroke, coronary artery disease, and more. In 2019, the Centers for Disease Control and Prevention estimated that the medical expenses related to obesity in the United States amounted to a staggering $173 billion (1). Recently, Ozempic, a medication primarily prescribed for diabetes management, has been gaining popularity for rapid weight loss as social media, celebrities, and more continue to discuss it heavily. Both Ozempic and Wegovy share the same active ingredient, semaglutide, a glucagon-like peptide-1. However, Wegovy features higher doses of semaglutide and is tailored for weight loss purposes, while Ozempic contains lower doses and was originally formulated for individuals who are prediabetic or have type 2 diabetes (2). This raises the question: Are semaglutide medications safe and efficacious for weight loss?

A recent article featured in Annals of Internal Medicine provides valuable insights on the mainstream prevalence of these “weight loss pills” and the efficacy of these medications (2). The author describes that obesity is influenced by both a neurohormonal component controlled by complex signaling pathways in the brain and a genetic component accounting for 40% to 80% of variability in body weight (2, 3). Additionally, the author provides evolutionary context arguing that our ancestors had a high neurohormonal and genetic drive for hunger to survive times of food scarcity. However, in the modern era where food is readily available, our innate drive is leading individuals into caloric excess. Thus, pharmaceuticals have developed medications to prevent energy from being extracted from food or that act as appetite suppressants. Ozempic and Wegovy both suppress appetite by inhibiting gastric emptying and stimulating glucagon-like peptide-1 receptors in the hypothalamus, promoting feelings of satiety (2, 4).

Although these medications seem promising for weight loss, patients regain most of the lost weight back within 1 year of discontinuing these drug treatments (2, 5). While we were shadowing a bariatric surgeon, he explained how powerful the neurohormonal axis is and that everyone has a unique “metabolic thermometer” that is heavily influenced by their genetics. He uses these semaglutide therapies temporarily to achieve a safer weight for his patients to undergo a sleeve gastrectomy, which he believes is a better long-term solution. Taking semaglutide, like any medication, has adverse effects, including gastrointestinal problems, like constipation and vomiting. Furthermore, there is an increased risk for pancreatitis, kidney failure, and medullary thyroid carcinoma, if patients have a family history of this cancer (6). The severe weight loss caused by these medications also has its own risks, including gallbladder disease and facial aging due to fat loss, which the media has called “Ozempic face” (6).

The side effects are weighed against the benefits, as Ozempic and Wegovy are helping control blood glucose levels, lower blood pressure, and reduce the risk for fatty liver disease from obesity (6). However, these benefits are achieved only when long-term administration is properly done and in conjunction with lifestyle and diet modifications. Long-term use poses another barrier as many insurance companies do not cover the cost of these drugs, where a month’s supply of Ozempic can be $900 and Wegovy upwards of $1300 (6). Therefore, it may be more realistic to follow the bariatric surgeon’s method of using semaglutide temporarily to help patients become eligible for weight loss surgery. If surgery is not an option, physicians should approach weight loss as an “opportunity” for their patients, as this education style has shown increased commitment to weight loss programs and achieved greater weight loss results (7).

References

1. Centers for Disease Control and Prevention. Adult obesity facts. Accessed at www.cdc.gov/Obesity/Data/Adult on 10 April 2024.
2. Taylor R. Hunger and the obesity epidemic: old insights reaffirmed by new medicines? [Editorial]. Ann Intern Med. 2023;176:995-996. [PMID: 37364261] doi:10.7326/M23-0744
3. Bouchard C. Genetics of obesity: what we have learned over decades of research. Obesity (Silver Spring). 2021;29:802-820. [PMID: 33899337] doi:10.1002/oby.23116
4. Chakhtoura M, Haber R, Ghezzawi M, et al. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. EClinicalMedicine. 2023;58:101882. [PMID: 36992862] doi:10.1016/j.eclinm.2023.101882
5. Wilding JPH, Batterham RL, Davies M, et al; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24:1553-1564. [PMID: 35441470] doi:10.1111/dom.14725
6. Suran M. As Ozempic's popularity soars, here's what to know about semaglutide and weight loss. JAMA. 2023;329:1627-1629. [PMID: 37099334] doi:10.1001/jama.2023.2438
7. Albury C, Webb H, Stokoe E, et al. Relationship between clinician language and the success of behavioral weight loss interventions. A mixed-methods cohort study. Ann Intern Med. 2023;176:1437-1447. [PMID: 37931269] doi:10.7326/M22-2360

Lauren Duffy, BS

Lauren is a second-year medical student at the Washington State University Elson S. Floyd College of Medicine in Spokane, Washington. She is from Seattle, Washington, and graduated from Washington State University with a bachelor’s degree in microbiology. Lauren has a passion for the gut microbiome and is interested in internal medicine and increasing health care access to underserved populations.

Harneet Sangha, BS

Harneet S. Sangha, BS, is currently a first-year medical student at the Elson S. Floyd College of Medicine. He earned his bachelor’s degree from the University of Washington in Seattle, where he majored in biology. Harneet has a deep-seated passion for health equity and is dedicated to improving access to quality health care for underserved populations. His commitment to medicine is driven by a desire to make a positive impact on the lives of his future patients, and he is enthusiastic about the diverse opportunities and challenges that a career in medicine offers.