Ozempic and Wegovy: The science and side effects behind the semaglutide weight loss drugs

Ozempic can help people lose weight quickly, but can also have serious side effects.

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Ozempic and Wegovy are brand names for the drug semaglutide. Many countries have approved Wegovy for weight loss in obese or overweight people and Ozempic for people with type 2 diabetes.

How do these medications work?

Drugs such as semaglutide mimic the actions of a hormone called glucagon-like peptide-1, or GLP-1. These GLP-1 analogs have several effects, including slowing stomach emptying, acting on the brain to reduce appetite, and increasing the release of insulin, which helps regulate blood sugar.

For more than a decade, GLP-1 analogs have been used to help people with type 2 diabetes control their blood sugar levels, and some users have experienced slight weight loss. “These drugs reinforce a system that already exists in the human body, whose role is to suppress the appetite after ingesting a meal,” explains Simon Cork at Imperial College London.

Why are they making headlines now?

GLP-1 analogs began to be prescribed for weight loss in people without type 2 diabetes. They also became available in more potent, easier-to-use formulations.

Initially, GLP-1 analogs were approved for use at a lower dose and were to be administered by twice-daily injections. In the latest formulations, these are injections once a week, the full dose of Wegovy being 2.4 milligrams to lose weight and Ozempic being used at a maximum dose of 2 milligrams for type 2 diabetes.

How widely available are they?

In 2021, Wegovy was approved for weight loss in several countries, including the United States and Canada. Praise from some famous users has brought it wide publicity.

Manufacturing issues meant its manufacturer, Novo Nordisk, was struggling to meet global demand, so some doctors began prescribing Ozempic, which had been approved several years earlier for people with type 2 diabetes in some countries. This led to a shortage of people who needed it to control their diabetes.

In the UK, Wegovy was approved in 2021, but only gained approval from England's medical guidelines body, the National Institute for Health and Care Excellence, in March 2023., when he said the drug should be administered by the country's National Health Service's weight-loss clinics. Wegovy is expected to be available in the UK this year, while Ozempic has been available for type 2 diabetes since 2019.

In June 2023, the UK government has announced the launch of a two-year pilot project giving obese people access to new medicineslike Wegovy, outside the hospital setting.

How effective are they?

Very. It's a cliché, but obesity doctors are talking about a paradigm shift in obesity management. Previously, a loss of around 5 percent of body weight was considered a good outcome for any weight loss intervention aside from stomach surgery and is considered a benchmark in obesity drug trials .

Wegovy leads to about a 15 percent reduction in body weight over one yearwhen combined with exercise and a healthy diet.

In fact, some people seem to think that GLP-1 analogs have made them too skinny, as evidenced by the rise of the search terms “Ozempic face” and “Ozempic butt.” “Ozempic doesn’t do anything specific to the skin,” says Alexandre Miras at Ulster University, UK. It's weight loss that causes these apparent side effects, with similar results often occurring after bariatric surgery, he says.

Do medications have side effects?

Side effects can be mild, such as nausea, constipation, and diarrhea, which tend to occur as people get used to the medication. The most concerning side effects include inflammation of the pancreas, although this is relatively rare.

What about hair loss?

Hair loss has been reported by some users of semaglutide. It also sometimes happens after significant weight loss from other causes, such as stomach surgery, Miras says.

Hair loss following bariatric surgery is thought to be due to physiological stress on the body, causing an increased number of hair follicles to enter their “resting” phase, resulting in hair loss within a few days. months later. This stops when weight loss stabilizes, but hair doesn't always grow back, Miras says.

Do these medications cause suicidal thoughts?

GLP-1 analogues – such as Ozempic and Wegovy – are under investigation by the European Medicines Agency (EMA) after recent reports that they may cause thoughts of suicide or self-harm. This was after the Icelandic health regulator received three such reports regarding semaglutide and another drug called liraglutide, which is an earlier analogue of GLP-1.

The EMA says it analyzes approximately 150 case reports of possible self-harm and suicidal thoughts. This does not mean that the drugs caused these effects, only that people reported these experiences after they started taking them. “Further work is needed to determine whether a causal link exists,” says Michael Schwartz at the University of Washington in Seattle.

A spokesperson for Novo Nordisk, the maker of liraglutide and the semaglutide drugs Ozempic and Wegovy, said: New scientist: “GLP-1 receptor agonists have been used to treat type 2 diabetes for over 15 years and for the treatment of obesity for eight years. Safety data collected during large clinical trial and post-marketing surveillance programs have not demonstrated a causal association between semaglutide or liraglutide and thoughts of suicide and self-harm.

Need a listening ear? British Samaritans:116123; US 988, Suicide and Crisis Lifeline: 988; telephone helplines in other countries.

Do these medications help fight addictions?

Maybe. There have been numerous anecdotal reports of people taking these medications for diabetes or weight control who lose the desire to drink alcohol or see the disappearance of other habits that could be described as “behavioral addictions”, such as compulsive shopping.

This is supported by animal research which revealed that GLP-1 analogues reduced the consumption of alcohol and addictive drugs. A small human trial hinted at a similar effect of a GLP-1 analogue called exenatide, which reduction in excessive alcohol consumption, but only in obese people.

The explanation may have to do with how the drugs work on the brain to reduce cravings, but the exact mechanism is unclear. We are only beginning to understand how these treatments might help people addicted to alcohol and drugs, says Daniel Drucker at Sinai Health in Toronto, Canada. “Clinical trial data are not yet available to support these anecdotes.”

What happens to a user's weight over the long term?

Wegovy's longest trial lasted two years and found that people's weight largely stable during the second year.

In most countries, Wegovy has been approved for use for two years, but if people stop taking the drug, they usually regain the lost weight – two-thirds after a year, according to a trial.

“Weight loss is only sustained as long as the medication is taken, because as soon as you stop taking it, all the physiological processes that try to restore your body weight resume,” Cork says.

This suggests that after two years of use, consumers will ask doctors to continue prescribing the drug “off-label.” “I think there will be a lot of pressure to try to change these guidelines,” Cork says.

Ozempic can be prescribed long-term for type 2 diabetes, as this disease is usually lifelong.

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