Few prescription drugs have entered the public consciousness as suddenly as Ozempic and Wegovy in recent years. Novo Nordisk's branded drugs have become as synonymous with weight loss as Viagra and Cialis are with erectile dysfunction. But while 2023 revealed that these and similar drugs are indeed the future of obesity treatment, it also showed that this future looks very troubling, and here's why. Sometimes it has little to do with the drug itself.
Semaglutide: the real deal
Semaglutide is the active ingredient in both Ozempic and Wigovy and is taken by weekly subcutaneous injection. This is a synthetic, longer-lasting version of her GLP-1, a hormone that regulates metabolic functions such as hunger and insulin production. Ozempic was approved by the Food and Drug Administration in 2017 as a treatment for type 2 diabetes. In 2021, high-dose Wegovy was approved for obesity.
Wegovy achieved unprecedented success in clinical trials that led to FDA approval, helping people lose an average of 15% of their baseline body weight. These results led many experts to predict the following: A new era in obesity medicine.And in data collected since then, semaglutide simply works as expected But it appears to have benefits beyond weight loss, including reducing symptoms of addiction.
In November, researchers published A series of cases of people with alcohol use disorder whose desire to drink began to decrease after they started taking semaglutide for obesity. Several teams are currently testing the drug in alcoholism and other conditions associated with compulsive behavior, such as bulimia. Elsewhere, scientists have begun studying whether GLP-1 can reduce inflammation in the brain and slow the progression of diseases like Alzheimer's disease. Early results are expected.
There may be other health benefits as well.This summer, Novo Nordisk released Results from the SELECT study examined heart-related outcomes in obese or overweight people with pre-existing cardiovascular disease who received high doses of semaglutide or a placebo. Compared to a placebo, people taking the drug had a 20% lower risk of serious (and potentially fatal) cardiovascular disease, such as heart attack or stroke, for up to five years. In October, the company decided A similar trial of semaglutide for chronic kidney disease was called for to end early after preliminary results found clear benefits.
This reduced risk is likely due primarily to weight loss, which is an important finding in itself. Many studies have shown that losing weight can improve the overall health of obese patients, but it is difficult to prove this directly. Part of the reason is that, outside of interventions, people generally have a hard time losing weight and maintaining significant amounts of weight for long enough to be studied. Like surgery. However, in some studies, was suggested These benefits are not derived from weight loss alone and may be related to semaglutide's other effects on the body.
Not all of these research avenues are necessarily successful. But even if they work in only some people, these drugs could improve symptoms and save millions more lives than anyone originally expected.
Contestants enter the ring: Tirzepatide
Perhaps the most important development to occur this year is that the FDA approval Eli Lilly's Zepbound Against Obesity in November. The drug's active ingredient is tirzepatide, which mimics both GLP-1 and another hunger-related hormone, GIP, and the combination appears to be even more powerful than Wegovy in treating obesity. In clinical trials, people taking tirzepatide lost, on average, 20% to 25% of their baseline body weight. This is a level of weight loss that approximates the results seen with most successful bariatric surgeries.
Zepbound's arrival not only intensifies the fierce competition in the obesity drug market going forward, but also suggests that these products are just the beginning.There are now dozens of them. Other obesity drug candidates There are others in the pipeline that will help people lose weight better than semaglutide and tirzepatide, and others that offer other benefits, such as being easier to take. via tablet Not an injection.
There's no free lunch: side effects of weight loss drugs
Although these drugs may seem like miracles, few treatments are risk-free. Ingesting these often causes gastrointestinal problems such as vomiting and diarrhea. These symptoms tend to fade over time and are usually not severe enough for most people to stop treatment.But there was also some kind of sign That it can cause serious complications such as gastroparesis (gastroparesis), pancreatitis, and even suicidal thoughts. In September, the FDA Has been updated Labeling for Wegovy and Ozempic warned that the products could cause ileus (intestinal obstruction) based on adverse event reporting data, but authorities have not confirmed this as a known risk. It was.
There is little evidence for some suspected side effects, such as suicidal thoughts. Currently supported Links to the use of GLP-1 over others. And in general, serious problems such as gastroparesis and intestinal obstruction appear to be rare. However, physicians and patients must remain aware of these issues and evaluate whether it is worth facing these risks.
Off-label and black market semaglutide
Not all complications associated with these drugs are medical. Due to production issues and unexpected demand, both Wegoby and Ozempic are in constant shortage, as many doctors have begun prescribing the latter drug off-label for weight loss purposes. This also has implications for the care of diabetic patients who are taking Ozempic as intended. switch Possibly switch to another less effective drug.
The large supply of these drugs, high list prices (more than $1,000 per month without insurance coverage), and persistent lack of insurance coverage are also contributing factors to their emergence. Gray market and black market. People are now buying the much cheaper custom-made version of semaglutide from compounding pharmacies, even though its safety and efficacy are not guaranteed. And the growing popularity of compounded semaglutide may be contributing to the rise in overdoses.Earlier this month, the American Poison Center report Poison control centers nationwide have received nearly 3,000 calls related to the drug so far this year, a 15-fold increase from calls received in 2019. In other countries, including Austria, counterfeit semaglutide is starting to become an epidemic, with some people already ending up in the hospital after taking products falsely labeled as containing insulin.
road ahead
The latest clinical data suggests that many people experience symptoms such as: regain some of the weight lost If you stop taking these medications. While this is not inherently a problem, it does complicate the situation, as many chronic diseases require ongoing treatment. For example, will people be able to continue paying for these drugs, especially as insurance companies begin to become more restrictive in their coverage of these drugs? What will happen to the health of people who lose or regain weight as a result of losing insurance? Harmful?
Unless dangerous and relatively common side effects are discovered, these drugs are unlikely to lose popularity anytime soon. But even in a world where these drugs are generally safe and effective, not everyone will be a fan of them.
Some critics say claimed These drugs do little to actually help most overweight people and perpetuate harmful messages about weight, such as the idea that you have to be thin to be healthy. Conversely, you don't have to scroll too far through social media posts about the drug to find people who downplay it as a bad thing. quick fix And they say people should lose weight the “real way” through lifestyle changes alone, as if people aren't spending. Billions of dollars a year It's no use trying to do that.
Others make a more nuanced argument that these drugs do not address the contributing factors to obesity, such as barriers to accessing nutritious fresh foods. But statins for cardiovascular disease and chemotherapy for colon cancer are also excluded, as are treatments for other chronic diseases associated with an unhealthy diet and lack of exercise.
Certainly, drugs like semaglutide and tirzepatide won't solve obesity on their own (assuming you believe obesity is something that can be solved). But they can and will continue to help some people lose weight and perhaps become healthier overall, as long as they can afford the cost or find a safe source in the first place. Probably. It is not so easy to predict anything beyond that, including the impact on society as a whole.
