What’s next if Wegovi and other new weight loss drugs really work?

In recent years some prescription drugs, like Ozempic and Vegovy, have suddenly entered the public consciousness. The Novo Nordisk brand name drugs have become as synonymous with weight loss as Viagra and Cialis are with erectile dysfunction. But while 2023 has made it clear that these and similar drugs are indeed the future of obesity treatment, it has also shown that this future sometimes looks pretty messed up for reasons that have nothing to do with the drugs themselves. Not there.

Semaglutide: The Real Deal

Ozempic and Vegovy both contain the active ingredient semaglutide, which is taken via weekly subcutaneous injection. This hormone is a synthetic and long-acting version of the GLP-1A hormone that regulates metabolic functions such as appetite and insulin production. Ozempic was approved by the Food and Drug Administration for the treatment of type 2 diabetes in 2017; In 2021, high-dose Vegovy was approved for obesity.

Wegovi demonstrated unprecedented success in clinical trials leading to FDA approval, helping people lose an average of 15% of their baseline weight. Those results were predicted by many experts. New era of obesity medicine, And in the data collected since then, semaglutide itself is not working as expected But it appears to offer benefits that go beyond weight loss, such as reducing some symptoms of addiction.

In November, researchers published A case series of people with alcohol use disorder who began taking semaglutide for obesity experienced reduced desire to drink alcohol. Several teams are currently testing the drug for other conditions associated with compulsive behavior, such as alcohol dependence and binge eating disorders. Elsewhere, scientists have begun to study whether GLP-1 might reduce brain inflammation and slow the progression of disorders such as Alzheimer’s, with some Promise of quick results.

There may be other health benefits as well. This summer, Novo Nordisk Issued Results from the SELECT trial, which looked at cardiovascular outcomes in obese or overweight people with pre-existing heart disease who were given high-dose semaglutide or placebo. Compared with a placebo, those taking the drug had a 20% lower risk of major (and potentially fatal) cardiovascular problems such as heart attack or stroke for up to five years. In October, the company decided To end a similar trial of semaglutide for chronic kidney disease early, after preliminary results showed clear benefits.

This reduction in risk is probably due to weight loss, which is an important finding in itself. Several studies have shown that losing weight can improve the overall health of people with obesity, but it is difficult to prove this directly because, apart from interventions such as surgery, people generally do not have enough weight to study. I struggle to lose weight and keep it off for a long time. , But some research has shown suggested These benefits do not result from weight loss alone and may be related to other effects of semaglutide on the body.

It is not necessary that all these research avenues prove beneficial. But even if only a few do, these drugs could improve and potentially save millions more lives than any original estimate.

A competitor enters the ring: Tirazeptide

Perhaps the most important development that occurred this year was the FDA Approval Eli Lilly’s Zepbound for obesity in November. The drug’s active ingredient is tirazepate, which mimics a combination of GLP-1 and another appetite-related hormone GIPA that appears to be even more powerful than Vegovy in treating obesity. In clinical trials, people taking tirazepate lost an average of 20% to 25% of their baseline weight, a level of weight loss close to the results of the most successful bariatric surgeries.

The arrival of Zepbounds not only reinforces a fierce competition for the obesity drug market, but suggests that these products are just the beginning. now there are dozens Other obesity drug candidates in the pipeline, some of which may help people lose more weight than semaglutide or tirazepide, or offer other benefits such as being easier to take through a pill Instead of injection.

No Free Lunch: Side Effects of Weight Loss Medication

These medications may seem almost miraculous, but few medical treatments are risk-free. People taking these will often experience gastrointestinal problems such as vomiting and diarrhea. These symptoms subside over time and are usually not so bad that most people stop taking treatment. but there has also been some hints People may develop serious complications such as gastroparesis (paralysis of the stomach), pancreatitis, and even suicidal thoughts. In September, the F.D.A. Updates The labeling of Vegovy and Ozempic warns that the products can potentially cause ileus (intestinal blockage), based on adverse event reporting data, although the agency stopped short of confirming this as a known risk.

There is less evidence for some of these suspected side effects, such as suicidal thoughts. currently supporting Link to GLP-1 usage compared to others. And in general, serious problems such as stomach paralysis and ileus appear to be rare. But doctors and patients need to be aware of these issues and evaluate whether the benefits are worth facing these risks.

Semaglutide off-label and on the black market

Not every complication associated with these drugs is medical. Production problems and unpredictable demand have led to frequent shortages of both Vegovy and Ozempic, as many doctors have begun prescribing the latter drug off-label for weight loss. This has resulted in an impact on the care of people with diabetes taking Ozempic. being switched To other, possibly less effective drugs.

Insufficient supply, high list prices (over $1,000 per month without coverage), and routine lack of insurance coverage of these drugs have also helped fuel its emergence. gray and black market, People are now purchasing custom-made and much cheaper semaglutide from compounding pharmacies, although there is no guarantee of its safety or effectiveness. And the increasing popularity of compounded semaglutide may contribute to an increase in overdoses. Earlier this month, America’s Poison Center informed of Nearly 3,000 drug-related calls have been made to poison control centers across the country so far this year, 15 times more than calls made in 2019. In other countries, including Austria, Fake Semaglutide It has begun to spread, and some people have already ended up in the hospital from taking mislabeled products that actually contain insulin.

the road ahead

The latest clinical data shows that many people will regain some of the weight they lost If they stop taking these medicines. This isn’t inherently a problem, as many chronic conditions require ongoing treatment, but it does complicate things. For example, will people be able to continue paying for these drugs, especially as insurance companies begin to impose more restrictions on their coverage? What happens to the health of people who lose and regain weight as a result of losing coverage, as weight cycling is generally considered to be Harmful,

Barring the discovery of any dangerous and relatively common side effects, it is unlikely that these drugs will become less popular any time soon. But even in a world where these drugs are generally safe and effective, not everyone will be a fan of them.

some critics argued These medications do little to actually help most obese people and spread harmful messages about obesity, such as the idea that people must be thin to be healthy. Conversely, you don’t have to scroll very far on social media posts about drugs to find people dismissing them. quick fix And saying that people should lose weight in a real way through lifestyle changes, as if people are not spending billions of dollars annually Trying to do so is futile.

Others argue more nuancedly, that these drugs do not address the drivers of obesity, such as barriers to access to nutritious, fresh foods. But then again, neither are statins for heart disease or chemotherapy for colon cancer treatments for other chronic conditions that are also associated with a less healthy diet or lack of exercise.

It is true that drugs like semaglutide and tirazepide will not solve obesity on their own (assuming you think it can be solved). But they can and will continue to help some people lose weight and possibly become more healthy overall, as long as you can afford the cost or find safe supplies in the first place. Predicting anything beyond that, including their impact on society at large, is not so easy.

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